Pulmonary TB and Delay in Anti-Tuberculous Treatment Are Important Risk Factors for COPD

Lee C-H, Lee M-C, Lin H-H, Shu C-C, Wang J-Y, et al. (2012) Pulmonary Tuberculosis and Delay in Anti-Tuberculous Treatment Are Important Risk Factors for Chronic Obstructive Pulmonary Disease. PLoS ONE 7(5): e37978. doi:10.1371/journal.pone.0037978 [TB0045]

·       Tuberculosis (TB) is an independent and long-lasting risk factor for developing chronic obstructive pulmonary disease (COPD).

·      The impact of TB on the risk of developing COPD is sustained for at least six years after TB diagnosis.

·      There is a dose-response relationship between delay in anti-TB treatment and the risk of developing COPD.

·      Delayed treatment can aggravate airway destruction and accelerate the development of COPD.

·      Early diagnosis of pulmonary TB and prompt initiation of appropriate anti-TB treatment are imperative. Improving the quality of TB diagnosis and treatment may help prevent some COPD cases.

·      Clinicians should maintain a high index of suspicion for COPD in patients with a prior history of TB.

·      Diabetes mellitus may have a protective effect on the development of COPD, possibly because patients might stop smoking after a diabetes diagnosis.


Abstract

Objective: Tuberculosis (TB) remains the leading cause of death among infectious diseases worldwide. It has been suggested as an important risk factor for chronic obstructive pulmonary disease (COPD), which is also a major cause of morbidity and mortality. This study investigated the impact of pulmonary TB and anti-TB treatment on the risk of developing COPD.

Design, Setting, and Participants: This cohort study used the National Health Insurance Database of Taiwan, particularly the Longitudinal Health Insurance Database 2005, to obtain 3,176 pulmonary TB cases and 15,880 control subjects matched in age, sex, and timing of entering the database.

Main Outcome Measures: Hazard ratios of potential risk factors for COPD, especially pulmonary TB and anti-TB treatment.

Results: The mean age of pulmonary TB cases was 51.96 ± 19.2 years. The interval between the initial study date and the commencement of anti-TB treatment (delay in anti-TB treatment) was 75.86 ± 65.4 days. Independent risk factors for developing COPD were age, male gender, low income, and history of pulmonary TB (hazard ratio 2.054 [1.768–2.387]), while diabetes mellitus was protective. The impact of TB persisted for six years after TB diagnosis and was significant in women and subjects aged over 70 years. Among TB patients, delay in anti-TB treatment had a dose-response relationship with the risk of developing COPD.

Conclusions: Some cases of COPD may be preventable by controlling the TB epidemic, early TB diagnosis, and prompt initiation of appropriate anti-TB treatment. Follow-up care and early intervention for COPD may be necessary for treated TB patients.


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