Airflow obstruction and chronic obstructive pulmonary disease are common in pulmonary tuberculosis even without sequelae findings on chest X-ray

Abstract

Purpose

Pulmonary tuberculosis (TB) is a well-known risk factor for airflow obstruction and chronic obstructive pulmonary disease (COPD). The prognosis of TB without sequelae on chest X-ray (CXR) remains uncertain.

Methods

We used the 2008–2009 Korea National Health and Nutrition Examination Survey (KNHANES) data and 2007–2012 KNHANES-matched Health Insurance Review and Assessment Service cohort data. Airflow obstruction was assessed using a pulmonary function test. COPD was defined using diagnostic codes and the use of COPD medication for 3-year. We classified subjects into three groups based on TB history and sequelae on CXR.

Results

In 4911 subjects, the CXR(–) (no TB sequelae on CXR) post-TB group (n = 134) showed similar characteristics and normal lung function compared to that of the control group (n = 4,405), while the CXR(+) (TB sequelae on CXR) post-TB group (n = 372) showed different characteristics and reduced lung function. The prevalence of airflow obstruction was 9.3%, 13.4%, and 26.6% in control, CXR(-) post-TB, and CXR(+) post-TB groups, respectively. COPD was more common in the post-TB with CXR(+) (6.5%) or without CXR (–) (4.5%) groups, than in the control group (1.8%). Compared to the CXR(–) post-TB group, the control group showed a lower risk for airflow obstruction (OR, 0.774; p = .008). The CXR(+) post-TB group showed a higher risk for airflow obstruction (OR, 1.456; p = .011). The Control group also showed a lower risk for the development of COPD than the CXR(-) post-TB group (OR, 0.496; p = .011).

Conclusions

We need to educate TB patients that airway obstruction and COPD can easily develop, even if TB sequelae are not observed on CXR.

Keywords:

• Pulmonary tuberculosis
• airflow obstruction
• COPD

Author contributions

HJP contributed to the conception and design of this study, analysed and interpreted the data, drafted and revised the article, and approved the final version of the article for publication. JWL, CYK, YK, CKR, KSJ, KHY collected, generated, and analysed the data, contributed to the draft, revised the article, and approved the final version of the article for publication. SS, as a professional statistician, takes scientific responsibility for the analysis and interpretation of the data. MKB, as the corresponding author, provided constructive criticism on the concept and design of this study, interpreted the data, drafted and revised the article, and approved the final version of the article for publication.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and analysed during the current study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by the Research Program funded Korea National Institute of Health [Fund CODE 2016ER670100, 2016ER670101, 2016ER670102, 2018ER67100, 2018ER67101, 2018ER67102, 2021ER120500, and 2021ER120501].