Development of COPD after a TB episode

Several studies have shown that people who recover from tuberculosis (TB) often experience lasting airway obstruction or ongoing respiratory symptoms. In China alone, around 100 million individuals are estimated to have chronic obstructive pulmonary disease (COPD), making up nearly a quarter of the global COPD burden. This study used data from the CHERRY cohort, an electronic health database covering 98% of adults in Yinzhou District, to explore the long-term impact of TB on COPD development. We included participants over 35 years of age and excluded anyone diagnosed with TB after a COPD diagnosis.

Tuberculosis cases were identified using the national disease reporting system and defined through ICD-10 codes. Similarly, COPD diagnoses were captured through the same coding system. Once someone was diagnosed with COPD, they no longer contributed to follow-up. The main analysis measured the time between enrollment (or TB diagnosis, if it occurred later) and the earliest of three events: COPD diagnosis, death, or the end of the study in September 2021. We compared COPD incidence in people with and without TB using Poisson tests and adjusted for various factors through three multivariable models.

The study enrolled nearly 200,000 individuals, with a median age of 46.5 years and an even gender distribution. During nearly 10 years of follow-up, over 16,000 developed COPD, including 23.6% of those with prior pulmonary TB. In contrast, the overall COPD incidence was 8.3%. After adjusting for age, lifestyle factors, comorbidities, and medication use, pulmonary TB remained a strong predictor of future COPD. The hazard ratios ranged from 2.63 in minimally adjusted models to 1.77 in fully adjusted models. This association was especially strong in older adults and those with lower educational attainment.

Importantly, the increased COPD risk remained even after accounting for smoking status, alcohol use, and physical activity, and the results were consistent across sensitivity analyses. These findings highlight the long-term respiratory consequences of TB and suggest that a history of TB should be considered a key risk factor when evaluating COPD risk. Preventing TB may not only reduce TB-related morbidity but also offer additional benefits in lowering COPD rates in the general population.

Source: 

1. Wang, J., Yu, L., Yang, Z., Shen, P., Sun, Y., Shui, L., Tang, M., Jin, M., Chen, B., Ge, Y. and Lin, H., 2025. Development of chronic obstructive pulmonary disease after a tuberculosis episode in a large, population-based cohort from Eastern China. International journal of epidemiology, 54(2), p.dyae174.