Pulmonary tuberculosis as a risk factor for chronic obstructive pulmonary disease: a systematic review and meta-analysis

Fan, Huanhuan; Wu, Fan; Liu, Jing; Zeng, Weifeng; Zheng, Silan; Tian, Heshen; Li, Haiqing; Yang, Huajing; Wang, Zihui; Deng, Zhishan; Peng, Jieqi; Zheng, Yuzhen; Xiao, Shan; Hu, Guoping; Zhou, Yumin; Ran, Pixin

doi:10.21037/atm-20-4576

Cited by 39 publications

(30 citation statements)

References 48 publications

(28 reference statements)

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“…In the present study with a rigorous sampling design and strictly quality control, we found a nearly 1.31 time increase in risk of airflow obstruction in post-TB subjects after adjusting for confounders, and a stronger association in never smokers (OR: 1.37; 95% CI 1.04 to 1.78). Besides, airflow obstruction was present in 21.3% of post-TB cases, which are consistent with a recent meta-analysis reporting a pooled prevalence of COPD in patients with post pulmonary TB of 21% (95% CI: 16% to 25%)5 and another study from low- income and middle- income countries reporting COPD was more common (25.7%) among those with previous tuberculosis than those without a history of tuberculosis 6. Therefore, for vast majority of patients after TB, the development of adjuvant interventions to prevent or to suspend further deterioration of lung function in individuals with post-TB could be an essential tool.…”

Section: Discussionsupporting

confidence: 90%

“…While smoking remains the key risk factor for chronic obstructive pulmonary disease (COPD), a considerable burden of the disease in low-income and middle-income countries cannot be explained by smoking alone. TB and other non-smoking risk factors of COPD such as domestic pollution are of increasing importance 3–6. An association between past TB and airflow obstruction, characteristic of COPD, has been reported in large population-based epidemiological studies 7–10.…”

Section: Introductionmentioning

confidence: 99%

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Airflow obstruction and small airway dysfunction following pulmonary tuberculosis: a cross-sectional survey

Xing

Sun

Janssens

et al. 2022

Thorax

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ObjectivesPulmonary function impairment and chronic respiratory symptoms after tuberculosis are relatively common in low-income and middle-income countries. We aimed to estimate the impact of post-tuberculosis (post-TB) on pulmonary function.MethodsThis large cross-sectional, population-based study included subjects aged 15 years or older with technically acceptable postbronchodilator spirometry measurements. Post-TB was diagnosed on the basis of radiological evidence and/or medical history. Airflow obstruction was defined as a postbronchodilator forced expiratory volume in 1 s/forced vital capacity ratio below the lower limit of normal of Global Lung Function Initiative (GLI) lung function equations. Small airway dysfunction was diagnosed if at least two of the following indicators were less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50% or FEF 75%.ResultsIn this population sample (N=8680, mean age: 40.1 years), 610 (7.0% (95% CI 6.5 to 7.6) participants were post-TB. Post-TB subjects had more frequent respiratory symptoms (46.8% vs 28.3%). Among post-TB subjects, 130 (21.3% (95% CI 18.1 to 24.8)) had airflow obstruction; OR of airflow obstruction was significantly associated with post-TB after adjustment for other confounding factors (OR 1.31, 95% CI 1.05 to 1.62). Post-TB was also associated with small airway dysfunction (OR 1.28, 95% CI1.07 to 1.53), which was present in 297 (48.9% (95% CI 33.9 to 53.0)) post-TB subjects.ConclusionsOur findings support existing knowledge that post-TB is positively associated with pulmonary function impairment and make for frequent respiratory symptoms. Post-TB should be considered as a potentially important cause of airflow obstruction and respiratory symptoms in patients originating from countries with a high burden of tuberculosis.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Airflow obstruction and small airway dysfunction following pulmonary tuberculosis: a cross-sectional survey

Xing

Sun

Janssens

et al. 2022

Thorax

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“… 9 In a meta-analysis, the pooled prevalence of COPD in individuals with previous pulmonary tuberculosis was 21%. 37 In the China Pulmonary Health (CPH) Study, the overall prevalence of tuberculosis history in COPD individuals was less than 5.0%, 3 which was much lower than the prevalence in our study. However, a pooled analysis of individual data from the PREPOCOL-PLATINO-BOLD-EPI-SCAN studies showed that the prevalence of previous tuberculosis in individuals living at altitude >1500 m above sea level was significantly lower than those living at altitude <1500 m. 38 Three studies included in this pooled analysis were from Latin American regions and this result was inconsistent with our study.…”

Section: Discussioncontrasting

confidence: 72%

Clinical and Radiological Features of COPD Patients Living at ≥3000 m Above Sea Level in the Tibet Plateau

Liang¹,

Yangzom²,

Lhamo³

et al. 2021

COPD

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Background COPD at high altitude may have different risk factors and unique clinical and radiological phenotypes. We aimed to investigate the demographic data, clinical and radiological features of COPD patients permanently residing at the Tibet Plateau (≥3000 meters above sea level). Methods We conducted an observational cross-sectional study which consecutively enrolled COPD patients visiting the outpatient of Respiratory Medicine at Tibet Autonomous Region People’s Hospital from January 2018 to March 2021. All patients were Tibetan permanent residents aging ≥40 years and met the diagnosis of COPD according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Data including demographic characteristics, altitude of residence, risk factors, respiratory symptoms, comorbidities and medications, as well as computed tomography (CT) measurements were collected. Results Eighty-four patients with definite COPD were enrolled for analysis. Their mean age was 64.7 (±9.1) years. All patients lived at ≥3000 m above sea level and 34.5% of them lived at ≥4000 m. About 8.3% of the patients were current smokers and 44.0% were ex-smokers. Up to 88.1% of the patients reported long-term exposure to indoor biomass fuels. Most of the patients were classified as having mild-to-moderate (GOLD I: 27.4%; GOLD II: 51.2%) COPD, while 89.3% had a CAT score ≥10. Only 36.9% of the patients received regular long-term medications for COPD in the past year, in whom ICS/LABA and oral theophylline were the most common used pharmacological therapy. On CT scanning, the majority of our patients (70.7%) showed no or minimal emphysema, while signs of previous tuberculosis were found in 45.1% of the patients. Conclusion COPD patients living at the Tibet Plateau had a heavy respiratory symptom burden, but most of them did not receive adequate pharmacological treatment. Indoor biomass fuel exposure and previous tuberculosis were prevalent, while the emphysema phenotype was less common in this population.

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“…Many infectious respiratory pathogens are known to result in chronic respiratory disorders including chronic obstructive respiratory disease (COPD; a potential late consequence of tuberculosis, histoplasmosis, etc.) and asthma (which can manifest after childhood Respiratory Syncytial Virus infection) ( 12 , 13 ). Though less well-known, parasitic infections—from protozoa like Trypanosoma cruzi (an infection that manifests as Chagas disease, leading to the development of cardiomyopathy or GI disease in 30% of infected individuals) and Trypanosoma brucei (an infection that causes sleeping sickness, leading to chronic neurologic disease in Sub-Saharan Africa) to helminths—can also increase one’s risk for NCDs ( 14 ).…”

Section: The Global Impact Of Non-communicable Diseasesmentioning

confidence: 99%

The role of helminths in the development of non-communicable diseases

Duffey

Alex

et al. 2022

Front. Immunol.

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Non-communicable diseases (NCDs) like cardiovascular disease, chronic respiratory diseases, cancers, diabetes, and neuropsychiatric diseases cause significant global morbidity and mortality which disproportionately affect those living in low resource regions including low- and middle-income countries (LMICs). In order to reduce NCD morbidity and mortality in LMIC it is imperative to understand risk factors associated with the development of NCDs. Certain infections are known risk factors for many NCDs. Several parasitic helminth infections, which occur most commonly in LMICs, have been identified as potential drivers of NCDs in parasite-endemic regions. Though understudied, the impact of helminth infections on the development of NCDs is likely related to helminth-specific factors, including species, developmental stage and disease burden. Mechanical and chemical damage induced by the helminth in combination with pathologic host immune responses contribute to the long-term inflammation that increases risk for NCD development. Robust studies from animal models and human clinical trials are needed to understand the immunologic mechanisms of helminth-induced NCDs. Understanding the complex connection between helminths and NCDs will aid in targeted public health programs to reduce helminth-induced NCDs and reduce the high rates of morbidity that affects millions of people living in parasite-endemic, LMICs globally.

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Pulmonary tuberculosis as a risk factor for chronic obstructive pulmonary disease: a systematic review and meta-analysis

Cited by 39 publications

References 48 publications

Airflow obstruction and small airway dysfunction following pulmonary tuberculosis: a cross-sectional survey

Airflow obstruction and small airway dysfunction following pulmonary tuberculosis: a cross-sectional survey

Clinical and Radiological Features of COPD Patients Living at ≥3000 m Above Sea Level in the Tibet Plateau

The role of helminths in the development of non-communicable diseases

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