Cough Frequency During Treatment Associated With Baseline Cavitary Volume and Proximity to the Airway in Pulmonary TB.
Bui, David P
López, José W
Vu, Nancy M
Bravard, Marjory A
Lee, Gwenyth O
Tracey, Brian H
Mollura, Daniel J
Friedland, Jon S
Moore, David A J
Evans, Carlton A
Gilman, Robert H
AffiliationUniv Arizona, Mel & Enid Zuckerman Coll Publ Hlth, Dept Epidemiol & Biostat, Tucson, AZ USA
MetadataShow full item record
PublisherELSEVIER SCIENCE BV
CitationProaño, A., Bui, D. P., López, J. W., Vu, N. M., Bravard, M. A., Lee, G. O., ... & Mollura, D. J. (2018). Cough Frequency During Treatment Associated With Baseline Cavitary Volume and Proximity to the Airway in Pulmonary TB. Chest, 153(6), 1358-1367.
RightsCopyright 2018 The Authors. Published by Elsevier Inc under license from the American College of Chest Physicians. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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AbstractCough frequency, and its duration, is a biomarker that can be used in low-resource settings without the need of laboratory culture and has been associated with transmission and treatment response. Radiologic characteristics associated with increased cough frequency may be important in understanding transmission. The relationship between cough frequency and cavitary lung disease has not been studied. We analyzed data in 41 adults who were HIV negative and had culture-confirmed, drug-susceptible pulmonary TB throughout treatment. Cough recordings were based on the Cayetano Cough Monitor, and sputum samples were evaluated using microscopic observation drug susceptibility broth culture; among culture-positive samples, bacillary burden was assessed by means of time to positivity. CT scans were analyzed by a US-board-certified radiologist and a computer-automated algorithm. The algorithm evaluated cavity volume and cavitary proximity to the airway. CT scans were obtained within 1 month of treatment initiation. We compared small cavities (≤ 7 mL) and large cavities (> 7 mL) and cavities located closer to (≤ 10 mm) and farther from (> 10 mm) the airway to cough frequency and cough cessation until treatment day 60. Cough frequency during treatment was twofold higher in participants with large cavity volumes (rate ratio [RR], 1.98; P = .01) and cavities located closer to the airway (RR, 2.44; P = .001). Comparably, cough ceased three times faster in participants with smaller cavities (adjusted hazard ratio [HR], 2.89; P = .06) and those farther from the airway (adjusted HR, 3.61;, P = .02). Similar results were found for bacillary burden and culture conversion during treatment. Cough frequency during treatment is greater and lasts longer in patients with larger cavities, especially those closer to the airway.
NoteOpen access article
VersionFinal published version
SponsorsNational Institute of Allergy and Infectious Diseases [R21AI094143]; Fogarty International Center at the National Institutes of Health [D43TW006581, D43TW001140, D43TW010074, R25TW009340, R24TW007988, D43TW009349]; Grand Challenges Canada [0539-01-10, 0537-01-10]; Center for Infectious Disease Imaging; National Institute of Allergy and Infectious Diseases; National Institute of Biomedical Imaging and Bioengineering from the National Institutes of Health; Wellcome Trust [078067/Z/05/Z, 105788/Z/14/Z, 201251/Z/16/Z]; Imperial Biomedical Research Centre; Joint Global Health Trials [MR/K007467/1]; government of Canada [W5_PER_CDT1_PRISMA]; Bill & Melinda Gates Foundation [OPP1118545]; Innovation for Health and Development funding
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