The Definition of Past Tuberculosis Affects the Magnitude of Association between Pulmonary Tuberculosis and Respiratory Dysfunction: Korea National Health and Nutrition Examination Survey, 2008–2012

Abstract

Tuberculosis (TB) is associated with an increased risk of chronic lung impairment. The aim of this study was to compare the clinical characteristics and lung functions according to definition of past TB. We used the population-based, Korea National Health and Nutrition Examination Survey (KNHANES) (2008–2012) to analyze 13,522 subjects age 40 years or older who underwent spirometry and chest X-ray (CXR). Subjects with TB lesions on CXR (with or without a history of TB) were older, more likely to be male, ever smokers, and of low socioeconomic status than subjects with only a history of TB or without evidence of TB. Airflow obstruction (AFO) was associated with only a history of TB (odds ratio [OR] 1.53, 95% confidence interval [CI] 0.95–2.46), only TB lesion on CXR (OR 2.37, 95% CI 1.80–3.12), and both a history and TB lesions on CXR (OR 4.47, 95% CI 3.07–6.51) after adjustment for gender, age, body mass index, education, income, and smoking amount (P for trend < 0.001). Spirometric restriction was associated with only a history of TB (OR 1.29, 95% CI 0.80–2.08), only TB lesions on CXR (OR 2.03, 95% CI 1.49–2.76), and both a history and TB lesions on CXR (OR 2.65, 95% CI 1.74–4.05) after adjustment for the above variables (P for trend < 0.001). How to define past TB in population study affects the magnitude of association between past TB and respiratory dysfunction. Without considering TB lesions on CXR, the association between TB and respiratory dysfunction could be underestimated.

Risk of Sarcopenia and Osteoporosis in Male Tuberculosis Survivors: Korea National Health and Nutrition Examination Survey

“…These results differ from the impact of pulmonary TB on respiratory function. It has been reported that subjects having only a history of pulmonary TB without TB scars on CXR have lower pulmonary function and higher proportion of air flow obstruction than subjects without evidence of TB 14 .…”

“…The destructive nature of pulmonary TB may induce chronic lung impairment even if TB treatment is effective 30 , 31 . In one study, subjects with both medical history and TB lesions on CXR have a 4.5-times higher risk for chronic obstructive pulmonary disease (COPD) and 2.7-times increased risk for restriction dysfunction compared to subjects without evidence of TB 14 . Osteoporosis and sarcopenia are frequently found in patients with COPD 32 .…”

Tuberculosis and lung damage: from epidemiology to pathophysiology

“…Another study (n=5571) showed a higher prevalence of COPD in those with a history of TB (30.7%) versus those without (13.9%) [ 12 ]. In a large study of 13522 adults aged ≥40 years set in South Korea, a history of TB and lesions on chest radiographs were associated with 4.47 increased odds of airflow obstruction (95% CI 3.07–6.51) after adjusting for age, smoking, body mass index (BMI) and other confounders [ 24 ]. Furthermore, a meta-analysis demonstrated that a history of treated TB was a risk factor for COPD (pooled OR 3.05, 95% CI 2.42–3.85) independent of smoking and age [ 11 ].…”

Assessment of Symptomatic Post Tuberculosis Patients by Spirometry and Chest X Ray

“…The mean age of the patients was found to be 42.84 ± 16.50. A study conducted by Choi, CJ et al 20 in South Korea had similar age distribution among the respondents aged >40 years in study of 13522 patients. This is because people in this age group (21-60 years) are more physically active and carry out outdoor activity than people in age group >60 years and therefore, are having more chances exposure for TB.…”