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High Morbidity during Treatment and Residual Pulmonary Disability in Pulmonary Tuberculosis: Under-Recognised Phenomena

Ralph, Anna P.; Kenangalem, Enny; Waramori, Govert; Pontororing, Gysje J.; Sandjaja; Tjitra, Emiliana; Maguire, Graeme P.; Kelly, Paul M.; Anstey, Nicholas

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BACKGROUND In pulmonary tuberculosis (PTB), morbidity during treatment and residual pulmonary disability can be under-estimated. METHODS Among adults with smear-positive PTB at an outpatient clinic in Papua, Indonesia, we assessed morbidity at baseline and during treatment, and 6-month residual disability, by measuring functional capacity (six-minute walk test [6MWT] and pulmonary function), quality of life (St George's Respiratory Questionnaire [SGRQ]) and Adverse Events ([AE]: new symptoms...[Show more]

dc.contributor.authorRalph, Anna P.
dc.contributor.authorKenangalem, Enny
dc.contributor.authorWaramori, Govert
dc.contributor.authorPontororing, Gysje J.
dc.contributor.authorSandjaja
dc.contributor.authorTjitra, Emiliana
dc.contributor.authorMaguire, Graeme P.
dc.contributor.authorKelly, Paul M.
dc.contributor.authorAnstey, Nicholas
dc.date.accessioned2015-11-26T22:46:05Z
dc.date.available2015-11-26T22:46:05Z
dc.identifier.issn1932-6203
dc.identifier.urihttp://hdl.handle.net/1885/16855
dc.description.abstractBACKGROUND In pulmonary tuberculosis (PTB), morbidity during treatment and residual pulmonary disability can be under-estimated. METHODS Among adults with smear-positive PTB at an outpatient clinic in Papua, Indonesia, we assessed morbidity at baseline and during treatment, and 6-month residual disability, by measuring functional capacity (six-minute walk test [6MWT] and pulmonary function), quality of life (St George's Respiratory Questionnaire [SGRQ]) and Adverse Events ([AE]: new symptoms not present at outset). Results were compared with findings in locally-recruited volunteers. RESULTS 200 PTB patients and 40 volunteers were enrolled. 6WMT was 497m (interquartile range 460-529) in controls versus 408m (IQR 346-450) in PTB patients at baseline (p<0.0001) and 470m (IQR 418-515) in PTB patients after 6 months (p=0.02 versus controls). SGRQ total score was 0 units (IQR 0-2.9) in controls, versus 36.9 (27.4-52.8) in PTB patients at baseline (p<0.0001) and 4.3 (1.7-8.8) by 6 months (p<0.0001). Mean percentage of predicted FEV1 was 92% (standard deviation 19.9) in controls, versus 63% (19.4) in PTB patients at baseline (p<0.0001) and 71% (17.5) by 6 months (p<0.0001). After 6 months, 27% of TB patients still had at least moderate-severe pulmonary function impairment, and 57% still had respiratory symptoms, despite most achieving 'successful' treatment outcomes, and reporting good quality of life. More-advanced disease at baseline (longer illness duration, worse baseline X-ray) and HIV positivity predicted residual disability. AE at any time during treatment were common: itch 59%, arthralgia 58%, headache 40%, nausea 33%, vomiting 16%. CONCLUSION We found high 6-month residual pulmonary disability and high AE rates. Although PTB treatment is highly successful, the extent of morbidity during treatment and residual impairment could be overlooked if not specifically sought. Calculations of PTB-related burden of disease should acknowledge that TB-related morbidity does not stop at 6 months. Early case detection and treatment are key in minimising residual impairment.
dc.description.sponsorshipThe study received funding from the Australian Respiratory Council, Royal Australasian College of Physicians (Covance Award to APR), National Health and Medical Research Council (NHMRC) of Australia (Grants 605806 and 496600, a scholarship to APR, and fellowships to APR, TWY, PMK, NMA). Graeme Maguire is supported by an NHMRC Practitioner Fellowship and the Margaret Ross Chair in Indigenous Health. Views expressed in this publication are those of the authors and do not reflect the views of NHMRC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
dc.publisherPublic Library of Science
dc.rights© 2013 Ralph et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
dc.sourcePLoS ONE
dc.subjectadult
dc.subjectantitubercular agents
dc.subjectcase-control studies
dc.subjectdisabled persons
dc.subjectfemale
dc.subjectfollow-up studies
dc.subjecthumans
dc.subjectindonesia
dc.subjectmale
dc.subjectmorbidity
dc.subjectquality of life
dc.subjectrespiratory function tests
dc.subjecttreatment outcome
dc.subjecttuberculosis, pulmonary
dc.subjectyoung adult
dc.titleHigh Morbidity during Treatment and Residual Pulmonary Disability in Pulmonary Tuberculosis: Under-Recognised Phenomena
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume8
dc.date.issued2013-11-29
local.identifier.absfor111700
local.identifier.ariespublicationf5625xPUB10153
local.type.statusPublished Version
local.contributor.affiliationRalph, Anna P, Charles Darwin University, Australia
local.contributor.affiliationKenangalem, Enny, Menzies School of Health Research, Australia
local.contributor.affiliationWaramori, G, Public Health & Malaria Control Department, Indonesia
local.contributor.affiliationPontororing, Gysje J, National Institute of Health Research and Development Research Program, Indonesia
local.contributor.affiliationSandjaja, ., National Institute of Health Research and Development, Indonesia
local.contributor.affiliationTjitra, Emiliana, Ministry of Health, Indonesia, Indonesia
local.contributor.affiliationMaguire, Graeme P., James Cook University, Australia
local.contributor.affiliationKelly, Paul, College of Medicine, Biology and Environment, CMBE ANU Medical School, ANU Medical School, The Australian National University
local.contributor.affiliationAnstey, Nicholas, Menzies School of Health Research, Australia
dc.relationhttp://purl.org/au-research/grants/nhmrc/605806
dc.relationhttp://purl.org/au-research/grants/nhmrc/496600
local.identifier.essn1932-6203
local.bibliographicCitation.issue11
local.bibliographicCitation.startpagee80302
local.identifier.doi10.1371/journal.pone.0080302
dc.date.updated2015-12-11T10:56:55Z
local.identifier.scopusID2-s2.0-84896699217
local.identifier.thomsonID000327670300009
CollectionsANU Research Publications

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