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CLINICAL STANDARDS FOR THE ASSESSMENT, MANAGEMENT AND REHABILITATION OF POST-TB LUNG DISEASE
Doença pulmonar pós-TB
Sequelas
Reabilitação pulmonar
Padrões clínicos
Author
Migliori, G. B.
Marx, F. M.
Ambrosino, N.
Zampogna, E.
Schaaf, H. S.
van der Zalm, M. M.
Allwood, B.
Byrne, A. L.
Mortimer, K.
Wallis, R. S.
Fox, G. J.
Leung, C. C.
Chakaya, J. M.
Seaworth, B.
Rachow, A.
Marais, B. J.
Furin, J.
Akkerman, O. W.
Al Yaquobi, F.
Amaral, A. F. S.
Borisov, S.
Caminero, J. A.
Carvalo, A. C. C.
Chesov, D.
Codecasa, L. R.
Teixeira, R. C.
Dalcomo, M. P.
Datta, S.
Dinh-Xuan, A. T.
Duarte, R.
Evans, C. A.
García_García, J. M.
Günther, G.
Hoddinott, G.
Huddart, S.
Ivanova, O.
Laniado-Laborín, R.
Manga, S.
Manika, K.
Mariandyshev, A.
Mello, F. C. Q.
Mpagama, S. G.
Muñoz-Torrico, M.
Nahid, P.
Ong, C. W. M.
Palmero, D. J.
Piubello, A.
Pontali, E.
Silva, D. R.
Singla, R.
Spanevello, A.
Tiberi, S.
Udwadia, Z. F.
Vitacca, M.
Centis, R.
D´Ambrosio, L.
Sotgiu, G.
Lange, C.
Visca, D.
Marx, F. M.
Ambrosino, N.
Zampogna, E.
Schaaf, H. S.
van der Zalm, M. M.
Allwood, B.
Byrne, A. L.
Mortimer, K.
Wallis, R. S.
Fox, G. J.
Leung, C. C.
Chakaya, J. M.
Seaworth, B.
Rachow, A.
Marais, B. J.
Furin, J.
Akkerman, O. W.
Al Yaquobi, F.
Amaral, A. F. S.
Borisov, S.
Caminero, J. A.
Carvalo, A. C. C.
Chesov, D.
Codecasa, L. R.
Teixeira, R. C.
Dalcomo, M. P.
Datta, S.
Dinh-Xuan, A. T.
Duarte, R.
Evans, C. A.
García_García, J. M.
Günther, G.
Hoddinott, G.
Huddart, S.
Ivanova, O.
Laniado-Laborín, R.
Manga, S.
Manika, K.
Mariandyshev, A.
Mello, F. C. Q.
Mpagama, S. G.
Muñoz-Torrico, M.
Nahid, P.
Ong, C. W. M.
Palmero, D. J.
Piubello, A.
Pontali, E.
Silva, D. R.
Singla, R.
Spanevello, A.
Tiberi, S.
Udwadia, Z. F.
Vitacca, M.
Centis, R.
D´Ambrosio, L.
Sotgiu, G.
Lange, C.
Visca, D.
Affilliation
Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici ScientificiMaugeri IRCCS. Tradate, Italy.
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town / DSINRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University. Stellenbosch, South Africa.
Division of Pulmonary Rehabilitation, Istituti Clinici ScientificiMaugeri IRCCS. Montescano (PV).
Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
Division of Pulmonology, Department of Medicine, Stellenbosch University &Tygerberg Hospital, South Africa.
Heart Lung Clinic St Vincent’s Hospital and Clinical School, University ofNewSouthWales. Sydney, NSW, Australia / Partners In Health (Socios En Salud Sucursal). Lima, Peru.
Liverpool School of TropicalMedicine. Liverpool, UK.
Aurum Institute, Johannesburg. South Africa.
Faculty ofMedicine and Health, The University of Sydney. Sydney, NSW. Australia.
Hong Kong Tuberculosis, Chest and Heart Diseases Association. Hong Kong.
Department ofMedicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University. Nairobi, Kenya / Department of Clinical Sciences, Liverpool School of TropicalMedicine. Liverpool, UK.
Heartland National TB Center of Excellence. San Antonio, TX, USA / University of Texas Health Science Center, Tyler. TX, USA.
Division of Infectious Diseases and Tropical Medicine,Medical Centre of the University of Munich (LMU),Munich. Germany / GermanCenter for Infection Research (DZIF). Partner SiteMunich. Germany.
The Children’s Hospital at Westmead and the University of Sydney . WHO Collaborating Center in Tuberculosis, University of Sydney, Sydney, NSW, Australia.
Harvard Medical School, Department of Global Health and Social Medicine. Boston, MA, USA.
University ofGroningen, University Medical Center Groningen. Department of Pulmonary diseases and Tuberculosis. Groningen / University of Groningen, University Medical Center Groningen, TB center Beatrixoord, Groningen, the Netherlands.
TB and Acute Respiratory Diseases Section, Department of Communicable Diseases, Directorate General of Disease Surveillance and Control. Ministry of Health, Oman.
National Heart and Lung Institute, Imperial College London. London, UK.
Moscow Research and Clinical Center for Tuberculosis Control, Moscow Health Department. Moscow, Russian Federation.
Mycobacterial Unit, Pneumology Department. University General Hospital of Gran Canaria ‘‘Dr. Negrin’’. Las Palmas, Gran Canaria / ALOSATB Academy, Spain.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Inovacõed em Terapias, Ensino e Bioproduto. Rio de Janeiro, RJ, Brasil.
Department of Pneumology andAllergology, NicolaeTestemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova / Division of Clinical Infectious Diseases, Research Center Borstel. Borstel, Germany..
TB ReferenceCentre,VillaMarelli Institute, Niguarda Hospital. Milan, Italy.
National Institute of Respiratory Diseases and the Environment (INERAM). Asunción, Paraguay / Radboud University Medical Center, TB Expert Center Dekkerswald, Department of Respiratory Diseases, Nijmegen - Groesbeek, The Netherlands.
Fundação Oswaldo Cruz. Ministério da Saúde. Centro de Referência Helio Fraga. Rio de Janeiro, RJ, Brasil.
Department of clinical sciences, Liverpool School of Tropical Medicine, Liverpool, UK / Innovation For Health And Development (IFHAD) Laboratory for Research and Development. Universidad Peruana Cayetano Heredia, Lima, Peru / Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru.
Université de Paris, APHP Centre, Lung Function Unit, Department of Respiratory Diseases, Cochin Hospital, Paris, France.
Institute of Public Health, Porto University; Medical School, Porto University. Hospital Centre of Vila Nova de Gaia/ Espinho, Porto, Portugal.
Innovation For Health And Development (IFHAD) Laboratory for Research and Development. Universidad Peruana Cayetano Heredia, Lima, Peru / Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru / Department of Infectious Diseases, Imperial College London, London, UK.
Tuberculosis Research Programme SEPAR. Barcelona, Spain.
Department of Pulmonology. Inselspital Bern. University of Bern, Switzerland.
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty ofMedicine and Health Sciences, Stellenbosch University, Cape Town.
UCSF Center for Tuberculosis,University o fCalifornia San Francisco. San Francisco, CA, USA / UCSF Division of Pulmonary and Critical CareMedicine. Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
Division of Infectious Diseases and TropicalMedicine,Medical Centre of the University of Munich (LMU),Munich, Germany / German Center for InfectionResearch (DZIF), Partner Site Munich, Germany.;
Clínica de Tuberculosis, Hospital General Tijuana, Universidad Autónoma De Baja California, Mexico.
Medecins Sans Frontieres (MSF). Operational Center, Paris, France.
Pulmonary Department, Aristotle University of Thessaloniki. ‘‘G. Papanikolaou’’ Hospital., Thessaloniki, Greece.
Northern StateMedical University, Northern Arctic Federal University, Arkhangelsk,. Russian Federation.
Universidade Federal do Rio de Janeiro. Instituto de Doenças Toráxicas. Rio de Janeiro, RJ, Brasil.
Kibongóto Infectious Diseases Hospital, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro, Tanzania.
Tuberculosis Clinic, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
UCSF Center for Tuberculosis,University o fCalifornia San Francisco. San Francisco, CA, USA / UCSF Division of Pulmonary and Critical CareMedicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA;
Infectious Disease Translational Research Programme, Department ofMedicine, National University of Singapore, Yong Loo Lin School ofMedicine, Singapore / National University of Singapore Institute for Health Innovation&Technology (iHealthtech), Singapore.
Pulmonology Division, MunicipalHospital F.J.Muñiz and Instituto Vaccarezza. Buenos Aires, Argentina.
Damien Foundation, Brussels. Belgium.
Department of Infectious Diseases, Galliera Hospital. Genoa, Italy.
Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Porto Alegre, RS, Brasil.
Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy / Department ofMedicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy.
Department of Infection, Royal London Hospital, Barts Health NHS Trust, London / Blizard Institute, QueenMary University of London, London,
Department of Respiratory Medicine, Hinduja Hospital&Research Center, Mumbai, India.
Respiratory Unit, Istituti Clinici ScientificiMaugeri IRCCS. Lumezzane (BS), Italy.
Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici ScientificiMaugeri IRCCS. Tradate, Italy.
Public Health Consulting Group, Lugano, Switzerland.
Clinical Epidemiology andMedical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
Division ofClinical Infectious Diseases, Research Center Borstel, Borstel / German Center for Infection Research (DZIF), Clinical standards for post-TB lung disease 809 Clinical Tuberculosis Unit, Borstel / Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany..
Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy / Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy.
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town / DSINRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University. Stellenbosch, South Africa.
Division of Pulmonary Rehabilitation, Istituti Clinici ScientificiMaugeri IRCCS. Montescano (PV).
Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
Division of Pulmonology, Department of Medicine, Stellenbosch University &Tygerberg Hospital, South Africa.
Heart Lung Clinic St Vincent’s Hospital and Clinical School, University ofNewSouthWales. Sydney, NSW, Australia / Partners In Health (Socios En Salud Sucursal). Lima, Peru.
Liverpool School of TropicalMedicine. Liverpool, UK.
Aurum Institute, Johannesburg. South Africa.
Faculty ofMedicine and Health, The University of Sydney. Sydney, NSW. Australia.
Hong Kong Tuberculosis, Chest and Heart Diseases Association. Hong Kong.
Department ofMedicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University. Nairobi, Kenya / Department of Clinical Sciences, Liverpool School of TropicalMedicine. Liverpool, UK.
Heartland National TB Center of Excellence. San Antonio, TX, USA / University of Texas Health Science Center, Tyler. TX, USA.
Division of Infectious Diseases and Tropical Medicine,Medical Centre of the University of Munich (LMU),Munich. Germany / GermanCenter for Infection Research (DZIF). Partner SiteMunich. Germany.
The Children’s Hospital at Westmead and the University of Sydney . WHO Collaborating Center in Tuberculosis, University of Sydney, Sydney, NSW, Australia.
Harvard Medical School, Department of Global Health and Social Medicine. Boston, MA, USA.
University ofGroningen, University Medical Center Groningen. Department of Pulmonary diseases and Tuberculosis. Groningen / University of Groningen, University Medical Center Groningen, TB center Beatrixoord, Groningen, the Netherlands.
TB and Acute Respiratory Diseases Section, Department of Communicable Diseases, Directorate General of Disease Surveillance and Control. Ministry of Health, Oman.
National Heart and Lung Institute, Imperial College London. London, UK.
Moscow Research and Clinical Center for Tuberculosis Control, Moscow Health Department. Moscow, Russian Federation.
Mycobacterial Unit, Pneumology Department. University General Hospital of Gran Canaria ‘‘Dr. Negrin’’. Las Palmas, Gran Canaria / ALOSATB Academy, Spain.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Inovacõed em Terapias, Ensino e Bioproduto. Rio de Janeiro, RJ, Brasil.
Department of Pneumology andAllergology, NicolaeTestemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova / Division of Clinical Infectious Diseases, Research Center Borstel. Borstel, Germany..
TB ReferenceCentre,VillaMarelli Institute, Niguarda Hospital. Milan, Italy.
National Institute of Respiratory Diseases and the Environment (INERAM). Asunción, Paraguay / Radboud University Medical Center, TB Expert Center Dekkerswald, Department of Respiratory Diseases, Nijmegen - Groesbeek, The Netherlands.
Fundação Oswaldo Cruz. Ministério da Saúde. Centro de Referência Helio Fraga. Rio de Janeiro, RJ, Brasil.
Department of clinical sciences, Liverpool School of Tropical Medicine, Liverpool, UK / Innovation For Health And Development (IFHAD) Laboratory for Research and Development. Universidad Peruana Cayetano Heredia, Lima, Peru / Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru.
Université de Paris, APHP Centre, Lung Function Unit, Department of Respiratory Diseases, Cochin Hospital, Paris, France.
Institute of Public Health, Porto University; Medical School, Porto University. Hospital Centre of Vila Nova de Gaia/ Espinho, Porto, Portugal.
Innovation For Health And Development (IFHAD) Laboratory for Research and Development. Universidad Peruana Cayetano Heredia, Lima, Peru / Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru / Department of Infectious Diseases, Imperial College London, London, UK.
Tuberculosis Research Programme SEPAR. Barcelona, Spain.
Department of Pulmonology. Inselspital Bern. University of Bern, Switzerland.
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty ofMedicine and Health Sciences, Stellenbosch University, Cape Town.
UCSF Center for Tuberculosis,University o fCalifornia San Francisco. San Francisco, CA, USA / UCSF Division of Pulmonary and Critical CareMedicine. Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
Division of Infectious Diseases and TropicalMedicine,Medical Centre of the University of Munich (LMU),Munich, Germany / German Center for InfectionResearch (DZIF), Partner Site Munich, Germany.;
Clínica de Tuberculosis, Hospital General Tijuana, Universidad Autónoma De Baja California, Mexico.
Medecins Sans Frontieres (MSF). Operational Center, Paris, France.
Pulmonary Department, Aristotle University of Thessaloniki. ‘‘G. Papanikolaou’’ Hospital., Thessaloniki, Greece.
Northern StateMedical University, Northern Arctic Federal University, Arkhangelsk,. Russian Federation.
Universidade Federal do Rio de Janeiro. Instituto de Doenças Toráxicas. Rio de Janeiro, RJ, Brasil.
Kibongóto Infectious Diseases Hospital, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro, Tanzania.
Tuberculosis Clinic, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
UCSF Center for Tuberculosis,University o fCalifornia San Francisco. San Francisco, CA, USA / UCSF Division of Pulmonary and Critical CareMedicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA;
Infectious Disease Translational Research Programme, Department ofMedicine, National University of Singapore, Yong Loo Lin School ofMedicine, Singapore / National University of Singapore Institute for Health Innovation&Technology (iHealthtech), Singapore.
Pulmonology Division, MunicipalHospital F.J.Muñiz and Instituto Vaccarezza. Buenos Aires, Argentina.
Damien Foundation, Brussels. Belgium.
Department of Infectious Diseases, Galliera Hospital. Genoa, Italy.
Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Porto Alegre, RS, Brasil.
Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy / Department ofMedicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy.
Department of Infection, Royal London Hospital, Barts Health NHS Trust, London / Blizard Institute, QueenMary University of London, London,
Department of Respiratory Medicine, Hinduja Hospital&Research Center, Mumbai, India.
Respiratory Unit, Istituti Clinici ScientificiMaugeri IRCCS. Lumezzane (BS), Italy.
Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici ScientificiMaugeri IRCCS. Tradate, Italy.
Public Health Consulting Group, Lugano, Switzerland.
Clinical Epidemiology andMedical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
Division ofClinical Infectious Diseases, Research Center Borstel, Borstel / German Center for Infection Research (DZIF), Clinical standards for post-TB lung disease 809 Clinical Tuberculosis Unit, Borstel / Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany..
Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy / Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy.
Abstract
BACKGROUND: Increasing evidence suggests that post-
TB lung disease (PTLD) causes significant morbidity and
mortality. The aim of these clinical standards is to provide
guidance on the assessment andmanagement of PTLDand
the implementation of pulmonary rehabilitation (PR).
METHODS : A panel of global experts in the field of TB
care and PR was identified; 62 participated in a Delphi
process. A 5-point Likert scale was used to score the
initial ideas for standards and after several rounds of
revision the document was approved (with 100%
agreement).
RESULT S : Five clinical standards were defined: Standard
1, to assess patients at the end of TB treatment for PTLD
(with adaptation for children and specific settings/situations);
Standard 2, to identify patients with PTLD for PR;
Standard 3, tailoring the PR programme to patient needs
and the local setting; Standard 4, to evaluate the
effectiveness of PR; and Standard 5, to conduct education
and counselling. Standard 6 addresses public health aspects
of PTLD and outcomes due to PR.
CONCLUS ION: This is the first consensus-based set of
Clinical Standards for PTLD. Our aim is to improve
patient care and quality of life by guiding clinicians,
programme managers and public health officers in
planning and implementing adequate measures to assess
and manage PTLD.
Keywords in Portuguese
TuberculoseDoença pulmonar pós-TB
Sequelas
Reabilitação pulmonar
Padrões clínicos
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