A Systematic Review of the Association between Pulmonary Tuberculosis and the Development of Chronic Airflow Obstruction in Adults

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a major public health concern, accounting for 3 million deaths annually, 90% of which occur in low- and middle-income countries. Pulmonary tuberculosis (PTB) as a contributory factor in the aetiology of COPD is under debate, with most epidemiologic evidence suggesting a positive association. Objectives: To compile a systematic review of evidence for an association between PTB and the development of chronic airflow obstruction (CAO). Methods: We performed a systematic review of original English-language, peer-reviewed literature using the PubMed/MEDLINE database. CAO was defined by spirometry [FEV₁:FVC ratio <0.70 or <LLN (lower limit of normal) for age]. Results: Nineteen studies (1 case series, 3 case-control studies, 4 cohort studies, 8 single-centre cross-sectional studies and 3 multi-centre cross-sectional studies) met the eligibility criteria. All but 2 reported a positive association between PTB and CAO. Three of 4 large population-based surveys (n = 4,291-8,066) confirmed a significant association between PTB and CAO (OR 1.37 - 2.94). A formal meta-analysis was not possible owing to marked heterogeneity between studies. Conclusions: This systematic review confirms evidence for a positive association between a past history of tuberculosis and the presence of CAO. The association is independent of cigarette smoking. Causality is likely but cannot be assumed.

Time for the Global Rollout of Endoscopic Lung Volume Reduction

“…Although smoking is the most common risk factor for the development of COPD, long-term biomass fuel exposure and tuberculosis may contribute to the disease burden in some developing countries [2]. The disease is generally managed with pharmacotherapy, as well as guidance about smoking cessation and pulmonary rehabilitation [3].…”

Poverty cannot be inhaled and it is not a genetic condition. How can it be associated with chronic airflow obstruction?

“…SES based on occupation has been related to COPD prevalence: manual workers and non-manual assistants (assumed to be lower SES) having a significantly higher prevalence of COPD than professionals [17]. TB, a disease clearly related to poverty, has been strongly associated with the development of CAO [18]. However, as a specific disease, the obstructive disease associated with TB might not be included under the umbrella of the term COPD.…”

COPD in nonsmokers: the biomass hypothesis – to be or not to be?

“…This is particularly relevant because other common causes of CAO in adult never-smokers (table 1), like bronchial asthma with fixed airflow obstruction, would have been interesting to disentangle [3,[10][11][12][13][14][15][16]. In addition, it would have been informative to be able to assess how potential selection bias and relatively low response rates could affect the generalisability of the results.…”

“…There is growing evidence supporting a positive association between a history of pulmonary tuberculosis and CAO, independent of cigarette smoking [16]. SMITH et al [7] found significant, independent associations of CAO with reported history of tuberculosis and also with low household income.…”