Chest
Volume 113, Issue 4, April 1998, Pages 933-943
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Clinical Investigations: Infection
Pulmonary Tuberculosis Treated With Directly Observed Therapy: Serial Changes in Lung Structure and Function

https://doi.org/10.1378/chest.113.4.933Get rights and content

Objectives

(1) To correlate structure (CT) with function in pulmonary tuberculosis (TB), and (2) to describe the evolution of structural and functional abnormalities when pulmonary TB is treated with directly observed therapy.

Subjects and methods

Twenty-five patients with drug-susceptible pulmonary TB, 15 cavitary and 10 noncavitary, were studied prospectively. Conventional CT and pulmonary function testing (spirometry, diffusing capacity, and arterial blood gases) were performed at baseline, and after 1 and 6 months of directly observed therapy.

Results

All but one patient with noncavitary miliary TB had CT evidence of endobronchial disease, and all patients with cavitary disease had coexistent reduced lung attenuation, the latter presumably a result of gas trapping, hypoxic vasoconstriction, and vascular injury. Functional impairment was minimal and in proportion to the number of diseased segments and cavitary volume. Bronchiectasis was significantly more likely to complicate cavitary than noncavitary disease (64 vs 11%; p<0.05).

Conclusions

CT findings correlate well with function in pulmonary TB. Physiologic data were consistent with the concept that pulmonary TB is an endobronchial disease that causes parallel reductions in ventilation and perfusion. This concurrent involvement of both airways and contiguous pulmonary blood supply offers an explanation for the minimal respiratory limitation experienced by these patients despite often extensive lung disease. Supervised therapy of drug-susceptible disease results in minimal structural and functional residua.

Section snippets

MATERIALS AND METHODS

Over a 17-month period, all adults (18 years or older) diagnosed as having new active (never previously reported) pulmonary TB in the province of Manitoba (population 1,091,942 in 1991), Canada, were evaluated prospectively for entry into a study of lung structure and function. Patients were required to meet all of the following entrance criteria: (1) no known preexisting lung disease; (2) no illness and no therapy known to compromise immune function; (3) willing and able to receive supervised

RESULTS

During the 17-month study period, there were 84 adults diagnosed as having new active pulmonary TB. Of these, 25 (30%), 15 with cavitary and 10 with noncavitary disease, met the entrance criteria of the study.

The baseline demographic, clinical, and laboratory characteristics of the study patients are given in Table 1. Patients with cavitary and noncavitary disease did not differ significantly with respect to age, ethnicity, symptom duration, smoking history, or BMI. Compared with patients with

DISCUSSION

We have presented structural (CT) and functional (PFT) data on 25 patients with culture-positive, drug-susceptible, pulmonary TB, 15 cavitary and 10 noncavitary. All patients were considered to have postprimary disease. The structural data confirm and extend the findings of Im et al6 who correlated the abnormalities seen on CT of the lung in postprimary TB with independent pathologic findings. We found, as they did, that endobronchial spread, presumably the result of passage of liquified

ACKNOWLEDGMENT

The authors are grateful to Lynda Mendella, research nurse, Dr. Mark Rigby and the staff of the Radiology Department, University of Manitoba, Dr. Dan McCarthy and the staff of the Pulmonary Function Laboratory, University of Manitoba, Dr. Bruce Light for his review, and Arlene Klassen and Kathy Harlos for their preparation of the manuscript.

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    Supported by grants from the Manitoba Medical Service Foundation, the Sellers Foundation, and the Upjohn Company of Canada.

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