5.4.3. Post-TB lung disease in children and adolescents

Data from adults with TB show that a substantial proportion of people report residual symptoms, including cough and dyspnoea, despite microbiological cure at the end of TB treatment. This impacts on their quality of life and increases the risk of premature death (141–143). Previous PTB substantially increases the risk of recurrent TB, which may, at least in part, be due to residual lung damage (144, 145).

Assessment at the end of TB treatment aims to identify children with post-TB lung disease and should be considered in children with more severe forms of PTB and in children who remain symptomatic at the end of TB treatment. The long-term effects of PTB depend on the type (parenchymal, nodal, other), severity and age. Children with destructive parenchymal disease and those with untreated airway complications and who develop bronchial stenosis may be at particularly high risk of long-term respiratory morbidity. Other children at high risk are those who develop broncho-oesophageal fistula.

If resources permit, long-term follow-up care should be established to manage these children (see Table 5.16). Assessment should include a symptom screen, basic clinical examination and nutritional assessment. Radiological imaging should be considered at the end of treatment to assess residual abnormalities, especially in children with more extensive disease and to allow for comparison if TB recurs, if symptoms are ongoing, or if new respiratory symptoms occur. Chest computed tomography (CT) scans are not widely available in low-resource settings, or indicated, but they should be considered if there are substantial chronic or recurrent respiratory symptoms or signs and radiological abnormalities to evaluate the extent of post-TB lung disease, or to exclude another underlying diagnosis, including potential DR-TB. In such cases, if CT was not done at diagnosis, it should be considered during or at the end of treatment.

Lung function testing should be considered in all children old enough to complete testing (typically aged 4 years and over) who had severe PTB and should include pre- and post-bronchodilation spirometry according to European Respiratory Society and American Thoracic Society guidelines (146) using Global Lung Function Initiative reference ranges (147).

Table 5.16. End-of-treatment assessment of post-TB lung disease in children

a If there are any residual symptoms, further investigations should be performed.

Adult post-TB lung disease is heterogeneous and includes pathology affecting the airways, parenchyma, and pleural and pulmonary vascular compartments with mixed patterns (131). Medical treatment and long-term follow-up of children and adolescents with post-TB lung disease should be guided by symptoms, type of respiratory disease and additional investigations. Bronchodilation may be effective in children with responsive obstructive airway disease, but evidence is limited. Referral should be
made to a respiratory or pulmonology clinic if available for the management of bronchiectasis (148). The roles of pulmonary rehabilitation and airway clearance techniques require further investigation, and their use should be guided by symptoms and recurrent infections.

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