Chung et al identified predictors for a deterioration in pulmonary function in patients who have completed therapy for pulmonary tuberculosis. These can help to identify a patient who may require more aggressive management. The authors are from National Taiwan University, Buddhist Tzu Chi General Hospital and the Taiwan Anti-Mycobacterial Investigation (TAMI) Group in Taiwan.


Patient selection: pulmonary tuberculosis


The Radiographic Score (RS) of Snider et al was used to evaluate the extent of pulmonary disease on the chest X-ray prior to therapy and to monitor the response to therapy.


Some patients experienced a decline in pulmonary function. The nadir in pulmonary function occurred about 18 months after treatment completion.


Predictors of a deterioration in pulmonary function after therapy:

(1) smear-positive disease prior to therapy

(2) extensive pulmonary disease prior to therapy (based on the radiographic score)

(3) longer anti-tuberculous treatment duration

(4) need to make a change in the treatment regimen during treatment

(5) limited radiographic improvement following therapy (based on the radiographic score)


Pulmonary function should be monitored:

(1) prior to initiating treatment to establish the baseline

(2) if there are significant respiratory symptoms following therapy

(3) in patients with one or more predictors for a deterioration in pulmonary function


Factors that may limit the predictive value of these risk factors:

(1) failure of cure with persistent or relapsed disease (multi-drug resistant mycobacterial infection, etc)

(2) concurrent pulmonary comorbidity (pneumoconiosis, asthma, etc) that were excluded from study

(3) HIV disease


To read more or access our algorithms and calculators, please log in or register.