| Abstract: |
The current study was carried out to evaluate the incidence of obstructive ventilatory pulmonary dysfunction among patients with pulmonary tuberculosis .This study include 210 patients .They were classified into 3 groupsGroup I : Tuberculous patients at the time of diagnosis .Group II : Patients during treatment and classified into 2 subgroups:At 3 months from the start of treatment. At 6 months from the start of treatment.Group III : Patients after the end of treatment and classified into 2 subgroups according to time from the end of treatment. At 6 months from the end of treatmentAt 12 months from the end of treatmentThey were selected from Z.U.H Chest Department and Zagazig Chest HospitalThe following was done for every patient1-Medical history taking with special reference toPersonal and socioeconomic dataSmoking habitDegree of smoking(cigarette-goza )Respiratory symptoms according to British Medical Research Council Standardized QuestionersAssociated disease2-Complet clinical examination (general –local )3-Radiological examination of the chest4-Activity of TB and criteria of activity (clinical-radiological- bacteriological )5-Regimense of antituberculous therapy6-Tuberculin skin test7-Microbiological examination8-Spirometric pulmonary function9-CT Chest if indicated10-Aspiration of pleural fluid and examination for (physical-chemical- bacteriological-cytological ) in case of tuberculous pleural effusion11-Other routine laboratory investigationsCBCESRLiver and kidney functionECG –ECHO if indicatedThe result as following1- Male was more common than female among studied groups ,they are 64.3 % versus 35.7 %in female in group I ,71.4 % versus28.6 % in group II and 58.6 % versus41.4 % in group2- Incidence of smokers were more common than non smokers among studied patients,64.3% smoker against 35.7% non smoker in group I,74.3 % smoker against 25.7 %non smoker in group II and 60% smoker against 40 % non smoker in group III3- The incidence of heavy smoker in cigarette and goza was more common among studied patients .the incidence of heavy cigarette smoking was 24.3 % in group I .25.7 % in group II and 27.2 % in groupIII4- The incidence of low socioeconomic standard more common in 3 groups ,was 70 % in group I ,65.7 % in group II and 65.7 % in group III5- Cough ,expectoration and haemptysis were more commonest presenting symptoms in 3 groups6- Fever ,anorexia were the most commonest presenting symptoms(82.8 % , 75.7 % )respectively . Night sweating and weight loss( 70 %,64.3 % ) respectively7 - Diabetes mellitus was the commonest associated manifestation among studied patients,21.4 % in group I ,15.7 % in group II , 10 % in group III and about 17.1 % from the total number of patient8- The most common type in 3 groups was pulmonary lesion (64.29 % in group I (62.50.1%) at 3 month , 50 % at 6 month in group 11 and (62.86 % ) at 6 month ,57.14 % at 12 month in group1119- Sputum positive was 100 % in group I ,10 % at 3 month during treatment in group II and 0% at 6 month in group II and in group III10 -The most common type of radiological presentation in group I was far advanced lesion about 66.67 %, while the moderate and minimal lesion more common in group II and III11-In this study it was found that ,in group I 21.4 % have obstructive pattern, 21.4 % have restrictive pattern , 14.2 % have small airway dysfunction .In group II at 3 month during treatment 8.5 % have obstructive pattern , 5.7 % have restrictive pattern, 7.1 % have small airway dysfunction and at 6 month 7.1 %, 4.2 %, 2.8 % respectively .In group III at 6 month after treatment 7.1 % obstructive , 4.2 %restrictive , 2.8 % small airway disease but at 12 month 7.1% , 2.8 %, 1.4 % respectively12-Obstructive pattern was common among studied group in old age ,46.7% in group I ,50 % ,60 % respectively at 3,6 month .40% ,60 %respectively at 6,12 month in group III13- Obstructive pattern was common among studied group in cigarette smoker,53.3 in group I ,66.7 % ,60 % respectively at 3,6 month .40%,60 % respectively at 6,12 month in group III14- The incidence of obstructive pattern was more common in low socioeconomic standard, was 66.7% in group I ,54.5 % in group II and 60% in group III15- The incidence of obstructive pattern was more common in patients presented with cough ,expectoration and haemptysis and also when thereis residual cough and expectoration16- The incidence of obstructive pattern was more common in patients presented with sputum positive rather than negative17- The incidence of obstructive pattern was more common in patients presented with far advanced level radio logically in group I while in group II and III mainly minimal and moderate residual radiology18- The incidence of obstructive pattern was more common in patientspresented with pulmonary lesion19-Restrictive pattern was common among studied group in old age ,46.7% in group I ,50 % ,66.7 % respectively at 3,6 month .66.7%,50 % respectively at 6,12 month in group III20- Restrictive pattern was common among studied group in cigarette smoker,36% in group I ,50 % ,66.7% respectively at 3,6 month .66.7%,50 % respectively at 6,12 month in group III21- The incidence of restrictive pattern was more common in low socioeconomic standard, was 66.7% in group I ,57.1 % in group II and 60% in group III22- The incidence of restrictive pattern was more common in patients presented with cough ,expectoration and haemptysis and also when thereis residual cough and expectoration23- The incidence of restrictive pattern was more common in patients presented with sputum positive24- The incidence of restrictive pattern was more common in patients presented with far advanced level radio logically in group I and moderate and minimal lesion in group II and III25- The incidence of restrictive pattern was more common in patientswith pulmonary lesion ,about 66.67% in group I and 50 % ,60 % in group II at 3 ,6 month respectively and 40 % 50 % in group III at 6 ,12 month respectively26-Small airway disease was common among studied group in old age ,50% in group I ,60 % ,50% respectively at 3,6 month .50%,100% respectively at 6,12 month in group III27- Small airway disease was common among studied group in goza smoker, 30% in group I ,20 % ,50% respectively at 3,6 month .50%,100 % respectively at 6,12 month in group III28- The incidence of small airway disease was more common in low socioeconomic standard, was 70% in group I ,57.1 % in group II and 66.7% in group III29- The incidence of small airway disease was more common in patients presented with cough ,expectoration and haemptysis and also when thereis residual cough and expectoration30- The incidence of small airway disease was more common in patients presented with sputum positive31- The incidence of small airway disease was more common in patients presented with far advanced level radio logically in group I and in minimal and moderate in group II and III32- The incidence of small airway disease was more common in patients presented with pulmonary lesion 60 % in group I 50 % ,66.7 % in group II, at 3,6 month,66.7 ,50 % in group III at 6 ,12 month respectively33-Residual radiology after treatment in group II normal 74.2 %, fibrosis 8.6 % ,calcification 10 % ,consolidation 7.2 % .In group III 82.9 % ,5.7 % 7.2 % 4.2 % respectively34 There is correlation between residual radiology and pulmonary function .in group II , calcification represent the most common impaired abnormal function 54.6 % in obstructive ,57.2 % in restrictive ,42.9 % in small airway disease35-. There is correlation between residual radiology and pulmonary function .in group III calcification represent the most common impaired abnormal function 57.2 % in obstructive ,60 % in restrictive ,66.7 % consolidation in small airway diseaseconclusions1-At the end of treatment of pulmonary tuberculosis ,7.1% of patients have the functional definition of COPD which continued to be the same 6 and 12 month after treatment .2-Small airway dysfunction was found in 4.28% at the end of treatment which continued to be 4.28% and 2.58% at 6 and 12 month after treatment3-Restrictive dysfunction was found to be 2.85% at the end of treatment ,2.85% after 6 month of treatment and 1.42 %after 12 month of treatment4-Old age, smoking, low socioeconomic status and far advanced radiological extent was found to be the main contributers to ventilatory pulmonary dysfunction in patients with pulmonary tuberculosisRecommendations1-To follow the same patients for long period from the time of diagnosis to determine exactly the natural history of ventilatory dysfunction of these patients2- Effort to enhance antismoking campaign must be encourage nation and worldwide3-More efforts for early detection and proper management to prevent late sequalae
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