Patient selection: pulmonary tuberculosis
The Radiographic Score (RS) of Snider et al was used to evaluate the extent of pulmonary disease on the chest X-ray prior to therapy and to monitor the response to therapy.
Some patients experienced a decline in pulmonary function. The nadir in pulmonary function occurred about 18 months after treatment completion.
Predictors of a deterioration in pulmonary function after therapy:
(1) smear-positive disease prior to therapy
(2) extensive pulmonary disease prior to therapy (based on the radiographic score)
(3) longer anti-tuberculous treatment duration
(4) need to make a change in the treatment regimen during treatment
(5) limited radiographic improvement following therapy (based on the radiographic score)
Pulmonary function should be monitored:
(1) prior to initiating treatment to establish the baseline
(2) if there are significant respiratory symptoms following therapy
(3) in patients with one or more predictors for a deterioration in pulmonary function
Factors that may limit the predictive value of these risk factors:
(1) failure of cure with persistent or relapsed disease (multi-drug resistant mycobacterial infection, etc)
(2) concurrent pulmonary comorbidity (pneumoconiosis, asthma, etc) that were excluded from study
(3) HIV disease
