[Treatment of bronchial obstruction in patients with pulmonary tuberculosis].
Whether the main points of treatment for bronchial obstructive syndrome (BOS) in chronic obstructive lung disease (COLD) can be adapted for patients with pulmonary tuberculosis (PT) was studied. For this purpose, 435 patients with PT with signs of BOS (forced expiratory volume at 1 second (FEV1) < 80% of the normal values) were examined. To establish differences in the efficiency of therapy, according to the activity of a process and to the magnitude of the impaired architectonics of the respiratory system, three main groups of observation were formed: 1) patients with infiltrative PT (IPT); 2) those with fibrocavernous PT (FCPT); and 3) those with posttuberculous pneumosclerosis (PS). According to the severity of BOS, the patients were divided into 3 subgroups: 1) 104 patients with FEV1 > 70% of the normal values; 2) 229 patients with FEV1 69-50%; 3) 102 patients with FEV1 < 50%. The patients with IPT and FCPT received the conventional antituberculous therapy under respective clinical, laboratory, and X-ray control. The patients with PS had no antituberculous therapy. All the patients underwent 3-month clinical and functional monitoring evaluating changes in life quality, by using the respiratory questionnaire of the Saint George hospital. The findings have led to the conclusion that the use of the proposed therapy for bronchial obstructive syndrome in patients with pulmonary tuberculosis was highly effective, promotes the amelioration of the degree of respiratory symptoms in patients with IPT by 2 to 8 times, in those with FCPT by more than 2-3 times, and in those with PS by 1.45-10 times. The differences in the efficiency of bronchodilator therapy depend on the baseline level of bronchial obstruction. In patients with pulmonary tuberculosis concurrent with BO, the use of current inhalation bronchodilator therapy results in a substantial increase in FEV1, which differentiates BOS in PT from COLD. The use of the proposed therapy in the multimodality treatment of patients with pulmonary tuberculosis showed no statistically significant differences in the changes in the degree of X-ray symptoms while this therapy permits acceleration of abacillation in patients with IPT by 16.8% and in those with FCPT by 14.8%. Effective bronchodilator therapy considerably enhances life quality in patients. Thus, early systematic and long-term performance of the bronchodilator therapy, based on the principles of bronchodilator therapy for COLD, in patients with PT concurrent with BOS may substantially enhance the efficiency of treatment in this category of patients.
E I
EI
Shmelev
G M
GM
Kuklina
E E
EE
Kalinina
D000995:Antitubercular Agents / Q000627:therapeutic use*; D029481:Bronchitis, Chronic / Q000188:drug therapy* / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D012720:Severity of Illness Index
D000995:Antitubercular Agents; D001993:Bronchodilator Agents