Lung functioning and health-related quality of life among adult patients with completed treatment for pulmonary tuberculosis at two urban referral hospitals in Kampala.

Abstract

Introduction: Patients with tuberculosis may have residue lung damage that results in chronic respiratory diseases as evidenced by lung function abnormalities and altered health-related quality of life. The prevalence of and factors associated with lung functioning among TB patients with a completed course of treatment remain unknown in Uganda. Objective: To determine the prevalence of lung functioning abnormalities, factors associated with lung functioning abnormalities and health related quality of life in adults with completed treatment for pulmonary tuberculosis at two urban referral hospitals in Kampala. Methods: This cross-sectional study, included participants from an ongoing lung disease cohort in Uganda. Eligible patients were aged 18-60 years. Lung function was assessed using spirometry and the tests graded according to GOLD criteria for obstructive lung disease. Crude and adjusted prevalence ratios of factors associated with abnormal lung function were estimated using Modified Poisson regression models; analyses were done using Stata version 14. St. George’s Respiratory Questionnaire (SGRQ) was used to measure HRQoL, while the Mann-Whitney test was used to assess for differences in median SGRQ scores. Thematic analysis was used to elicit participants’ experiences on symptom management. Results: There were 162 patients and 8 participants included in the quantitative and qualitative analysis respectively. The median (IQR) age was 32 (26-39) years, 89 (54.9%) were male and 65 (40.1%) were co-infected with HIV; median (IQR) CD4 count of 145 (53-296) cells/uL. The mean (SD) FEV1 and FVC were 2.57L (0.77) and 3.1L (0.85), respectively. Overall, 65 (40.1%) of the participants had abnormal lung function, 57 (87.7%) of whom had a restrictive pattern. Smoking and being female were associated with abnormal lung function (Adj.PR=1.88, 95% Cl 1.11-3.16, p=0.018) and (Adj.PR=1.81, 95% Cl 1.15-2.84, p=0.01). The SGRQ total and domain scores were higher in participants with cavitation or consolidation on initial chest x-ray, p<0.001). Participants with poor lung function had experiences related to coping strategies and their effectiveness, cost, and availability, expectations towards health care, and sources of health-related information. Conclusions: Abnormal lung function is common in patients completing PTB treatment in Kampala, Uganda. The HRQoL is lower in patients with features of severe PTB disease with severely affected individuals engaging in various coping mechanisms. Emphasis should be placed on screening PTB patients with severe disease in the presence of other risk factors for abnormal lung function at the end of PTB treatment, and promote pulmonary rehabilitation centers to improve quality of life in these individuals.