RT Journal Article SR Electronic T1 Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study JF Thorax JO Thorax FD BMJ Publishing Group Ltd and British Thoracic Society SP 269 OP 278 DO 10.1136/thoraxjnl-2019-213808 VO 75 IS 3 A1 Meghji, Jamilah A1 Lesosky, Maia A1 Joekes, Elizabeth A1 Banda, Peter A1 Rylance, Jamie A1 Gordon, Stephen A1 Jacob, Joseph A1 Zonderland, Harmien A1 MacPherson, Peter A1 Corbett, Elizabeth L A1 Mortimer, Kevin A1 Squire, Stephen Bertel YR 2020 UL http://thorax.bmj.com/content/75/3/269.abstract AB Background Post-tuberculosis lung damage (PTLD) is a recognised consequence of pulmonary TB (pTB). However, little is known about its prevalence, patterns and associated outcomes, especially in sub-Saharan Africa and HIV-positive adults.Methods Adult (≥15 years) survivors of a first episode of pTB in Blantyre, Malawi, completed the St George’s Respiratory Questionnaire, 6-minute walk test, spirometry and high-resolution CT (HRCT) chest imaging at TB treatment completion. Symptom, spirometry, health seeking, TB-retreatment and mortality data were collected prospectively to 1 year. Risk factors for persistent symptoms, pulmonary function decline and respiratory-related health-seeking were identified through multivariable regression modelling.Results Between February 2016 and April 2017, 405 participants were recruited. Median age was 35 years (IQR: 28 to 41), 77.3% (313/405) had had microbiologically proven pTB, and 60.3% (244/403) were HIV-positive. At pTB treatment completion, 60.7% (246/405) reported respiratory symptoms, 34.2% (125/365) had abnormal spirometry, 44.2% (170/385) had bronchiectasis ≥1 lobe and 9.4% (36/385) had ≥1 destroyed lobe on HRCT imaging. At 1 year, 30.7% (113/368) reported respiratory symptoms, 19.3% (59/305) and 14.1% (43/305) of patients had experienced declines in FEV1 or FVC of ≥100 mL, 16.3% (62/380) had reported ≥1 acute respiratory event and 12.2% (45/368) had symptoms affecting their ability to work.Conclusions PTLD is a common and under-recognised consequence of pTB that is disabling for patients and associated with adverse outcomes beyond pTB treatment completion. Increased efforts to prevent PTLD and guidelines for management of established disease are urgently needed. Low-cost clinical interventions to improve patient outcomes must be evaluated.