Long term management of people with post-tuberculosis lung disease

Abstract

Post-tuberculosis lung disease (PTLD) is emerging as a significant area of global interest. As the number of patients surviving tuberculosis (TB) increases, the subsequent long-term repercussions have drawn increased attention due to their profound clinical and socioeconomic impacts. A primary obstacle to its comprehensive study has been its marked heterogeneity. The disease presents a spectrum of clinical manifestations which encompass tracheobronchial stenosis, bronchiectasis, granulomas with fibrosis, cavitation with associated aspergillosis, chronic pleural diseases, and small airway diseases—all persistent consequences of PTLD. The spectrum of symptoms a patient may experience varies based on the severity of the initial infection and the efficacy of the treatment received. As a result, the long-term management of PTLD necessitates a detailed and specific approach, addressing each manifestation individually—a tailored strategy. In the immediate aftermath (0–12 months after anti-TB chemotherapy), there should be an emphasis on monitoring for relapse, tracheobronchial stenosis, and smoking cessation. Subsequent management should focus on addressing hemoptysis, managing infection including aspergillosis, and TB-associated chronic obstructive pulmonary disease or restrictive lung function. There remains a vast expanse of knowledge to be discovered in PTLD. This review emphasizes the pressing need for comprehensive, consolidated guidelines for management of patients with PTLD.

Understanding the Spectrum and Management of Post-Tuberculosis Lung Disease: A Comprehensive Review

“…Pulmonary rehabilitation programs play a vital role in optimizing lung function, enhancing exercise capacity, and improving quality of life in patients with PTLD [ 4 ]. These programs typically include a combination of exercise training, education, nutritional counseling, and psychosocial support tailored to individual patient needs [ 22 ].…”

“…Exercise training, including aerobic and resistance exercises, improves cardiorespiratory fitness, muscle strength, and endurance, thereby enhancing functional capacity and reducing dyspnea. Education sessions provide patients with information on disease management, breathing techniques, medication adherence, and self-management strategies to optimize treatment outcomes [ 22 , 23 ].…”

“…Nutritional counseling aims to address malnutrition and weight loss commonly observed in patients with advanced PTLD, emphasizing dietary modifications to meet energy requirements, promote weight gain, and optimize nutritional status [ 4 , 22 ]. Psychosocial support helps patients cope with the emotional and psychological challenges associated with chronic lung disease, fostering resilience and enhancing overall well-being.…”

Comprehensive care for people affected by TB: addressing TB-associated disabilities

“… 4 Over the past decade, the study of post-TB impairment and disabilities has gained momentum and this is reflected in the growing literature on the topic 5 to elucidate the burden, 6 the risk factors, 7 and the management of these conditions. 8 , 9 Although the scientific and clinical aspects are being intensively investigated, 10 – 12 few studies examine how TB-associated disabilities may be effectively detected and managed under programmatic conditions. 13 …”