Tuberc Respir Dis > Volume 35(1); 1988 > Article
Tuberculosis and Respiratory Diseases 1988;35(1):13-30.
DOI:    Published online March 1, 1988.
A Prospective Study on Initial Treatment Cases of Pulmonary Tuberculosis
Chan Sae Lee, Yie Yoon Kim
Pusan City Chapter Clinic of Korean Tuberculosis Association
초치료 폐결핵환자에 관한 미래지향적 연구
이찬세, 김의윤
The authors made a prospective study on 856 initial treatment cases of pulmonary tuberculosis registered at Pusan City Chapter Clinic of Korean Tuberculosis Association during last three and half years from 1983-8-1 to 1987-1-31. The results and conclusion are as follows; 1) The proportion of initial treatment cases to total pulmonary tuberculosis cases registered at this clinic was 29.8%. This is more than double increase than the previous study made 17 years ago made by one of these authors. 2) The sex ratio of male to female was 1.7 to 1. This means a definite increase of female ratio than the previous study. However it was similar with the one of the last National Tuberculosis Prevalence Survey and thought to be due to the increased actions of female patients for treatment rather than the increased disease among female population of the society. 3) There were 52.6% of minimal cases, 38.8% of moderately advanced, 8.6% of far advanced. The minimal cases ratio showed a definite increase than the previous study but the overall pictures were much similar with the last National Survey Results and it was also thought to be due to the increased treatment seeking activities of present cases. 4) The most prevalent age group was 21-30 years old with a rate of 38.2% and the age group distribution showed a parabola type similar with the previous one. The trend of gradual increase of the morbidities to ward to old age groups seen on the last National Survey was not yet seen on this study. This was taken as a result that the old age groups were still much hindered their treatment seeking actions by various reasons. 5) The overall sputum positive rate on diagnosis of these initial treatment cases was 34.0% while 9.6% had no examinations. These were explained that the lower positiveness was due to the larger proportion of the minimal cases and the lower no examination rate was due to the more cooperativeness of present cases than previous one. 6) The duration of the diseases after the onset or discovery until the registration among sputum positive cases showed that the more extensiveness of the pulmonary lesions had the longer durations as 76.7% of minimals in contrast to only 22.0% of far advanced cases were within 3 months duration. 7) About changeability classification of the pulmonary lesions on the admission. there were 28.6% of easily changeables, 27.0% of hardly changeable, and 44.4% of intermediate groups as a whole. The proportion of easily changeables were rather smaller than the previous study. It was explained by the fact of the larger numbers of asymptomatic sputum negative minimal cases among present study. 8) The classification of the modes of disease onset showed that 74.3% were gradual onset, 18.6% were found the diseases by the chest X.rays on various occasions, 5.1 % were hemoptic, and 2.0% were with symptoms of acute pnenmonias. This and the former phenomenal differences between two studies were supposed to be due to the increased eagerness of getting the treatment by those patients among present study because of enlightend medical expenses under the national insurance policy. The proportions of onset modes of the discovering the diseases by the chest X-ray examinations remained same as ever and it was still one of important ways to bring the initial treatment cases of the pulmonary tuberculosis to the clinic. 9) About the duration of treatment at this clinic, 67.4% of the cases continued their treatment for more than 7 months, this was much improvement to compare the previous study due mainly to the benefits of the national insurance policy. Although 32.4% of the cases had only two to three visits, about half of them were discharged as inactive needed no treatment with negative sputum and unchangeable minimal lesions 10) About the treatment results of the initial treatment cases, the sputum positives with 3-6 months treatment showed that the negative conversion rates of 75.0% and the mark ed improvement of the pulmonary lesions in 25% of them. The effectiveness of these early treatment phase were similar with the previous study cases instead of marked increase of the chemotherapeutic combination regimes, namely RFP., PZ., CS. , and EMB., in addition to SM ., INH ., PAS. The group of 7-10 months treated showed the sputum negative conversion rates of 97.2 %, the failure of negative conversion 2.8%, the marked improvement of the pulmonary lesions 49 .1 %, the worse progression of the lesions 2.8%, and the final discharges with inactive states were 91.7%. The results of more than 11 months treated group were the spuntum negative conversions 87.5%, the failure of negative conversion 5.7%, the marked improvement of the lesions 31.9%, the worse progression of the the lesions 3.4%, and the final discharges with inactive status were 87.5%. As a whole the treatment results of these cases showed some improvements than the previous study cases. 11) Among the sputum negative cases on admission of this study, the sputum examinations there-after became persistently positive in 1.7% of the 7 -10 month treated group and 1.8% of the more than 11 month treated group. The marked improvement of pulmonary lesions were 47.4% in the formers and 31.9% in the laters, the worse progression of the lesions were 1.7% and 1.8% , the final attainments of inactive status were 97.1 % and 96.4% respectively. 12) The moderately advanced group by the classification of the pulmonary lesions achieved the highest rates of the marked improvement of the pulmonary lesions but the largest rate of the attainment of inactive status were seen among the minimal case group. The failure of sputum negative conversion occurred more among the far advanced group. These results mean that even with present effective antituberculosis chematherpentic regimens, the early diagnosis and the early treatment were strongly required evermore. 13) On family history of the initial treatment patients, 11.1 % of them revealed one or more of the pulmory tuberculosis history among their members. The majority of the family patients, 67.4% (7.5 %) were presently on treatments, 23.2%(2.6%) were with past histories, 9.5 % (1.1%) were died of pulmonary tuberculosis. About the family relationships, the most frequent ones were the fathers of the index cases with 28 .4 %(3.6%), the next were the siblings with 25.3%(2.8%), and the mothers with 21. 1%(2.4%). The conjugal partners were rather small with 7.37%(0.8%). These results indicated that the ages of the index cases were rather young. There were 2 cases with 3 patients in each of their families and 1 case with 4 patients in a single family . In view of those facts the problems of tuberculosis in Korea should be considered as very much serious yet. 14) In conclusion the authors made following suggestions that the govemmental health insurance system should be further extended rapidly along side with more active social welfare system enough to encourage the patients and medical senice personals for more early diagnosis and for more regular eariy treatment of pulmonary tuberculosis by lowering the threshoulds of the medical services. That the treatment regimes also should be further broaded by lifting the limitations of 50 called fixed short terms chemotherapy policy at the public health service clinics. That the public health education policy should also more actively be continued as ever.

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