Post-tuberculosis lung disease and chronic obstructive pulmonary disease

Abstract

The burden of chronic airway diseases, including chronic obstructive pulmonary disease (COPD), continues to increase, especially in low- and middle-income countries. Post-tuberculosis lung disease (PTLD) is characterized by chronic lung changes after the "cure" of pulmonary tuberculosis (TB), which may be associated with the pathogenesis of COPD. However, data on its prevalence, clinical manifestations, computed tomography features, patterns of lung function impairment, and influencing factors are limited. The pathogenic mechanisms underlying PTLD remain to be elucidated. This review summarizes the recent advances in PTLD and TB-associated COPD. Research is urgently needed both for the prevention and management of PTLD.

Figure 1

Chest CT scans of tuberculosis sequelae in two COPD patients with a history of cigarette smoking. Extensive emphysema and a calcified lesion (A, B) and emphysema and scarred lesions with bronchiectatic changes (C, D) in the right upper lobe. COPD: Chronic obstructive pulmonary disease; CT: Computed tomography.

Figure 2

The interaction between PTLD and CS in TB-associated COPD. Mtb infection leads to active pulmonary TB, which may cause post-TB lung disease even after therapy in susceptible hosts. CS serves as a risk factor for Mtb infection and severe lung disease, and plays a critical role in TB-associated COPD. COPD: Chronic obstructive pulmonary disease; CS: Cigarette smoke; MMP: Matrix metalloproteinase; Mtb: Mycobacterium tuberculosis; PTLD: Post-tuberculosis lung disease; TB: Tuberculosis; TB-COPD: TB-associated COPD.