Investigating Lung Damage in Adolescents with Tuberculosis

Editor's note: This article was originally published in Spanish on Socios En Salud's website.

Each year, more than one million adolescents worldwide contract tuberculosis (TB)-the world's deadliest infectious disease.

Fortunately, TB is fully treatable and preventable, and most adolescents do receive and complete treatment. But unfortunately, that doesn't always mean they make a full recovery.

Between 57% and 67% of TB survivors experience some degree of chronic lung damage, according to various studies. These are young people with decades of life ahead of them who could be living with reduced lung function without knowing it, simply because it wasn't assessed in time.

Until now, the main problem has been that no validated tools to measure this harm in adolescents have existed. The available tools were all designed for adults with chronic illnesses.

To address this massive gap in care, Socios En Salud (SES), as Partners In Health is known in Peru, participated in a study that would create tools specifically for younger patients.

TB Doesn't End When Treatment Does

When a teenager is discharged from the hospital after treatment for TB, they are considered cured of the disease by clinical staff. However, this does not always mean their lungs have fully recovered. Post-tuberculosis lung disease encompasses respiratory complications that can persist long after successful treatment.

"Pulmonary tuberculosis, even when successfully treated, is associated with worse lung health in adolescence," said Dr. Silvia Chang, a pediatric infectious disease specialist at Hasbro Children's Hospital and Brown University.

Kioshi Vasquez (middle) visits SES at the Carabayllo Health Center for his TB care. Photo by Diego Diaz Catire / PIH

The adolescent population is particularly vulnerable because during this stage of life, the lungs are still developing. TB can disrupt this process, leaving permanent scarring and altering how air enters and exits the lungs.

In SES's study, evaluating 101 adolescents who had overcome pulmonary TB in Lima between March 2022 and September 2023, chest CT scans widely showed damage and complications such as structural distortion and bronchiectasis-irreversible expansion of the airways.

Unlike adults, adolescents typically have fewer comorbidities and less exposure to lung irritants, making the damage caused by TB particularly obvious and less attributable to other causes. Even so, they are one of the least studied groups in this field.

The result is worrying: every year, thousands of young people treated for TB are discharged without any follow-up on their lung function. Hospital discharge should not mark the end of care, but rather the beginning of a new phase of attention.

A Global Reach

To begin to give this patient population the attention they deserved, an international team, led by Dr. Chang, developed a research study, with SES leading the field activities, including recruitment, coordination with the Peruvian Ministry of Health (MINSA) facilities, and application of assessments.

Each of the 101 study participants was compared to a healthy adolescent of the same sex, age, and environment. Both groups had similar characteristics in height, weight, respiratory history, and exposure to irritants, which allowed the observed differences to be attributed to a participant's experience with TB.

Three types of assessment were used. First, researchers utilized an adapted version of the St. George's Respiratory Questionnaire (SGRQ), which measures symptoms, physical limitations, and impact on daily life. Second, the team considered spirometry, which assesses the amount of air a person can exhale with effort. Third, lung function was tested through oscillometry, a technique that analyzes respiratory function using sound waves while a person breathes normally.

"Assessing lung function and symptoms after treatment is just as important in adolescents as it is in adults," Dr. Chang said.

Without the on-the-ground work of SES, this type of research-connecting scientific evidence to communities that need it most-would not be possible.

Jajaira (left) receives a home visit from the SES team to evaluate lung function. Photo by Melquiades Huauya / PIH

Results and Next Steps

The results were clear in several aspects. The oscillometry assessment proved easier to perform, with all participants able to complete the function test. For the spirometry assessment, only 91.1% of participants were able to perform the test, which requires several strong exhales and can be difficult for adolescents with lung impairment.

Furthermore, the oscillometry test also showed greater consistency in its measurements. This does not replace spirometry but rather reinforces the idea that both techniques complement each other and can allow for a more comprehensive evaluation.

The questionnaire was also adjusted. The original version of the SGRQ, designed for adults, included questions that were not very relevant for adolescents. The team reduced it to 18 items and demonstrated that it maintains its validity, while also being easier to administer in the field.

The conclusion is straightforward: combining the abbreviated SGRQ, spirometry, and oscillometry allows for a comprehensive assessment of lung health in adolescents who have had TB.

Each tool contributes a different piece of the picture.

This study not only confirms the need for closer attention on this particular group but also identifies appropriate tools for contexts like Peru, where the TB burden is high and resources are limited.

However, the completion of this assessment doesn't conclude the effort to support these adolescents. As Dr. Chang explains, "More research is needed to understand how TB leads to long-term lung damage and to identify potential interventions."

Further research hopes to address new questions that emerged during this initial study: Why do some adolescents develop more long-term effects than others? Is there a key moment to intervene? What kind of follow-up should be routinely integrated after discharge?

These questions will shape the study's next stage. And, as before, SES will continue working on the ground, bringing research and innovation to those who need it most.

Learn More

PIH is also advancing TB care for people in Peru-and around the world-through a groundbreaking project called arcTB.

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