Tuberculosis (TB) remains a major public health challenge, particularly in high-burden countries. Endobronchial tuberculosis (EBTB), a distinct form of TB that involves the tracheobronchial tree, is often underdiagnosed due to its nonspecific presentation and overlap with other pulmonary conditions (1). EBTB may lead to complications such as bronchial stenosis, even after adequate anti-tubercular therapy (ATT), owing to persistent inflammation and fibrosis in the bronchial mucosa (2,3).

The pathophysiology of EBTB involves not only mycobacterial infection but also an exaggerated host immune response, resulting in mucosal damage, ulceration, and subsequent fibrotic healing (4). Although ATT remains the cornerstone of treatment, its inability to prevent long-term complications like airway narrowing has prompted interest in adjunctive therapies (5).

Corticosteroids, owing to their potent anti-inflammatory and immunosuppressive properties, have been considered as adjuvant agents to mitigate bronchial inflammation and minimize fibrotic complications (6). Several studies have demonstrated that early corticosteroid administration may reduce mucosal edema, improve symptom resolution, and prevent or delay the onset of bronchial stenosis (7,8). However, the evidence remains inconsistent, and the routine use of corticosteroids in EBTB is not universally accepted due to concerns regarding side effects and lack of consensus on dosage and duration (9).

This study aims to evaluate the efficacy of oral corticosteroids as an adjunct to standard ATT in patients diagnosed with endobronchial tuberculosis, focusing on clinical outcomes, radiological improvement, and the prevention of bronchial stenosis.

This prospective, randomized controlled study was conducted over a period of six months at a tertiary care teaching hospital. A total of 60 patients diagnosed with endobronchial tuberculosis (EBTB) based on clinical symptoms, radiographic findings, sputum acid-fast bacilli (AFB) positivity, and bronchoscopic evidence were enrolled after obtaining informed consent.

Inclusion Criteria:

Patients aged 18 to 60 years with newly diagnosed EBTB who were treatment-naïve and willing to participate in the study.

Exclusion Criteria:

Patients with known immunosuppressive conditions (e.g., HIV), chronic systemic steroid use, diabetes mellitus, contraindications to steroid therapy (e.g., peptic ulcer disease, active infections), or those who were pregnant or lactating were excluded.

Study Design and Intervention:

Participants were randomly assigned into two groups using a computer-generated randomization table:

• Group A (Control Group, n=30): Received standard anti-tubercular therapy (ATT) as per the Revised National Tuberculosis Control Program (RNTCP) guidelines.
• Group B (Study Group, n=30): Received standard ATT along with oral prednisolone at an initial dose of 1 mg/kg/day, tapered over a period of 6 weeks.

All patients were monitored for 12 weeks with scheduled follow-ups at baseline, 4 weeks, 8 weeks, and 12 weeks.

Outcome Measures:

Primary outcomes included:

1. Clinical Improvement: Resolution of symptoms such as cough, wheezing, chest discomfort, and dyspnea.
2. Radiological Response: Improvement on chest X-ray or CT scan.
3. Bronchoscopic Findings: Reduction in mucosal inflammation and prevention of bronchial stenosis on repeat bronchoscopy at 12 weeks.

Secondary outcomes involved monitoring for adverse effects of corticosteroid therapy, including hyperglycemia, infections, and gastrointestinal symptoms.

Data Analysis:

Data were analyzed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation and compared using Student’s t-test. Categorical variables were expressed as percentages and compared using the Chi-square test. A p-value of less than 0.05 was considered statistically significant.

A total of 60 patients were included in the final analysis, with 30 participants in each group. Both groups were comparable in terms of age, sex distribution, and baseline clinical parameters (Table 1).

Table 1: Baseline Characteristics of Study Participants

At the end of 12 weeks, a higher percentage of patients in the corticosteroid group (Group B) reported complete symptom resolution compared to the control group (Group A). Cough and dyspnea showed the most notable improvements (Table 2).

Table 2: Clinical Symptom Resolution at 12 Weeks

Radiological assessments showed a statistically significant improvement in the corticosteroid group, with 76.7% showing resolution of infiltrates versus 56.7% in the control group (Table 3).

Table 3: Radiological Improvement at Week 12

Bronchoscopic evaluation revealed a significantly lower incidence of bronchial stenosis in patients receiving corticosteroids (10%) as compared to the control group (30%) (Table 4).

Table 4: Bronchoscopic Findings at Week 12

No major adverse effects were reported in either group. Minor side effects such as transient hyperglycemia were observed in 3 patients in Group B but did not require discontinuation of therapy.

As shown in Tables 2–4, the addition of corticosteroids to standard anti-tubercular therapy significantly enhanced clinical recovery, radiological resolution, and reduced complications such as bronchial stenosis

The present study evaluated the role of corticosteroids as adjunctive therapy in patients with endobronchial tuberculosis (EBTB) and found that the addition of oral prednisolone to standard anti-tubercular treatment (ATT) significantly improved clinical, radiological, and bronchoscopic outcomes over a 12-week follow-up period.

Endobronchial tuberculosis, a lesser-known form of pulmonary TB, often presents with nonspecific symptoms and can lead to complications such as bronchial stenosis despite appropriate ATT (1,2). The pathogenesis involves direct infection and inflammation of the bronchial mucosa, which progresses to fibrosis and luminal narrowing, especially if not treated early or aggressively (3). Bronchial stenosis can cause long-term respiratory impairment and is considered one of the most debilitating sequelae of EBTB (4,5).

Corticosteroids, due to their potent anti-inflammatory and immunomodulatory effects, are known to mitigate tissue damage and fibrotic transformation in TB-related inflammation (6). In our study, patients receiving corticosteroids showed greater clinical improvement, with higher rates of symptom resolution, particularly cough and dyspnea. These findings are consistent with previous reports suggesting that corticosteroids may reduce mucosal edema and inflammation, thereby relieving airway obstruction (7,8).

Radiological improvement, defined as resolution or reduction of infiltrates or bronchial narrowing, was also more frequent in the corticosteroid group. This aligns with studies where corticosteroids demonstrated better radiographic clearance and prevented progressive airway damage in TB (9,10). The benefit was most evident in the reduced incidence of bronchial stenosis on repeat bronchoscopy. Only 10% of patients in the corticosteroid group developed stenosis compared to 30% in the control group, corroborating prior findings that early corticosteroid use may help prevent irreversible fibrotic narrowing (11,12).

Despite concerns about steroid-associated side effects, our study observed only minor and self-limiting adverse events, such as transient hyperglycemia. No severe infections or complications necessitating treatment discontinuation were reported, echoing the findings of earlier trials indicating that short-term corticosteroid use in TB is generally safe when carefully monitored (13,14).

However, the study has limitations. The sample size was relatively small, and follow-up was limited to 12 weeks. Long-term outcomes, including pulmonary function and recurrence of stenosis, were not assessed. Furthermore, the optimal dosage and tapering schedule of corticosteroids in EBTB remains uncertain, warranting further investigation through larger multicenter studies (15).

In summary, our findings support the use of corticosteroids as a valuable adjunct in the early management of EBTB to reduce inflammation, accelerate symptom relief, and prevent long-term complications such as bronchial stenosis.

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