Emphysema and bronchiectasis in COPD patients with previous pulmonary tuberculosis: computed tomography features and clinical implications

Figures & data

Table 1 Baseline and clinical characteristics of subjects with COPD, with and without PTB

Parameter	COPD	COPD with previous TB	COPD without previous TB	p-value
Subjects, n (%)	231	104 (45.0)	127 (55.0)
Male, n (%)	156 (67.5)	73 (70.2)	83 (65.4)	0.435
Age, (years)	76.8 (9.4)	77.5 (9.4)	76.1 (9.3)	0.247
Smoking status
Present smokers, n (%)	68 (29.4)	29 (27.9)	39 (30.7)	0.823
Former smokers, n (%)	122 (52.8)	55 (52.9)	67 (52.8)
Non-smokers, n (%)	41 (17.7)	20 (19.2)	21 (16.5)
Pack-years smoked	42.6 (25.3)	45.3 (26.4)	40.5 (24.4)	0.187
Body mass index, (kg/m^2)	23.2 (4.77)	22.8 (4.33)	23.6 (5.08)	0.186
History of chronic cough/sputum, (years)	19.1 (12.3)	20.1 (12.2)	18.3 (12.5)	0.182
History of dyspnea, (years)	6.28 (5.70)	7.31 (6.19)	5.44 (5.13)	0.008
Daily treatments, n (%)
Anticholinergic	160 (69.2)	69 (66.3)	91 (71.6)	0.384
Long-acting β adrenergic	143 (61.9)	62 (59.6)	81 (63.7)	0.517
ICS	143 (61.9)	62 (59.6)	81 (63.7)	0.517
mMRC	2.46 (1.15)	2.63 (1.16)	2.33 (1.13)	0.045
mMRC ≥2, n (%)	183 (79.2)	89 (85.6)	94 (74.0)	0.031
Exacerbations in the previous year	1.30 (1.27)	1.56 (1.39)	1.09 (1.12)	0.011
Hemoglobin, (g/L)	125.1 (17.1)	124.8 (16.3)	125.4 (17.8)	0.783
FEV1/FVC, %	0.46 (0.11)	0.45 (0.10)	0.47 (0.11)	0.252
FEV1% predicted	0.43 (0.13)	0.41 (0.12)	0.44 (0.14)	0.215
GOLD grading, n (%)
Grade II	83 (35.9)	37 (35.6)	46 (36.3)	0.987
Grade III	109 (47.2)	49 (47.1)	60 (47.2)
Grade IV	39 (16.9)	18 (17.3)	21 (16.5)
Location of PTB sequelae
Upper lobes, n (%)		99 (95.2)	0 (0)
Middle lobes, n (%)		2 (1.92)	0 (0)
Lower lobes, n (%)		8 (7.69)	0 (0)
Positive culture of bacteria, n (%)	53 (22.9)	29 (27.9)	24 (18.9)	0.106
Positive culture of Pseudomonas aeruginosa, n (%)	15 (6.5)	13 (12.5)	2 (1.6)	0.001

Notes: p-values represent the comparisons between COPD patients with TB and those without. Lingular segment of left lung was taken as “middle lobe” of left lung. Continuous data are expressed as mean (standard deviation), Categorical data are expressed as number (percentage). The statistically significance values p<0.05 shown in bold.

Abbreviations: PTB, pulmonary tuberculosis; TB, tuberculosis; ICS, inhaled corticosteroids; mMRC, modified Medical Research Council Questionnaire; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Table 2 CT characteristics of bronchiectasis and emphysema of subjects with COPD, with and without PTB

Parameters	COPD (n=231)	COPD with previous TB (n=104)	COPD without previous TB (n=127)	p-value
Bronchiectasis prevalence, n (%)	117 (50.6)	67 (64.4)	50 (39.4)	0.000
Upper lobes, n (%)	57 (48.7)	42 (62.7)	15 (30.0)	0.000
Middle lobes, n (%)	75 (64.1)	45 (67.2)	30 (60.0)	0.424
Lower lobes, n (%)	80 (68.3)	42 (62.6)	38 (76.0)	0.126
Smith scorea	6.97 (5.81)	7.78 (6.29)	5.90 (4.96)	0.162
Upper lobes	3.45 (2.05)	3.73 (2.66)	2.66 (1.23)	0.194
Middle lobes	3.96 (2.31)	4.06 (2.31)	3.80 (2.32)	0.541
Lower lobes	4.02 (2.31)	4.31 (2.34)	3.71 (2.26)	0.246
Bhalla scoreb
1, n (%)	109 (93.2)	59 (88.0)	50 (100.0)	0.031
≥2, n (%)	8 (6.8)	8 (11.9)	0 (0)
Bronchiectasis type
Cylindric	115 (98.3)	65 (97.0)	50 (100)
Cystic	0 (0)	0 (0)	0 (0)
Varicose	4 (3.4)	4 (5.9)	0 (0)
Emphysema prevalence, n (%)	144 (62.3)	70 (67.3)	74 (58.2)	0.158
Upper lobes, n (%)	133 (92.4)	67 (95.7)	66 (89.1)	0.141
Middle lobes, n (%)	99 (68.7)	57 (81.4)	42 (56.7)	0.001
Lower lobes, n (%)	91 (63.1)	51 (72.8)	40 (54.1)	0.019
Goddard scorea	7.00 (5.66)	7.88 (5.51)	6.17 (5.71)	0.028
Upper levels	3.57 (2.28)	3.59 (2.26)	3.56 (2.33)	0.940
Middle levels	2.92 (1.89)	2.82 (1.81)	3.05 (2.00)	0.684
Lower levels	2.68 (1.88)	2.95 (1.99)	2.33 (1.69)	0.120
Types of emphysema, prevalence
Centrilobular, n (%)	97 (42.0)	49 (47.1)	48 (37.8)	0.153
Panlobular, n (%)	80 (34.6)	45 (43.2)	35 (27.5)	0.013
Paraseptal, n (%)	46 (19.9)	24 (23.0)	22 (17.3)	0.276
Bullae, n (%)	62 (26.8)	34 (32.7)	28 (22.0)	0.069
Types of emphysema, scorea
Centrilobular	2.76 (1.59)	3.12 (1.71)	2.40 (1.39)	0.039
Panlobular	2.93 (1.71)	2.78 (1.67)	3.14 (1.76)	0.322
Paraseptal	1.71 (0.88)	1.71 (0.80)	1.73 (0.98)	0.943
Bullae	1.90 (1.11)	1.94 (1.07)	1.86 (1.17)	0.518

Notes:

a Smith score, Goddard score, and semi-quantitative score of different types of emphysema represent the means of patients with bronchiectasis, or with emphysema, or with a certain type of emphysema.

b Defined based on the highest Bhalla score of the patient. Lingular segment of the left lung was taken as “middle lobe” of the left lung. p-values represent the comparisons between COPD patients with TB and those without. Continuous data are expressed as mean (standard deviation), Categorical data are expressed as number (percentage). The statistically significance values p<0.05 shown in bold.

Abbreviations: PTB, pulmonary tuberculosis; TB, tuberculosis.

Figure 1 Bronchiectasis in case 1 with TB sequelae in RUL (HRCT).

Abbreviations: TB, tuberculosis; RUL, right upper lobe; HRCT, high-resolution CT, computed tomography.

Table 3 Bronchiectasis and emphysema of 2 lungs in 65 patients with TB sequelae in a single lung

Parameters	TB sequelae involved lung				Contralateral lung
	Upper lobe	Middle lobe	Lower lobe	Whole lung	Upper lobe	Middle lobe	Lower lobe	Whole lung
Bronchiectasis prevalence, n (%)	25 (38.5)**	21 (32.3)*	20 (30.8)	39 (60.0)**	7 (10.8)	10 (15.4)	13 (20.0)	20 (30.8)
Smith scorea	2.36 (1.03)	2.86 (1.01)	2.96 (0.94)	4.56 (3.15)	2.71 (1.25)	2.90 (1.19)	2.49 (1.08)	4.02 (3.32)
Bhalla score,b n (%)
1	25 (100)	20 (95.2)	18 (90.0)	36 (92.3)	7 (100)	7 (70.0)	12 (92.3)	17 (85.0)
≥2	0 (0)	1 (4.8)	2 (10.0)	3 (7.7)	0 (0)	3 (30.0)	1 (7.7)	3 (15.0)
Emphysema prevalence, n (%)	35 (53.8)	23 (35.4)	30 (46.2)	39 (60.0)	32 (49.2)	21 (32.3)	28 (43.1)	35 (53.8)
Centrilobular	21 (32.3)	7 (10.8)	13 (20.0)	25 (38.5)	18 (27.7)	10 (15.4)	13 (20.0)	21 (32.3)
Panlobular	17 (26.2)	9 (13.8)	14 (21.5)	25 (38.5)	13 (20.0)	5 (7.7)	13 (20.0)	19 (29.2)
Paraseptal	3 (4.6)	5 (7.7)	5 (7.7)	12 (18.5)	4 (6.2)	4 (6.2)	3 (4.6)	8 (12.3)
Bullae	10 (15.4)	6 (9.2)	7 (10.8)	17 (26.2)	9 (13.8)	3 (4.6)	5 (7.7)	13 (20.0)
Goddard scorea				4.28 (2.70)				4.20 (2.71)

Notes:

* Compared with “contralateral lung”, p<0.05;

** Compared with “contralateral lung”, p<0.01;

a Smith score and Goddard score represent the means of patients with bronchiectasis, or with emphysema;

b defined based on the highest Bhalla score of the patient. Lingular segment of left lung was taken as the “middle lobe” of the left lung. Continuous data are expressed as mean (standard deviation); Categorical data are expressed as number (percentage).

Abbreviation: TB, tuberculosis.

Figure 2 Similar emphysema at LUL and RUL in case 2 with TB sequelae in RUL (HRCT).

Abbreviations: LUL, left upper lobe; RUL, right upper lobe; TB, tuberculosis; HRCT, high-resolution CT.

Figure 3 Extensive emphysema and mild bronchiectasis in case 3 with TB sequelae at RUL (HRCT).

Notes: (A) upper level; (B) middle level; (C) lower level.
Abbreviations: TB, tuberculosis; RUL, right upper lobe; HRCT, high-resolution CT.