Abstract
Pulmonary (P) tuberculosis (TB) and COPD are both a significant worldwide burden in terms of morbidity and mortality. They can both induce similar respiratory symptoms and chronic air flow limitation (AFL) leading to diagnosis difficulties.
To clarify if COPD can be considered in patients with TB sequellae, we retrospectively analyzed cases of patients with AFL (FEV1/VC post bronchodilator <70%) and medical history of PTB, hospitalized between 2000 and 2010 in which diagnosis of COPD was more probable than TB sequella because of important tobacco use and clinical history. All patients underwent CT scan to precise P lesions. Patients with PTB after COPD diagnosis were excluded and those with extended PTB sequellae as well.
Fifteen patients were included. Mean age was 60 years (44-83 years). Mean smoking level was 58 pack year. The mean delay between TB history and diagnosis of COPD was 20 years. Dyspnea was present in all cases and associated to chronic cough and sputum in 87% of cases. CT scan showed besides TB sequellae, P emphysema in all cases (centrolobular in 75%). AFL was severe in 80% of cases (GOLD III and IV). Treatment was based on theophylline and/or inhaled long-acting B2 agonists in all cases. All patients had clinical improvement with bronchodilator. Outcome was marked by at least one exacerbation for 13 patients due to P embolism in 2 cases, pneumothorax in 1 case and respiratory infections in all other cases.
COPD should be considered in smokers with AFL even if they have a previous history of PTB. Despite few cases of paraseptal emphysema, the majority of these patients show predominant P centrolobular and panlobular emphysema with an outcome similar to those with COPD and no PTB history.
- © 2011 ERS
