Research

Obstructive pulmonary disease in patients with previous tuberculosis: Pathophysiology of a community-based cohort

Brian W Allwood, Rencia Gillespie, Maya Galperin-Aizenberg, Mary Bateman, Helena Olckers, Luis Taborda-Barata, Gregory L Calligaro, Qonita Said-Hartley, Richard van Zyl-Smit, Christopher B Cooper, Eva van Rikxoort, Jonathan Goldin, Nulda Beyers, Eric D Bateman

Abstract


Background. An association between chronic airflow limitation (CAL) and a history of pulmonary tuberculosis (PTB) has been confirmed in epidemiological studies, but the mechanisms responsible for this association are unclear. It is debated whether CAL in this context should be viewed as chronic obstructive pulmonary disease (COPD) or a separate phenotype.

Objective. To compare lung physiology and high-resolution computed tomography (HRCT) findings in subjects with CAL and evidence of previous (healed) PTB with those in subjects with smoking-related COPD without evidence of previous PTB.

Methods. Subjects with CAL identified during a Burden of Obstructive Lung Disease (BOLD) study performed in South Africa were studied. Investigations included questionnaires, lung physiology (spirometry, body plethysmography and diffusing capacity) and quantitative HRCT scans to assess bronchial anatomy and the presence of emphysema (<–950 HU), gas trapping (<–860 HU) and fibrosis (>–200 HU). Findings in subjects with a past history and/or HRCT evidence of PTB were compared with those in subjects without these features.

Results. One hundred and seven of 196 eligible subjects (54.6%) were enrolled, 104 performed physiology tests and 94 had an HRCT scan. Based on history and HRCT findings, subjects were categorised as no previous PTB (NPTB, n=31), probable previous PTB (n=33) or definite previous PTB (DPTB, n=39). Subjects with DPTB had a lower diffusing capacity (Δ=–17.7%; p=0.001) and inspiratory capacity (Δ=–21.5%; p=0.001) than NPTB subjects, and higher gas-trapping and fibrosis but not emphysema scores (Δ=+6.2% (p=0.021), +0.36% (p=0.017) and +3.5% (p=0.098), respectively).

Conclusions. The mechanisms of CAL associated with previous PTB appear to differ from those in the more common smoking-related COPD and warrant further study.


Authors' affiliations

Brian W Allwood, University of Cape Town Lung Institute, Cape Town, South Africa; Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Rencia Gillespie, University of Cape Town Lung Institute, Cape Town, South Africa

Maya Galperin-Aizenberg, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA

Mary Bateman, University of Cape Town Lung Institute, Cape Town, South Africa

Helena Olckers, University of Cape Town Lung Institute, Cape Town, South Africa

Luis Taborda-Barata, CICS – Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal

Gregory L Calligaro, University of Cape Town Lung Institute, Cape Town, South Africa

Qonita Said-Hartley, Department of Radiology, Faculty of Health Sciences, University of Cape Town, South Africa

Richard van Zyl-Smit, University of Cape Town Lung Institute, Cape Town, South Africa

Christopher B Cooper, David Geffen School of Medicine, University of California, Los Angeles, USA

Eva van Rikxoort, Radboud University Medical Center, Nijmegen, Netherlands

Jonathan Goldin, David Geffen School of Medicine, University of California, Los Angeles, USA

Nulda Beyers, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Eric D Bateman, University of Cape Town Lung Institute, Cape Town, South Africa

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Keywords

Chronic obstructive pulmonary disease; Phenotype; Tuberculosis; Lung function tests; Computed tomography; Medicine; Pulmonology; Radiology; Physiology; South Africa; Adults; Chronic airflow obstruction

Cite this article

South African Medical Journal 2017;107(5):440-445. DOI:10.7196/SAMJ.2017.v107i5.12118

Article History

Date submitted: 2017-04-25
Date published: 2017-04-25

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