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Spirometric Evaluation in Patients With Tuberculous Pleural Effusion Before, During and After Chemotherapy FREE TO VIEW

Kulwant S. Bhatia, MD; Sanjeev Kumar Kapoor, junior resident
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Govt. Medical College, Amritsar, Punjab, India


Chest. 2003;124(4_MeetingAbstracts):218S. doi:10.1378/chest.124.4_MeetingAbstracts.218S-b
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PURPOSE:  The present study was conducted in patients of tuberculous pleural effusion to look for any initial lung function impairment, changes occurring over time after the institution of anti-tubercular chemotherapy and also to note the residual abnormalities if any left at the end of 6 months of treatment

METHODS:  Fifty patients (37 male & 13 female) of untreated & uncomplicated cases who met the criteria of tuberculous pleural effusion were enrolled for the study. Based on X-ray chest, patients were classified as mild, moderate and severe pleural effusion. Spirometry was performed in all patients. A minimum of three forced expiratory maneuvers were performed and the best value recorded. Maximum aspiration of pleural effusion was done and patients were put on anti-TB chemotherapy. The patients were subjected to further spirometry at 1st, 2nd & 6th month of anti-TB chemotherapy. The changes in spirometric values with thoracocentesis & anti-TB chemotherapy were noted.

RESULTS:  Pleural effusion has a ventilatory restrictive and small airway obstructive pattern on spirometry, as mean pretreatment FVC, FEV1, FEV1% and FEF25-75% were 51.06, 63.14, 107.86, and 50.90 respectively. The derangements in spirometry were proportional to the severity of pleural effusion. All values showed statistically significant improvement after six months of treatment.CONCLUSIONS: Pleural effusion causes restrictive ventilatory defect and small airway obstruction. Thoracocentesis and early institution of anti-TB chemotherapy improves restriction as shown by readings of serial spirometry that were done on 1st, 2nd & 6th month of anti-TB chemotherapy. Even at the end of six months of therapy, small airway obstructive pattern improved, however some residual restrictive abnormalities were left which were directly proportional to the severity of pleural effusion prior to the start of treatment.

CLINICAL IMPLICATIONS:  Early detection, maximal aspiration and treatment improve the outcome.

DISCLOSURE:  K.S. Bhatia, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM




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