Life after pulmonary TB in Malawi: an evaluation of lung health, physical and economic well being (360G-Wellcome-106065_Z_14_A)

Despite the high incidence of chronic respiratory damage following treatment for pulmonary TB disease (PTB), including residual changes to lung physiology and structure, little is known about the associated medium or long-­-term morbidity, or the risk of empirical TB-­-retreatment due to chronic respiratory symptoms. There is a paucity of data from sub-­-Saharan Africa and HIV co-­-infected populations. In this prospective cohort study 400 adult patients will be recruited on completion of PTB treatment in urban Blantyre. The presence / absence of post-­-TB lung disease (PTLD) at baseline will be defined using computerised tomography imaging and spirometry. Patients will be followed for 1-­-year, during which morbidity (patient costs, health related quality of life, functional capacity, incidence rate of acute exacerbations) will be measured. Morbidity will be compared in patients with and without PTLD at baseline. A nested case-­-control will be conducted to investigate the relationship between chronic respiratory symptoms present 1-­-year after PTB treatment, which place patients at risk of empirical TB-­-retreatment, and PTLD at baseline. A predictive tool will be designed to identify those patients at risk of ongoing morbidity or chronic respiratory symptoms after PTB treatment, using clinical variables that can be easily measured on treatment completion in resource-­-limited settings.