Pulmonary Function Outcomes after Tuberculosis treatment in Children: A Systematic Review and Meta-analysis

Abstract

Background: Despite tuberculosis (TB) being a curable disease, current guidelines fail to account for long-term outcomes of post-tuberculosis lung disease (PTLD) - a cause of global morbidity despite successful completion of effective treatment. Our systematic review aimed to synthesise the available evidence on the lung function outcomes of childhood pulmonary tuberculosis (PTB). Methods: PubMed, ISI Web of Science, the Cochrane Library, and ProQuest databases were searched for English-only studies without time restriction (latest search date 22 March 2023). Inclusion criteria were (1) patients who had TB with pulmonary involvement at age ≤18 years; (2) pulmonary function tests (PFTs) performed on patients after treatment completion; and (3) observational studies, including cohort and cross-sectional studies. We adhered to the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: From 8040 records, five studies were included (involving n=567 children) with spirometry measures from four studies included into meta-analyses. The effect size of childhood TB on forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) z-scores were estimated to be -1.53 (95% CI: -2.65, -0.41; p=0.007) and -1.93 (95% CI: -3.35, -0.50; p=0.008) respectively. Discussion: The small number of included studies reflects this under-researched area, relative to the global burden of TB. Nevertheless, as childhood PTB impacts future lung function, pulmonary function tests (such as spirometry) should be considered a routine test when evaluating the long-term lung health of children beyond their completion of TB treatment.