TABLE 4.

Summary of key research priorities to address pulmonary impairment after tuberculosis (TB)

Epidemiological studies

Population-based studies that determine the prevalence of: 1) lung function defects by type (airflow obstruction, restrictive ventilatory defects, gas exchange abnormalities, V′/Q mismatch and mixed defects); and 2) lung damage by type (cavitation, fibrosis and bronchiectasis) Investigate risk factors (host, environmental, pathogen) associated with PIAT Measure impact of PIAT on quality of life Determine the prevalence of PIAT and characterise lung deficits in specific patient populations, such as those co-infected with HIV, who have diabetes mellitus or are infected with multidrug-resistant TB

Basic/translational science

Delineate the immunopathogenesis of pulmonary cavitation, fibrosis and bronchiectasis in pulmonary TB Determine the immunogenetic correlates of hyper-inflammation and tissue damage in pulmonary TB utilising genome-wide association studies similar to those in IPF and COPD Identify key biomarkers or immune pathways as targets for immunomodulation to reduce lung pathology in pulmonary TB

Clinical/translational science

Diagnosis and diagnostic tests: investigate the utility of chest radiographs, CT, PET-CT, pulse oximetry, 6-min walk test and PFTs prior and post-TB treatment in diagnosing those at increased risk for PIAT Prevention and treatment: Develop effective vaccines to prevent TB and lung tissue damage post infection Develop novel drugs and biologics for TB that not only shorten treatment duration, but also reduce lung tissue injury Investigate the use of adjunctive host-directed therapy to treat TB and associated lung pathology Evaluate the efficacy of the use of common COPD and anti-fibrotic medications in preventing and/or treatment of post-TB lung injury These initiatives would be informed by studies that address the basic/translational science priorities described above

V′/Q: ventilation/perfusion; PIAT: pulmonary impairment after TB; IPF: idiopathic pulmonary fibrosis; COPD: chronic obstructive pulmonary disease; CT: computed tomography; PET: positron emission tomography; PFT: pulmonary function test.