Tuberculosis is a disease of concern for the mankind since the time immemorial. Despite many significant developments in science the disease remained to be a challenge for the medical fraternity.  It is one of the major causes of mortality and morbidity worldwide. The world health Organization declared Tuberculosis as a global epidemic in the year 1993. [1] There is significant socio-economic impacts of the disease globally, due to its rising burden, particularly in most of the Asian countries, Eastern Europe and Africa where the disease is still endemic. [2,3] In many regions of the world where tuberculosis is common, tubercular pleural effusion maintains its position as leading inflammatory pleural disease. [4] Even after more than a century of discovery of the causative organism of the disease, we are still not in a position to completely control the epidemic. In 2015, an estimated 10.4 million people developed Tuberculosis of these 580,000 drug resistant and 1.8 million died from the disease. [5]

It is now ranked as the second human killer amongst all infectious diseases globally. It was estimated that out of 2.2 million annual incidence of tuberculosis cases in India 0.87 million were infective cases. India shoulders the 1/5th of the globally TB burden, Certain aspects of the disease still remain as mystery, which yet to be unveiled. Migration of people, emergence of drug resistance and increase incidence of HIV infections worldwide are some of the important contributing factors for growing health threat of tuberculosis. [6] Pulmonary tuberculosis affects the lung parenchyma and thereby causes many structural and functional changes in the lungs. [7] These changes lead to functional disability of the patients leading to significant morbidity. The functional changes may lead to severe disability in the patients even after successful anti tubercular treatment. [8] Pulmonary tuberculosis involves lung parenchyma, pleura and at times bronchi. The pathological features consist of exudation, caseation, cavitation & fibrosis in variable degrees, the lesions are general described as pleomorphic. These lesions impair lung function depending on the extent of involvement of lung parenchyma. [9]

The functional abnormalities comprise of restriction of lung volumes decrease in lung compliance & impaired gas transfer. It may also lead to generalized airflow obstruction when there is extensive involvement of airways. Involvement of pleura along with adhesion to the diaphragm may lead to restrictive lung disease and hypoxemia. [10] Peak expiratory flow meter is a very simple test used at the bedside which works as a wonderful tool in determining the underlying obstructive elements. [11] Extensive damage to the lungs in pulmonary tuberculosis also leads to functional disturbances in the heart and cardio vascular system. [12]

In country like India still tuberculosis the most prevalent chronic respiratory disease. Patients with low socio-economic status due to inadequate literacy, insufficient awareness about government programmes take incomplete anti tubercular treatment and ultimately suffer from severely deranged pulmonary function, the present study was under taken to correlate the derangement of lung functions with respect to the destruction in the lung parenchyma as a consequence of pulmonary tuberculosis and pleural tuberculosis. [13]

This is a prospective and observational study was conducted in the Department of Pulmonary Medicine, JJM Medical college, Davangere from April 2023 to March 2024. Total 30 healthy individuals from a Medical College & hospital with informed consent were grouped as controls. A detailed case history was taken with consent from all.

Inclusion criteria: All cases of treated pulmonary tuberculosis, pleural tuberculosis, and both

Exclusion criteria: Patients treated for Extrapulmonary tuberculosis (except pleural effusion). Patients with other respiratory disorders like history of Asthma, COPD, Collagen diseases, Silicosis, Thoracic surgery etc.,

A thorough clinical examination was done to assess the underlying pathology and on its basis a clinical diagnosis was made.

Chest X-Ray was done in all cases, the readings were independently made by two umpire readers for having correct assessment of underlying lesion. The extent of lesion was graded as minimal, moderately advanced or far advanced on the basis of guidelines given by National Tuberculosis Association of U.S. Presence of cavities if any and their number were also noted in each case.

Sputum examination for Acid fast bacilli by direct microscopy was done in all cases by the Auramine Rhodamine method of staining technique at Designated microscopy centre of Medical College as per the RNTCP Guidelines. Two samples were collected. On the basis of the examination report the patients were classed as sputum positive or negative. Sputum smear was grade

In the present study 131 treated cases of Pulmonary tuberculosis were subjected to different investigations like chest X-ray, sputum for AFB, Spirometry, ECG etc, to study the underlying pulmonary derangements. Thirty Healthy volunteers were selected amongst students & faculty and other employees of the hospital for this study as control. They also underwent the investigations like chest X-ray, Spirometry, ECG.

TABLE: 1 Age distribution

The mean age of the study group was 41.44+/-16.889 The mean age of control was 41.80+/-15.07

Table 2: Gender Distribution

Table 3: Sputum status

Sputum Negative Cases: A smaller proportion (27.69%) of the individuals tested are sputum negative, indicating no detectable pathogens or conditions associated with sputum positivity.

Table 4: Treatment category

CAT-1 Dominance: A majority (66.15%) of individuals fall under the CAT-1 treatment category. This may represent a first-line treatment approach or a standard protocol for initial cases. CAT-2 Representation: About one-third (33.84%) of the individuals are in CAT-2, possibly reflecting cases requiring a secondary treatment strategy or different management due to factors such as resistance, relapse, or treatment failure.

TABLE 5: TREATMENT COMPLETION

Among 131 study group, 40 (30.53%) patients stopped treatment in less than 2 months, 35(26.7%) stopped treatment in less than 4months. And 56(42.7%) have completed 6month or 8month regimen

Table 6: Sputum Grading

Table 7: Cavitary status

Table 8: Radiological grading

A Total of one hundred and thirty one cases have been evaluated in the present study , the pulmonary functions were examined and tabulated for analysis.

Thirty healthy controls were also examined to compare the lung function of study group with normal individuals. The male: female ratio of study group was 2.3:1. In the earlier studies by S Akkara et al in India 2011-12 [14] ratio was 4:1, In a similar type of study Rajesh et al the ratio was 1.5:1. [15] The lower rates of pulmonary tuberculosis in females might be due to under reporting of disease in females because of social and cultural factors which lead to lack of access to health care. This discrepancy may also be due to sedentary habits of females in comparison of males who has higher exposure by virtue of occupational habits.

The mean age of the study group 41.44+/-16.89 most of the patients (57.3%) belong to age group 16years-45 years, this age group constitutes the active working period of an individual and pulmonary tuberculosis affects mostly in this age group, many other studies showed prevalence of disease more in this age group.

Total 72% of the patients in the study group were sputum smear for acid fast bacilli Positive and the rest were sputum smear for acid fast bacilli negative. 92 Patients were new cases started with Cat-1 regimen, remaining 39 were retreated with cat-2. Among 131 study group, 40 (30.53%) patients stopped treatment in less than 2 months, 35 (26.7%) stopped treatment in less than 4months. And 56 (42.7%) have completed 6month or 8 month regimen.

The grading of sputum report was 3+ in majority of cases out of smear positive cases probably due to delay in presentation to the hospital in majority of the cases. Chest x rays of the study group (pulmonary tuberculosis) was observed properly it was found that 46.6 % had cavitary lesions amongst them 42 individuals had multiple cavities, had 19 individuals single cavities, the lesions were also graded minimal, moderate, far advanced 39 % of study group had minimal lesions 23% had moderate lesions& remaining 38% had far advanced.

Chest x rays of the study group (pulmonary tuberculosis) was observed properly it was found that 46.6 % had cavitary lesions amongst them 42 individuals had multiple cavities, had 19 individuals single cavities, the lesions were also graded minimal, moderate, far advanced 39 % of study group had minimal lesions 23% had moderate lesions& remaining38% had far advanced.

Tuberculosis Is a highly prevalent disease in a developing country like India, and there is also more incidence of pleural tuberculosis in the developing countries compared to developed countries. The disease is associated with significant derangement of lung functions, more the severity of the disease more is the functional derangement so early detection and treatment of tuberculosis are important measures to be taken to reduce the chances of development of chronic airflow limitations. Proper treatment with correct dosing as per as the RNTCP guidelines will reduce the risk of development of sequelae of the disease    This study revealed that more advanced lesions of tuberculosis will lead to long term morbidity of the patients because of pulmonary derangements. Delayed approach for treatment with incomplete treatment with anti tubercular drugs lead to severe pulmonary derangements. So emphasis should be given for the proper management and follow up of cases according to RNTCP guidelines to prevent morbidity.

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