The article we suggest this week, Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis?, describes the first XDR-TB case treated with both delamanid and bedaquiline reporting the rationale for prescribing both drugs. Despite difficulties encountered in the early phase of treatment, the interim treatment response is very good as the patient has been persistently sputum smear and culture negative since the second month of treatment. The article report also the actual debates about the risk of cardiotoxicity with QT prolonging drugs in salvage treatment for multidrug-resistant or XDR-TB patients.
The role of tuberculosis as a public health care priority and the availability of diagnostic tools to evaluate functional status (spirometry, plethysmography, and DLCO determination), arterial blood gases, capacity to perform exercise, lesions (chest X-ray and CT), and quality of life justify the effort to consider what needs to be done when patients have completed their treatment. To our knowledge, no review has ever evaluated this topic in a comprehensive manner. Our objective was to review the available evidence on this topic and draw conclusions regarding the future role of the “post-tuberculosis treatment” phase, which will potentially affect several million cases every year. We carried out a non-systematic literature review based on a PubMed search using specific keywords (various combinations of the terms “tuberculosis”, “rehabilitation”, “multidrug-resistant tuberculosis”, “pulmonary disease”, “obstructive lung disease”, and “lung volume measurements”). The reference lists of the most important studies were retrieved in order to improve the sensitivity of the search. Manuscripts written in English, Spanish, and Russian were selected. The main areas of interest were tuberculosis sequelae following tuberculosis diagnosis and treatment; “destroyed lung”; functional evaluation of sequelae; pulmonary rehabilitation interventions (physiotherapy, long-term oxygen therapy, and ventilation); and multidrug-resistant tuberculosis.The evidence found suggests that tuberculosis is definitively responsible for functional sequelae, primarily causing an obstructive pattern on spirometry (but also restrictive and mixed patterns), and that there is a rationale for pulmonary rehabilitation. We also provide a list of variables that should be discussed in future studies on pulmonary rehabilitation in patients with post-tuberculosis sequelae.
Authors: Tadolini M, Lingtsang RD, Tiberi S, Enwerem M, D'Ambrosio L, Sadutshang TD, Centis R, Migliori GB
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