[Evaluation of respiratory failure due to sequelae of tuberculosis]

Though the mortality of tuberculosis in Japan has been extremely rapidly depressed from about 150 deaths per 100,000 in 1950 down to about 4 in 1985 during the period of a couple of decades after the World War II. However, the declining trend of the mortality and the morbidity seem to be leveling off now and the morbidity of the tuberculosis remain on the almost same level which are much higher than that of the developed countries. We have to make the progress in the field of the new diagnostic technique and the creation of the new drugs applying the most frontier science and the social system supporting the completion of the treatment for every patient. On the other hand, it is also very important to take care of those who have been suffering from the sequelae of the pulmonary tuberculosis, which include chronic respiratory failure, cor pulmonale, and non-TB chronic pulmonary secondary infections. Among the sequelae we focus to the respiratory failure. Among the patients with various chronic respiratory diseases, there are many who are not hypoxic at rest but are hypoxic during physical exercise in the daily life. The pulmonary exercise test by treadmill or ergometer which needs a lot of work is the standard method to detect the exercise hypoxia. But this test is too complicated to come into wide use in the daily clinical study in Japan. Another exercise test has been eagerly expected for a long period. We newly developed a method to detect the exercise hypoxia in the patients' daily life without burdening the additional physical activities. The device of the new method consists of a portable pulse oxymeter with a built-in accelerometer which measures the oxygen saturation percutaneously and also measures simultaneously the vertical acceleration of the subject's physical movement by the accelerometer. The appropriate evaluation of exercise hypoxia of the patients with respiratory disturbances due to pulmonary tuberculosis sequelae, especially exercise hypoxia, should be performed widely all over the daily clinical examination by such a method as described in this report. Further the system of the evaluation of the exercise respiratory disturbances should be introduced in the various social regimen which concern with the disability due to the respiratory disturbances. We wish our society will be more matured society in which the patients with respiratory disturbances can afford to fully enjoy their lives. Both the frontier science against the tuberculosis and the measures against the sequelae of the pulmonary tuberculosis are one of our important challenges today.