Taylor Coston, MD, MPH
Nominated From: University of Washington
Research Site: Kenya Medical Research Institute
Research Area: tuberculosis, chronic lung disease, post-tuberculosis lung disease, exercise capacity
Primary Mentor: Dr. Dave Horne
Research Project
Determinants of impaired exercise capacity after pulmonary tuberculosis
Pulmonary tuberculosis (TB) remains a major public health challenge. A substantial proportion of TB survivors experience post-TB sequelae including chronic lung disease and cardiovascular dysfunction, which likely diminish functional exercise capacity and quality of life. Few studies have reported objective functional capacity measures in this population, and the clinical determinants of impaired exercise capacity recovery after TB are not well-understood. Addressing these gaps can inform post-TB care and identify modifiable factors that could enhance functional recovery in TB survivors. Our overall research objectives are to define functional recovery profiles among TB survivors, to identify host- and pathogen-related risk factors for impaired recovery, and to determine the contribution of persistent pulmonary abnormalities. We will leverage an ongoing prospective cohort study at the Kenya Medical Research Institute (KEMRI) in Nairobi, Kenya focused on post-TB lung disease. The robust infrastructure and strong collaborative relationships between the University of Washington and KEMRI offer a unique opportunity to address critical gaps in knowledge of post-TB recovery. I will add an incremental shuttle walk test and a validated VO2max questionnaire (FitMáx©) to parent study visits to augment spirometry, respiratory symptom and quality of life questionnaires, and chest imaging that will be collected in TB patients enrolled at the start of treatment and followed for two years. I will also perform these measurements in uninfected household contacts of TB patients as a control group. Using these novel data, I will pursue the following specific aims: Aim 1) Characterize recovery of exercise capacity following TB treatment and identify host- and pathogen-related risk factors for impaired recovery; Aim 2) Determine if reduced lung function and radiographic abnormalities following TB treatment are associated with lower exercise capacity.
Research Significance
Despite significant gains in TB prevention, diagnosis, and treatment in Kenya, TB incidence remains high. Moreover, emerging literature shows most of the long-term health burden associated with TB manifests after successful treatment. Exercise capacity is an important patient-centered metric in chronic illness, particularly pulmonary and cardiac diseases, where it can be a stronger predictor of poor quality of life and survival than spirometry or oxygenation. Characterizing functional impartment following TB and identifying risk factors are important steps to define the scope of the problem, identify therapeutic targets, and prioritize patients who may benefit from interventions such as pulmonary rehabilitation, nutritional support, or smoking cessation. The insights gained from this study will guide future efforts to improve post-TB care, an urgent public health objective in Kenya and throughout the world.
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