Avaliação funcional em pacientes tratados de Tuberculose Pulmonar

Abstract

Tuberculosis is an infectious and transmissible disease caused by ycobacterium tuberculosis. Approximately 70,000 new cases and 4,600 deaths are registered annually in Brazil. Even when treated correctly, most patients have radiological sequelae, and total lung capacity may be reduced due to scarring. In addition, chronic obstructive airway obstruction has developed as a result of destructive changes in the pulmonar parenchyma. These changes may affect pulmonary compliance, resulting in collapse of the peripheral airways and, consequently, air trapping, which predisposes to changes in lung function. There are few data on the clinical, functional and radiological evolution of these patients. Thus, the objective of this dissertation was to evaluate the variation of pulmonary function in patients with sequela of pulmonary tuberculosis. The specific objectives are to evaluate bronchodilator response in patients with chronic obstructive airway obstruction due to pulmonary tuberculosis and to correlate functional findings with the clinical and radiological data of patients with TBP sequelae. Two tudies were carried out. The first was conducted from a main multicenter study. Patients without pulmonary disease, without previous history of smoking, and with obstructive ventilatory disorder were selected for spirometry. Fifty-nine patients performed acceptable spirometric curves after bronchodilator use. 13/59 (22.3%) presented a positive response. Among those, 7/59 (11.9%) had FEV1 variation, 5/59 (7.1%) FVC variation and 1/59 (1.7%) presented a imultaneous variation in FEV1 and FVC. Conclusion: A fifth of the patients without previous lung disease or history of smoking treated with TBP with chronic obstructive airway obstruction presented a bronchodilator response. In the second study, the population was composed of patients treated for pulmonary tuberculosis in the outpatient clinic of the Hospital das Clínicas of UFMG who completed the treatment and obtained cure criteria from January 1, 2012 to June 30, 2016. Of the 55 patients who underwent spirometry 23/55 (41.82%) had obstructive ventilatory disorder and 11/55 (20%) had mild OVD. 29/55 patients underwent pulmonary function tests and 24/55 six minutes walking test on two occasions. When comparing the results of the variables obtained in the two exams, we did not find statistical difference (RR-p =0.646, CRF-p = 0.799, CPT-p = 0.878, VR / CPT-p = 0.767, CV-p = 0.366, FVC = 0.258, FEV1-p = 0.330, FEV1 / FVC-p = 0.458, FEF25-75%, p = 0.556, DCO-p = 0.398, distance at TC6M-p0.470). There was a correlation between lower FEV1 values with lower diffusion of carbon monoxid values (p <0.001) and lower diffusion of carbon monoxid values with lower walking distance (p <0.001). There was a correlation between radiographic changes and lower values of FEV1 (p = 0.033). Conclusion: The most frequent spirometric alteration was obstructive ventilatory disorder, there was a correlation between the lower values of FEV1 with lower diffusion of carbon monoxid values and lower values of diffusion of carbon monoxid with shorter walking distance.Pulmonary function remained unchanged over time. Key words: Tuberculosis, sequelae, pulmonary function, spirometry, walking test