Long-term outcomes of tracheobronchial stenosis due to tuberculosis (TSTB) in symptomatic patients: airway intervention vs. conservative management

Ken Cheah Hooi Lee; Shera Tan; Junyang Ken Goh; Anne Ann Ling Hsu; Su Ying Low

doi:10.21037/JTD-20-670

Long-term outcomes of tracheobronchial stenosis due to tuberculosis (TSTB) in symptomatic patients: airway intervention vs. conservative management

J Thorac Dis. 2020 Jul;12(7):3640-3650. doi: 10.21037/JTD-20-670.

Authors

Ken Cheah Hooi Lee^{1

2}, Shera Tan³, Junyang Ken Goh^{1

2}, Anne Ann Ling Hsu^{1

2}, Su Ying Low^{1

2}

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.
² Lung Center, Duke-National University Singapore SingHealth, Singapore, Singapore.
³ Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore, Singapore.

Abstract

Background: Patients with tracheobronchial stenosis due to tuberculosis (TSTB) have a variable clinical course and response to treatment including airway intervention. There are no clear guidelines on the best approach to manage such patients. This study examines long-term outcomes of patients with TSTB and factors associated with recurrent symptoms or need for repeat airway intervention following initial bronchoscopic intervention.

Methods: This is a retrospective analysis of patients with TSTB over an 18-year period. Symptoms, radiological, bronchoscopic findings, airway interventions and complications were obtained. Multivariate logistic regression analysis was performed to identify factors predictive of recurrence of symptoms or need for repeat airway intervention.

Results: A total of 131 patients with mean age 50±18 years and median follow-up 5 (interquartile range, 2-10) years were included. Nineteen (29.7%) patients underwent balloon dilatation alone, 22 (34.4%) had additional resection or stenting, and 19 (29.7%) underwent all 3 procedures. Among patients conservatively managed, a larger proportion (55.6%) of patients with no recurrence of symptoms had active TB. Patients who developed recurrent symptoms had longer symptom duration (12 vs. 3 months, P=0.025), and more had recurrent lower respiratory tract infections (50% vs. 5.6%, P=0.003), lung collapse (90.0% vs. 41.7%, P=0.011) or linear fibrosis (70.0% vs. 30.6%, P=0.033) compared to those without recurrent symptoms. Bronchomalacia (OR =17.18; 95% CI, 3.43-86.18) and prior bronchoscopic airway resection (OR =4.97; 95% CI, 1.20-20.60) were strongly associated with the recurrence of symptoms or need for repeat airway intervention on multivariate logistic regression analysis.

Conclusions: Bronchomalacia and prior bronchoscopic airway resection are associated with the recurrence of symptoms despite airway intervention. Patients who are diagnosed with TSTB early in the course of active TB may be conservatively managed.

Keywords: Tuberculosis; airway intervention; bronchomalacia; tracheobronchial stenosis.