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Preventing lung function decline and pleural thickening after pleural TB: a systematic review
J A Abrego-Fernández1, E Gordillo-Valdés1, J M Porcel2
1Pleural Clinic, National Institute of Respiratory Diseases (INER), Mexico City, Mexico.
Summary
Intrapleural fibrinolysis effectively improves lung function in pleural tuberculosis (PTB) patients, reducing restrictive functional sequelae (RFS). Other treatments like pleural drainage may offer symptomatic relief but require further investigation for pulmonary function impacts.
Area of Science:
- Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Pleural tuberculosis (PTB) can lead to restrictive functional sequelae (RFS) despite standard anti-TB therapy.
- Identifying effective adjunctive treatments is crucial for mitigating PTB-related lung function impairment.
Purpose of the Study:
- To systematically review and synthesize evidence on adjunctive treatments for PTB.
- To assess the impact of interventions on pulmonary function tests (PFTs) and RFS.
Main Methods:
- Systematic literature review across multiple databases (PubMed, Cochrane, EMBASE, etc.).
- Focused on treatments including oral steroids, pleural drainage, intrapleural therapy, and pleuroscopy.
- Adhered to Cochrane's Synthesis Without Meta-analysis (SWiM) guidelines.
Main Results:
- Intrapleural fibrinolysis with urokinase significantly improved %FVC and delta-FVC at 6 months in free-flowing PTB effusions.
- Oral steroids showed no improvement in PFTs; pleural drainage results were inconclusive for PFTs.
- Pleuroscopy effects on PFTs were not studied, though other benefits were noted for drainage and pleuroscopy.
Conclusions:
- Intrapleural therapies demonstrate strong evidence in preventing RFS in PTB.
- Pleural drainage may alleviate dyspnea, but further research is needed on pleuroscopy's role in PFT improvement.
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