Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease

Abstract

Historically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference.

Figure 1. Radiological patterns of post-tuberculosis lung disease. In A, a chest CT scan showing irregular dense opacity with bronchiectasis from the hilum to the right lung apex associated with apical pleural thickening, elevation of the hilum, and volumetric reduction on this side. In B, a chest CT scan showing consolidative opacity with a fibroatelectatic appearance in the right lower lobe, predominantly affecting the anterior, lateral, and posterior basal segments, determining its volumetric reduction and highlighting the associated bronchiectasis in the anterior basal segment. Cylindrical bronchiolectasis in the upper segment of the right lower lobe. In C, a chest X-ray showing fibrotic opacity in the right upper lobe with pleural thickening and volumetric reduction of the right lung, leading to elevation of the right phrenic dome. In D, a chest CT scan showing a residual excavated lesion in the anterior segment of the right upper lobe filled with mobile contents upon change of decubitus, corroborating repercussions of superimposed saprophytic fungal infectious involvement. In E, imaging scans showing confluent laminar atelectasis, volumetric loss, and architectural distortion in the upper lobes, with intervening calcifications, favoring chronic/residual changes.