Dynamics of Cough Frequency in Adults Undergoing Treatment for Pulmonary Tuberculosis.


Proaño, A; Bravard, MA; Lopez, JW; Lee, GO; Bui, D; Datta, S; Comina, G; Zimic, M; Coronel, J; Caviedes, L; Cabrera, JL; Salas, A; Ticona, E; Vu, NM; Kirwan, DE; Loader, MI; Friedland, JS; Moore, DA; Evans, CA; Tracey, BH; Gilman, RH; Tuberculosis Working Group in Peru, ; (2017) Dynamics of Cough Frequency in Adults Undergoing Treatment for Pulmonary Tuberculosis. Clinical infectious diseases. ISSN 1058-4838 DOI: https://doi.org/10.1093/cid/cix039

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Abstract

: Cough is the major determinant of tuberculosis transmission. Despite this, there is a paucity of information regarding characteristics of cough frequency throughout the day and in response to tuberculosis therapy. Here we evaluate the circadian cycle of cough; cough frequency risk factors; and the impact of appropriate treatment on cough and bacillary load.<br/> : We prospectively evaluated HIV-negative adults (n=64) with a new diagnosis of culture-proven, drug-susceptible pul-monary tuberculosis immediately prior to treatment and repeatedly until treatment day 62. At each time-point, partici-pant cough was recorded (n=670) and analyzed using the Cayetano Cough Monitor. Consecutive coughs at least 2-seconds apart were counted as separate cough episodes. Sputum samples (n=426) were tested with microscopic-observation drug-susceptibility broth culture, and in culture-positive samples (n=252) the time to culture positivity was used to estimate bacillary load.<br/> : The highest cough frequency occurred from 1-2 p.m., and the lowest from 1-2 a.m. (2.4 versus 1.1 cough episodes/hour, respectively). Cough frequency was higher among participants who had higher sputum bacillary load (p&lt;0.01). Pre-treatment median cough episodes/hour was 2.3 (IQR=1.2-4.1), which at 14 treatment days decreased to 0.48 (IQR=0.0-1.4) and at the end of the study decreased to 0.18 (IQR=0.0-0.59), both reductions p&lt;0.001. By 14 treatment days, the probability of culture conversion was 29% (95% CI=19-41%).<br/> : Coughs were most frequent during daytime. Two weeks of appropriate treatment significantly reduced cough frequency and made one-third of participants achieve culture conversion. Thus treatment by two weeks considerably diminishes but not eliminates the potential for airborne tuberculosis transmission.<br/>

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: TB Centre
PubMed ID: 28329268
Web of Science ID: 399377100005
URI: http://researchonline.lshtm.ac.uk/id/eprint/3682754

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