Tuberc Respir Dis.  2011 Apr;70(4):323-329.

Differences between Patients with TB-Destroyed Lung and Patients with COPD Admitted to the ICU

• Seo YK
• Lee CH
• Lee HK
• Lee YM
• Park HK
• Choi SB
• Kim HG
• Jang HJ
• Yum HK
• Lee SH

Abstract

BACKGROUND
Although patients with tuberculous-destroyed lung (TDL) account for a significant proportion of those with chronic airflow obstruction, it is difficult to distinguish patients with airway obstruction due to TDL from patients with pure chronic obstructive pulmonary disease (COPD) on initial presentation with dyspnea. We investigated clinical features differing between (i) patients with TDL and airway obstruction and (ii) those with COPD admitted to the intensive care unit (ICU) due to dyspnea.
METHODS
We reviewed the medical records of patients with TDL who had a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of <70% on a pulmonary function test (PFT; best value closest to admission) and patients with COPD without a history of pulmonary tuberculosis (TB) who were admitted to the ICU. Ultimately, 16 patients with TDL and 16 with COPD were compared, excluding patients with co-morbidities.
RESULTS
The mean ages of the patients with TDL and COPD were 63.7 and 71.2 years, respectively. Mean FVC% (50.4% vs. 71.9%; p<0.01) and mean FEV1% (39.1% vs. 58.4%; p<0.01) were significantly lower in the TDL group than in the COPD group. More frequent consolidation with TB (68.8% vs. 31.3%; p=0.03) and more tracheostomies (50.0% vs. 0.0%; p=0.02) were observed in the TDL than in the COPD group.
CONCLUSION
Upon ICU admission, patients with TDL had TB pneumonia more frequently, more diminished PFT results, and more tracheostomies than patients with COPD.

Keyword

Tuberculosis, Pulmonary; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive; Intensive Care Units

MeSH Terms

Airway Obstruction
Dyspnea
Forced Expiratory Volume
Humans
Intensive Care Units
Lung
Lung Diseases, Obstructive
Medical Records
Pneumonia
Pulmonary Disease, Chronic Obstructive
Respiratory Function Tests
Tracheostomy
Tuberculosis, Pulmonary
Vital Capacity

Reference

1. World Health Organization. WHO Report 2008: global tuberculosis control - surveillance, planning, financing. 2008. Geneva: World Health Organization.

2. Hong SB, Oh BJ, Kim YS, Kang EH, Kim CH, Park YB, et al. Characteristics of mechanical ventilation employed in intensive care units: a multicenter survey of hospitals. J Korean Med Sci. 2008. 23:948–953.

3. Snider GL, Doctor L, Demas TA, Shaw AR. Obstructive airway disease in patients with treated pulmonary tuberculosis. Am Rev Respir Dis. 1971. 103:625–640.

4. Choe KO, Jeong HJ, Sohn HY. Tuberculous bronchial stenosis: CT findings in 28 cases. AJR Am J Roentgenol. 1990. 155:971–976.

5. Cosio BG, Agustí A. Update in chronic obstructive pulmonary disease 2009. Am J Respir Crit Care Med. 2010. 181:655–660.

6. Park JH, Na JO, Kim EK, Lim CM, Shim TS, Lee SD, et al. The prognosis of respiratory failure in patients with tuberculous destroyed lung. Int J Tuberc Lung Dis. 2001. 5:963–967.

7. Penner C, Roberts D, Kunimoto D, Manfreda J, Long R. Tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation. Am J Respir Crit Care Med. 1995. 151:867–872.

8. Soler-Cataluña JJ, Martínez-García MA, Román Sánchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005. 60:925–931.

9. Lee JH, Chang JH. Lung function in patients with chronic airflow obstruction due to tuberculous destroyed lung. Respir Med. 2003. 97:1237–1242.

10. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007. 176:532–555.

11. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005. 26:948–968.

12. Martin CJ, Cochran TH, Katsura S. Tuberculosis, emphysema, and bronchitis. Am Rev Respir Dis. 1968. 97:1089–1094.

13. Rosenzweig DY, Stead WW. The role of tuberculosis and other forms of bronchopulmonary necrosis in the pathogenesis of bronchiectasis. Am Rev Respir Dis. 1966. 93:769–785.

14. Im JG, Itoh H, Lee KS, Han MC. CT-pathology correlation of pulmonary tuberculosis. Crit Rev Diagn Imaging. 1995. 36:227–285.

15. Katz J, Kunofsky S. Tuberculosis as a cause of the increasing mortality from emphysema. Am Rev Respir Dis. 1964. 89:673–679.

16. MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001. 120:6 Suppl. 375S–395S.

17. Gladwin MT, Pierson DJ. Mechanical ventilation of the patient with severe chronic obstructive pulmonary disease. Intensive Care Med. 1998. 24:898–910.

18. Lee SH, Hur GY, Jung KH, Lee SY, Lee SY, Kim JH, et al. Clinical Investigation of Tuberculous Pneumonia. Tuberc Respir Dis. 2004. 57:19–24.

19. Choi D, Lee KS, Suh GY, Kim TS, Kwon OJ, Rhee CH, et al. Pulmonary tuberculosis presenting as acute respiratory failure: radiologic findings. J Comput Assist Tomogr. 1999. 23:107–113.

20. Frame RN, Johnson MC, Eichenhorn MS, Bower GC, Popovich J Jr. Active tuberculosis in the medical intensive care unit: a 15-year retrospective analysis. Crit Care Med. 1987. 15:1012–1014.

21. Lin SM, Wang TY, Liu WT, Chang CC, Lin HC, Liu CY, et al. Predictive factors for mortality among non-HIV-infected patients with pulmonary tuberculosis and respiratory failure. Int J Tuberc Lung Dis. 2009. 13:335–340.