Clinical, imaging, bronchoscopic characteristics and pulmonary function features in patients with endobronchial...

Endobronchial tuberculosis (EBTB) is a common manifestation of tuberculosis (TB) that may cause airway obstruction if not promptly diagnosed and treated. This study described clinical, imaging, bronchoscopic characteristics and pulmonary function in patients with EBTB.

A single-centre cross-sectional study.

The study was conducted at the National Lung Hospital, a tertiary hospital specialised in TB and lung diseases in Vietnam from May 2023 to May 2024.

We consecutively enrolled 91 patients aged ≥16 years with bacteriologically confirmed EBTB, defined by positive Mycobacterium tuberculosis detection using GeneXpert MTB/RIF assay or liquid culture from bronchial biopsy or aspirate specimens with or without compatible histopathological findings. All participants underwent a standardised diagnostic workup, including chest high resolution CT (HRCT) scan, spirometry, bronchoscopy and histopathology.

The outcome of our study was the presence of central airway obstruction (CAO), defined as ≥50% narrowing of the trachea, mainstem bronchi, bronchus intermedius, lobar and segmental bronchi visually estimated on bronchoscopy and supported by HRCT findings.

Median age was 37 years (IQR: 27-54), 64.8% female; 31.9% were post-TB treatment cases and 68.1% newly diagnosed. Overall, 65.9% of patients had ventilatory defects, most commonly the restrictive pattern (66.7%). Lesions were more frequent in the left airway than right (64.8% vs 31.9%, p<0.001). CAO was found in 71.4% of patients, more common in post-TB cases (86.2% vs 64.5%). Multivariate logistic regression analyses showed that three variables were independently associated with the risk of CAO on bronchoscopy, including shorter duration from symptom onset to hospitalisation (<8 weeks) (adjusted OR (aOR) = 3.93, 95% CI 1.18 to 13.03), dyspnoea (aOR = 3.85, 95% CI 1.27 to 11.68) and forced expiratory volume in one second (FEV₁) <80% (aOR = 5.45, 95% CI 1.28 to 23.33).

Ventilatory defects and CAO were common among patients with EBTB. A high level of suspicion should be applied to patients presenting with dyspnoea, shorter duration from symptom onset to hospitalisation (<8 weeks) and reduced FEV₁ (< 80%).