Pulmonary Tuberculosis; A Dominant Etiology of Pulmonary Hypertension in Endemic Areas

Background: Many patients with chronic lung disorders like infections, COPD, ILD, OSA & Thrombo-embolism, present with dyspnea, not showing adequate improvement by conventional treatment. Most of these were diagnosed as pulmonary hypertension by further multidisciplinary work-up. Such patients show reduced life expectancy due to late diagnosis and insufficient treatment. Many TB patients often remain undiagnosed in this context. The understanding of etiology and risk factors is essential for a high index of suspicion. Objective: To explore the etiology of Pulmonary Hypertension in chronic respiratory patients. Study Design: A Retrospective Observational Study. Settings: Male pulmonology ward, Gulab Devi Chest Hospital, Lahore Pakistan. Duration: 37 months from January 2014 to February 2017. Methodology: 231, consecutive cases, having Age >14 years with clinical and radiological suspicion of pulmonary hypertension were included. Patients having Age >90 years and <14years, not willing for further investigations were excluded. Detailed history, physical examination, radiological, hematological, bacteriological biochemical and immunologic findings were recorded. PH was diagnosed by ECG, Echocardiography, CT-Angiography. HRCT thorax & PFTs, were employed to recognize the underlying lung disorders. Risk factors were identified. Data tabulated, analyzed statistically and conclusions were drawn. Results: 69/231 (29.87%) cases with active and 76/231(32.90%) with old-treated TB, 50(21.64%) COPD, 10(4.32%) pneumonia, 5(2.16%) CLD, six bronchiectasis and three cases of chest deformities were diagnosed PH. Cigarette smoking, DM and obesity were major risk factors. Conclusion: Pulmonary Tuberculosis can be the dominant etiology of PH in high prevalence populations.