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RESEARCH LETTER
Year : 2021  |  Volume : 38  |  Issue : 1  |  Page : 101-103  

Characteristics and outcomes of endobronchial tuberculosis therapy


Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia - Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia

Date of Web Publication31-Dec-2020

Correspondence Address:
Mia Elhidsi
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia - Persahabatan National Respiratory Referral Hospital, Jakarta
Indonesia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_132_20

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How to cite this article:
Aniwidyaningsih W, Elhidsi M, Sari A, Burhan E. Characteristics and outcomes of endobronchial tuberculosis therapy. Lung India 2021;38:101-3

How to cite this URL:
Aniwidyaningsih W, Elhidsi M, Sari A, Burhan E. Characteristics and outcomes of endobronchial tuberculosis therapy. Lung India [serial online] 2021 [cited 2021 Jan 22];38:101-3. Available from: https://www.lungindia.com/text.asp?2021/38/1/101/306006



Sir,

Nonclassical respiratory symptoms in endobronchial tuberculosis (EBTB) often cause misdiagnosis. EBTB is a health problem due to the formation of bronchostenosis as a complication, regardless of anti-TB administration. The eradication of Mycobacterium tuberculosis and prevention of persistent airway stenosis are the goals of EBTB therapy through early diagnosis and optimum therapy.

We report clinical and radiological improvements with acid-fast bacillus (AFB) conversion in EBTB patients with anti-TB drugs, steroids, and bronchoscopic dilatation.

We collected retrospectively data of EBTB patients from January 2013 to December 2017. The protocol was approved by the Ethical Committee of Faculty of Medicine Universitas Indonesia. There were 30 patients with EBTB. The patients' characteristics are summarized in [Table 1]. The majority were female (86.7%), with a mean age of 28 years, and had never received prior anti-TB drugs (63.3%). The average period of medication was 12 months. Most (80%) were given a combination of rifampicin, isoniazid, pyrazinamide, and ethambutol. Almost all patients received steroids; 73.3% were with inhalation steroids, while 23.3% used systemic steroids. All EBTB patients had bronchoscopic abnormalities. The lesions' location was in the trachea (60%), main left bronchus (40%), right main bronchus (33.3%), and carina (10%). Bronchoscopic balloon dilatation was done in 23.2% of subjects.
Table 1: Characteristics of EBTB Patients (n=30)

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There were improvements in symptoms [Table 2]. All patients had radiological abnormalities in chest X-ray at the beginning of treatment, while on the end, 50% of the patients had normal chest X-ray. There were 3.33% of the patients who had normal bronchoscopic findings and 26.6% of the patients with 100% AFB conversion at the end of therapy.
Table 2: EBTB Therapy Response (n=30)

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In this study, we found more females and young age; it is similar with several previous studies.[1],[2] Female gender, a period of respiratory symptoms more than 4 weeks, and no prior TB therapy might be the independent predictive factors of EBTB in active pulmonary TB patients.[3] The correlation between prior TB treatment and comorbidities and risk of EBTB is still unknown.[4]

The EBTB symptoms might be affected by the type, location, and a number of airway lesions. The endobronchial involvement in lung TB can be 95%–97% detected using thoracic computed tomography (CT).[5] In this study, we found specific EBTB in CT scans such as consolidation (45%), airway obstruction (45%), and a tree in the bud appearance (15% of cases).

Bronchoscopy is not routinely performed in TB patients, but it should be routinely performed to evaluate EBTB lesion subtype and therapy response. In the early phases, we can find nonspecific bronchitis lesions or normal bronchus. Meanwhile, fibrostenosis lesion as the advanced phase of the EBTB disease course was often found.[2] Bronchoscopic balloon dilatation provides stenosis improvements in this study although the proportion persisted at the end of treatment. Early treatment suggested better outcome.[6]

The steroid is often considered beneficial to prevent bronchial stenosis due to its anti-inflammation effect.[7] The systemic steroid was given in patients with bronchial stenosis with advanced invasive treatment a few days before and after balloon dilatation. The administration of anti-TB drugs with systemic or inhaled steroid can reduce EBTB symptoms quickly but cannot prevent or diminish existing fibrostenosis lesions.[8]

Hence, the combination of pharmacological and invasive bronchoscopic therapy may be further studied for EBTB patients to prevent persistent airway stenosis and improve quality of life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Jovanovic D, Rich A, Samardzic N, Popevic S, Marcovic-Denic L, Skodric-Trifunovic V, et al. Endobronchial tuberculosis in Serbia over a 20 year period: Analysis and review of current literature. J Mycobact Dis 2019;8:1-6.  Back to cited text no. 1
    
2.
Lee JY, Yi CA, Kim TS, Kim H, Kim J, Han J, et al. CT scan features as predictors of patient outcome after bronchial intervention in endobronchial TB. Chest 2010;138:380-5.  Back to cited text no. 2
    
3.
Ni S, Fu Z, Zhao J, Liu H. Inhaled corticosteroids (ICS) and risk of mycobacterium in patients with chronic respiratory diseases: A meta-analysis. J Thorac Dis 2014;6:971-8.  Back to cited text no. 3
    
4.
Baker MA, Harries AD, Jeon CY, Hart JE, Kapur A, Lonnroth K, et al. The impact of diabetes on tuberculosis treatment outcomes: A systematic review. BMC Med 2011;9:81.  Back to cited text no. 4
    
5.
Kashyap S, Solanki A. Challenges in endobronchial tuberculosis: From diagnosis to management. Pulm Med 2014;2014:594806.  Back to cited text no. 5
    
6.
Um SW, Yoon YS, Lee SM, Yim JJ, Yoo CG, Chung HS, et al. Predictors of persistent airway stenosis in patients with endobronchial tuberculosis. Int J Tuberc Lung Dis 2008;12:57-62.  Back to cited text no. 6
    
7.
Kim Y, Kim K, Joe J, Park H, Lee M, Kim Y, et al. Changes in the levels of interferon-gamma and transforming growth factor-beta influence bronchial stenosis during the treatment of endobronchial tuberculosis. Respiration 2007;74:202-7.  Back to cited text no. 7
    
8.
Shahzad T, Irfan M. Endobronchial tuberculosis-a review. J Thorac Dis 2016;8:3797-802.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2]



 

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