Preventing lung function decline and pleural thickening after pleural TB: a systematic review

<sec><title>BACKGROUND</title>Pleural TB (PTB) is treated with standard anti-TB therapy, but additional treatments may be necessary to mitigate restrictive functional sequelae (RFS). This study identifies effective adjunctive management options to prevent PTB sequelae.</sec><sec><title>METHODS</title>We systematically reviewed studies from PubMed, Cochrane Library, EMBASE, CINAHL, Web of Science, and Ovid, focusing on PTB treatments like oral steroids, pleural drainage, intrapleural therapy, and pleuroscopy. Our primary goal was to assess the impact on pulmonary function test (PFT) results, adhering to Cochrane’s synthesis without meta-analysis (SWiM) guidelines. PROSPERO registry: CRD420251047448.</sec><sec><title>RESULTS</title>21 out of 1,110 articles met the criteria (8 randomised, 13 nonrandomised). Intrapleural fibrinolysis with urokinase significantly improved predicted forced vital capacity (%FVC) and delta-FVC at 6 months (%FVC increased from 62.6% to 87.2% [ P < 0.01]; delta-FVC = +24.6%; P < 0.01) in free-flowing PTB effusions. No improvements were noted with oral steroids, pleural drainage yielded inconclusive results, and no studies examined pleuroscopy’s effects on PFT. However, both latter interventions demonstrated improvement in other outcomes.</sec><sec><title>CONCLUSION</title>Intrapleural therapies provide robust evidence against RFS in PTB; pleural drainage may help with dyspnoea, while further studies are needed on pleuroscopy.</sec>