Prior tuberculosis in children linked to poor lung function, quality of life
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Previous tuberculosis in Gambian children was significantly associated with impaired lung function and health-related quality of life, according to a cross-sectional comparative study published in Thorax.
“Lung development begins in utero and continues into early adulthood before declining from about 20 to 25 years of age. Consequently, early insults to the lungs have been shown to affect lung growth and development adversely,” Esin Nkereuwem, MD, of the vaccines and immunity theme at the Medical Research Council Unit The Gambia at The London School of Hygiene & Tropical Medicine (MRCG at LSHTM) in Fajara, Gambia, and the Infectious and Tropical Diseases at The London School of Hygiene & Tropical Medicine in London, U.K., and colleagues wrote. “This has the potential to accelerate decline in lung function, and increase risk of chronic respiratory illnesses in later life, with consequent reduction in the [health-related quality of life].”
Researchers evaluated data of 68 children (median age, 8.9 years; 52.9% boys) who were diagnosed with tuberculosis at MRCG at LSHTM between January 2014 and December 2019 when aged younger than 15 years and who had completed pulmonary tuberculosis treatment at least 6 months prior to study enrollment. Researchers compared this group with 91 age-matched children (median age, 11.5 years; 62.6% boys) without a history of tuberculosis.
Researchers measured symptoms, spirometry and health-related quality of life using the Pediatric Quality of Life scale (PedsQL). Only 76.5% of those in the tuberculosis group and 94.5% of children in the control group met the quality criteria for spirometry.
Researchers observed lung function impairment among 38.5% of children with a history tuberculosis compared with 17.4% of children in the control group (P = .009). FEV1 (P < .001), FVC (P = .014) and FEV1/FVC (P < .001) z scores were all significantly lower among children with a history of tuberculosis compared with the control group.
Children in the tuberculosis group were more likely to report at least one recurrent respiratory symptom in the preceding 6 months (51.5% vs. 37.4%), including cough (30.9% vs. 22%), and they were more likely to report failure to gain weight (27.9% vs. 14.3%) compared with the control group.
Prior pulmonary tuberculosis (adjusted OR = 3.9; 95% CI, 1.1-15.1) and self-reported frequent or repeated chronic cough history (aOR = 19; 95% CI, 1.6-226) were both significantly associated with lung function impairment.
In addition, researchers observed significantly lower self-reported physical functioning scores on the PedsQL among those in the tuberculosis group (68.8% vs. 81.3%; P = .016), as well as lower scores for parent-reported physical, emotional, psychological, social and total health-related quality of life.
“Longitudinal studies to further characterize the evolution of symptoms and lung volumes after [tuberculosis] treatment completion in children are needed to help define and further characterize [post-tuberculosis lung disease] in children,” the researchers wrote. “Finally, we recommend a more holistic approach to define [tuberculosis] treatment outcome which considers the evaluation and management of sequelae, especially in children, to improve health and well-being across the life course.”