[Development and treatment of respiratory failure due to tuberculosis]

Though the incidence, prevalence, and mortality of tuberculosis have decreased so quickly in last thirty years in Japan, we still have many persons suffering from so called tuberculosis sequelae who complain pulmonary symptoms, particularly respiratory failure. As I have been studying this problems for last many years as a part of tuberculosis treatment, I would like to summarize the present status of the problem. 1) Acute respiratory failure is observed in DIC followed by miliary tuberculosis and in far advanced cases. 2) Chronic respiratory failure is common in pulmonary tuberculosis sequelae. Sexual ratio, male to female is three to two and average age is 60.5. It is quite reasonable that advanced restrictive failure, %VC less than 40%, occurs in 70% of all cases, but obstructive disturbance, FEV1.0% less than 55%, was also observed in 40% of cases. It is still not so clear why tuberculosis sequelae shows obstructive ventilatory failure, but the response to obstruction with the administration of beta-stimulant is observed. Advanced hypoxemia, PaO2 less than 50 Torr, is observed in 30% and hypercapnea is observed in 70% of total cases. Clinical right heart disturbance is observed in 80% of cases. 3) Based on to calculation from the number of interval organ failure and questionnaire to hospitals, the number of persons suffering from respiratory failure is estimated at 20 per 100,000, and it is presumed that the prevalence of respiratory failure will begin to decrease in two to five years later. 4) Pulmonary hypertension, mPA 28.8 mmHg, and higher PVR, 402, are observed in 90 catheterized cases. alpha-NA Peptide in serum and ACT, RVET by echocardiogram are well related to the value of mPA. 5) Average accumulated survival rate is 50% after three years, and it related closely with PaO2. 6) Long term oxygen therapy is the most reasonable and practical treatment for not only to increase the life span but also to improve QOL of the patient. Exercise training is also effective. Almitrine (clinical trial base in Japan), Doxopram and other drugs are effective to recover hypoxemia and to improve pulmonary hypertension. Home mechanical ventilation just started in Japan, and two cases for tuberculosis sequelae are reported. In persons suffering from respiratory failure, special consideration should be made on the treatment of complications, for example abdominal surgery. 7) Social measures, for example, residence with sheltered workshop and vocational training center are quite important to care the respiratory failure due to tuberculosis sequelae. Profile and follow up study of the residence and the training center are reported.(ABSTRACT TRUNCATED AT 400 WORDS)