The effects of bronchodilators in patients with tuberculosis-destroyed lung and chronic airflow obstruction

Abstract

Background: Parenchymal lung destruction secondary to tuberculosis is often associated with chronic airflow limitation and bronchodilators are used empirically in patients with tuberculosis-destroyed lung and chronic airflow obstruction (TDL-CAO). Aims and objectives: This multicenter retrospective study examined the impact of bronchodilators on the annual change in the forced expiratory volume in 1 second (FEV 1 ) in TDL-CAO patients. Methods: The study classified 126 patients with TDL-CAO into three groups: 1) patients without bronchodilators between two pulmonary function tests (PFTs); 2) patients with bronchodilators from before the initial PFT until the last PFT; and 3) patients with bronchodilators after the initial PFT until the last PFT. Results: The median FEV 1 declined by 21 and 10 mL/yr in groups 1 and 2, respectively, while it increased by 11 mL/yr in group 3 ( P for trend = 0.009). The annual decline in FEV 1 did not differ between groups 1 and 2, while theannual decline in FEV 1 in group 3 was significantly slower than in groups 1 and 2 ( P = 0.026), even after adjusting for covariates (adjusted P = 0.049). Conclusions: Long-term bronchodilator use does not affect the lung function decline in TDL-CAO patients, but the improvement in FEV 1 after bronchodilator initiation appears to delay the disease course, suggesting that bronchodilator use be considered in TDL-CAO patients.