The effect of therapeutic pleural drainage on the short- and long-term sequelae of tuberculous pleural effusions

Background. Tuberculosis (TB) remains a common cause of pleural exudates in many parts of the globe. Pleural fibrosis with restriction is a well-known complication of tuberculous pleuritis. Current evidence suggests that pleural drainage offers little benefit over and above anti-TB treatment in improving pulmonary function. Methods. We enrolled 20 patients with proven tuberculous pleural effusions (mean age 32.7 years, 10 males, 12 HIV-positive), and performed therapeutic pleural drainage in 10 randomly selected cases. Pulmonary function testing (PFT), chest radiography and transthoracic ultrasound were performed on all patients before treatment and at 7 - 10 days, 3 months and 6 months. Results. Complete therapeutic drainage was achieved in only 4 of the 10 patients randomised to undergo drainage. No significant immediate benefit was achieved in the 10 patients assigned to intervention. However, compared with the non-intervention group, the intervention group showed significant changes in several functional parameters at 6 months, including changes in forced vital capacity from baseline (1.40 L v. 0.65 L; p <0.001), forced expiratory volume in 1 second (1.37 L v. 0.60 L; p =0.002), total lung capacity (1.76 L v. 0.88 L; p =0.034) and diffusion capacity for carbon monoxide (7.42 v. 2.19 mL/min/mmHg, p =0.013). No difference was observed in the change in 6-minute walking distance (113.4 m v. 126 m; p =0.798) compared with the control group at 6 months. Conclusions. Therapeutic drainage may offer additional medium- and long-term functional benefits to patients with pleural TB, in addition to anti-TB drug therapy alone, as evident in the improvement in PFT results.