Asthma as a sequelae to pulmonary tuberculosis

Background: The Th2 lymphocytes, responsible for immediate type hypersensitivity in asthma do not co-exist with Th1 lymphocytes produced as a part of cell mediated enhanced effects of immunological response (CMI) in active tuberculosis. Therefore, development of asthma post TB has been debated. Aims: To assess if there is occurrence of asthma and other atopic manifestations in pulmonary TB (PTB) sequelae. Methods: 30 patients with a past history of PTB without any history of atopy or asthma presenting with SOB and/or wheeze were analysed. They were evaluated by spirometry. Patients with >12% post bronchodilator reversibility on spirometry were considered as asthmatic. Total serum IgE, sputum for eosinophils, absolute eosinophil count (AEC), systemic manifestations of atopy and family history of asthma, typically seen in asthmatics were also taken into account. Results: Out of the 30 pts, 16 pts had reversible (Asthma) and 14 had irreversible airway obstruction. All the patients among the reversible category were positive for at least two other parameters, estabilishing a stronger diagnosis of asthma. Conclusion: A subset of PTB patients can later develop asthma, probably after the enhanced level of Th1 lymphocytes has reduced to normal with anti-tubercular therapy. These patients are likely to benefit with the use of inhaled corticosteroids along with other bronchodilator therapy