A Case Report On Post Tuberculosis Chronic Obstructive Pulmonary Disease with Acute Exacerbation of COPD with Atrial Fibrillation (Rate Controlled) With Aspergilloma

Tejas Falke^1*, Jaya Khandar² and Madhuri Shambharkar²

^*Correspondence: Tejas Falke, Department of Nursing, Datta Meghe Institute of Higher Education and Research (Deemed To Be University), India, Email:

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Introduction

COPD is a prevalent yet often ignored illness that has been continuously rising over the past 50 years, affecting more than 400 million individuals worldwide and currently ranking third in terms of cause of death, after stroke and cardiovascular disease. According to predictions by the World Economic Forum, annually global expenditures of COPD will exceed those of heart diseases by 2030, coming in at US$50 trillion. It is anticipated that the number of smokers will rise over the 30 years to come because of the rise in cigarettes among nations that are developing and the rise in lifespans in wealthy countries. This implies that until 2030, probably will be higher annual deaths above 4.5 million. Since the majority of these studies involve cigarette smoking patients and as COPD has become more prevalent in non-smokers, that is a sub-registry for these assessments. This has been linked to the use of the biomass and additional fuels as well as pollutants in the environment [1].

When Tuberculosis occurs along with COPD brought on by cigarette smoking, the result is a substantially dropped forceful vital capacity (FVC) & post-bronchodilator respiration volume in 1 second (FEV1), neither of which shows weakened breathing capacity. Additionally, tuberculosis- induced COPD itself exhibits a significantly decreased post-bronchodilator responsiveness than smoke-induced COPD, indicating that the airway obstruction is persistently blocked. Males are more likely than females to develop COPD as a result of TB, exhibiting adjusted likelihood ratios of 4.0 and 1.7, correspondingly. Extreme forms of COPD have a substantial connection with the presence of past TB. A record of TB increases the likelihood of having obstruction of airflow in later years with a modified probability ratio of 2.5, based to findings from the Epidemiology of Obstructed Lungs Disease (BOLD) research. The total number of TB episodes correlates significantly with the extent and frequency of obstruction of air flow in tuberculosis of the lungs [2].

The majority of CPA’s clinical manifestations is not specific and is gradually developing. Loss of weight, fatigue breathing difficulties hemoptysis, and an ongoing cough that is productive are typical signs. When there's no associated CCA/CFA, a simple aspergilloma often appears with minimal or no manifestations [3].

Previous tuberculosis of the pulmonary tract (TB) is linked to a decrease of lung function and has the potential to adversely affect the structure of the lungs. Still unknown, though, is the connection between airflow obstruction-the defining aspect of Chronic Pulmonary Obstructive Disease (COPD)-and respiratory deterioration resulting from TB [4].

Especially in developing and poor countries, TB is the most frequent transmissible illness that kills people worldwide. The respiratory tract is where tuberculosis (TB) is most commonly active, yet it can damage any organ or tissue. When treatment is not received, tuberculosis (TB) is associated with a 50% five-year risk of death and chronic inflammation. Even with the great effectiveness of standard anti-TB medication-which has a rapid recovery of symptoms and a low relapse rate-non-adherence remains a significant obstacle to effective treatment. Following treatment, changes in pulmonary function affect approximately one third of people with pulmonary tuberculosis (TB), with obstructed defect being the most common abnormality [5].

Case Presentation

On the 5th September 2023, A 69 year old male patient basically belonged to the kherda he was brought to AVBRH (medicine) HDU with the following symptoms: Dribbling while micturition since from 4 days, Increased the force of micturition, Chest Pain since from 1 month, cough since from 5 days, Fever since from 10 days, Irregular heart rhythm, hypertension and constipation. He is 58 kg weight and height is 173cm & His BMI approximately (19.4 kg/m). After providing the primary preventive measures to the patient he was immediately shifted to the high dependency unit due to his critical condition.

In the Physical Examination There are only least number of abnormalities were found in the Head to toe examination such as in respiratory system it shows that Air entry bilaterally reduced bilateral crepts and wheeze present, In cardiovascular system Tachycardia with irregularly irregular rhythm, Abnormal bowel movement present, facial expression dull for the known case of hypertension TAB AMLO 5mg OD has running. Through it is found that patient have a post TB COPD with acute exacerbation of COPD with atrial fibrillation (rate controlled) with aspergilloma. His multiple investigations were done like Chest X-ray was done suggestive of areas of patchy fibrosis present bilaterally with emphysematous lung fields, HRCT scan of thorax was done on 12/9/23 suggestive of cavitary lesion in right lung, ECG was done suggestive of atrial fibrillation, USG abdomen pelvis was done suggestive of no obvious abnormality. 2D ECHO was done on 8/9/23 suggestive of mild degenerative valves, mild PAH ,IVC normal, No clot, No vegetation’s, No IE, mild pericardial effusion ,mild pleural effusion, No RWMA, LVEF- 50%, grade 1 diastolic dysfunction. HRCT thorax was done on 12/9/23 suggestive of cavitary lesion in right lung. Pulmonologist opinion was taken I/V/O further management, advised Bronchoscopy, sputum for AFB, CBNAAT. Upper gastrointestinal Endoscopy was done on13/9/23 suggestive of Antral Ulcer (FOREST CLASS III), Diffuse Pangastritis RUT positive.

Gastrologist Opinion was taken I/V/O Endoscopy findings, Advised (TAB SOMPRAZ HP KIT 3-0-3 for 14 days). ENT Opinion was taken in view of hearing loss, advised (TAB NEUROBION FORTE OD), Hearing Aid trial. Regular Chest Physiotherapy was done. Pure tone Audiometry was done on 21/9/23 suggestive of severe mixed hearing loss in both the ears. Patient general condition was moderate and he was kept under the observation with all the necessary special care given to the patient and the prognosis of the patient was moderate he was under the observation of the healthcare members.

Discussion

On the 5th September 2023 , A 69 year old male patient brought to AVBR Hospital among the (medicine) HDU with the following symptoms: Dribbling while micturition since from 4 days, Increased the force of micturition, Chest Pain since from 1 month, cough since from 5 days, Fever since from 10 days, Irregular heart rhythm, hypertension and constipation. Chest X-ray was done suggestive of areas of patchy fibrosis present bilaterally with emphysematous lung fields, HRCT scan of thorax was done on 12/9/23 suggestive of cavitatory lesion in right lung, ECG was done suggestive of atrial fibrillation it is determined that the patient has a post TB COPD with acute exacerbation of COPD with atrial fibrillation (rate controlled) with aspergilloma. Therefore patient was previously diagnosed with tuberculosis 10-12 years back and has undergone tuberculosis treatment at Kasturba Gandhi Hospital Sewagram Wardha; however also having history of benign prostetic hyperplasia 12 years back and TURP 12 years back now the several complications occurred which is associated to the health so he was admitted in the hospital [6].

According to the overall study, an obstructive ventilator defect was present in 55.3% of treated pulmonary tuberculosis patients who presented with dyspnea. Prior research has also demonstrated that treated pulmonary tuberculosis was associated with a higher prevalence of an obstructive pattern of lung functional impairment. The PLATINO research, a recent big study, discovered that FEV1 is typically lower than FVC.

On the other hand, a prior study had discovered that there was a greater annual drop in FVC compared to FEV1 after following 40 individuals for 15 years. There is evidence of an inverse relationship between FEV1 and the original chest radiograph's disease severity in patients with treated pulmonary tuberculosis [7].

A person with tuberculosis has an increased risk of developing chronic obstructive pulmonary disease, especially in the elderly. Even if other conditions including HIV/AIDS, diabetes, cancer, etc. increase the likelihood of developing tuberculosis, the exact link between chronic obstructive pulmonary disease and tuberculosis and death has not yet been established [8].

In contrast to the situation with prior tuberculosis, the correlation between smoking cigarettes and COPD is well-established. Six Based on the sample available for our investigation, we were unable to assess the risk of COPD development among nonsmoking patients with TB history because there was no statistically significant difference in smoking between the TB history positive and negative groups (P=0.28). A history of tuberculosis (TB) may produce airway obstruction in nonsmokers, according to some previously published studies. However, the limited number of studies and sparse supporting data make it unclear whether a TB history is a risk factor for COPD apart from smoking. An increased frequency of exacerbations is linked to decreased survival, a quicker decline in FEV1, loss in health status, and worsened COPD. Based on the GOLD categorization, a study found that the average annual number of exacerbations for mild COPD was 0.8, for moderate COPD it was 1.2, for severe COPD it was 1.6, and for very severe COPD it was ~2.1.9. In a different study, it was found that following COPD exacerbations, the BODE index worsened by 0.8 and 1.1 points, respectively, after one and two years of follow- up. Nonetheless, amongst those who weren't showing an aggravation, there was no discernible shift in the BODE index. Exacerbations have a substantial impact on survival, as evidenced by the worsening of the BODE index in COPD patients upon arrival. The average number of hospitalizations for COPD exacerbations among the participants in our study was 2.46 for those with a history of tuberculosis and 1.56 for those without (P<0.001). It was also shown. That the proportion of patients who had ever been hospitalized.

Within a year of discharge was significantly higher in the group with prior tuberculosis (75.3% vs. 62.8%; P=0.02). Interestingly, despite their younger age, patients with a history of tuberculosis had a significantly greater mean number of hospitalizations per year and a larger percentage of ever-hospitalized patients due to COPD exacerbations. This holds particular significance since it can change the patient's classification from A to C or B to D based on the GOLD combined assessment of COPD, potentially leading to an increase in mortality.

Individuals who have been diagnosed with COPD may need to modify their way of living. Quitting smoking is the most significant lifestyle adjustment a patient can make. Those with mild to moderate COPD should take particular note of this. It can alleviate some COPD symptoms while delaying others. Other lifestyle adjustments could be clearing out lung irritants from the house and office and learning energy-saving techniques for regular tasks. For patient with post TB -COPD, maintaining a healthy diet is especially crucial because their everyday activities frequently need more energy than usual. The patient consumes more energy at rest since breathing becomes more difficult for them when they have COPD. An individual with a chronic illness like COPD will start to lose weight if they don't eat enough food to counteract this energy use.

Prescription drugs may be used to increase airflow, lessen lung inflammation and spasms, and thin or minimize mucus and fluid accumulation. Treating infections with antibiotics may be beneficial if they are linked to COPD. Maintaining up-to-date vaccinations against pneumonia and the flu can lower the risk of infection, which can exacerbate COPD symptoms. Occupational therapy or physical therapy can be used to assist control COPD symptoms. If there is not enough oxygen in the blood, oxygen treatment may be utilized. Breathlessness may be alleviated and the patient's range of motion may be increased with this therapy. Pulmonary rehabilitation, which gives patients information and counseling to help them manage the illness, is often recommended by doctors.

Surgery could be a therapeutic choice for certain people. For patients who aren't responding to medicine and are under 65, a lung transplant or lung volume reduction surgery may be the best course of action.

The Chronic Obstructive Pulmonary Disease Program's multidisciplinary team can decide which course of action is best for each patient [9].

Conclusion

There is an immediate need for more study on the pathophysiology and discovery of biomarkers for PTLD due to the disease's significant global impact. Prediction models are required to identify patients who are likely to show a fast deterioration in lung function and who are at high risk of developing severe PTLD early in the course of the disease. Above all, in order to enhance long-term results and lower premature mortality, we want data on strategies for PTLD treatment and prevention as well as pulmonary rehabilitation.

Additional Information

Disclosures

All participants in this study provided informed consent or waived it. Conflicts of interest: All authors hereby disclose the following in accordance with the ICMJE standard disclosure form.

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All authors have affirmed that the submitted
work was not funded by any outside sources.

Financial relationships

All writers have stated that they do not now or over the last three years have any financial ties to any organizations that would be interested in the work they have submitted.

Other relationships

All authors have stated that they have no other affiliations or activities that may be seen as having impacted the work that has been submitted.

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