Abstract Background Post tuberculosis lung disease (PTLD) manifests in various forms, including tuberculosis-associated chronic obstructive pulmonary disease (TB-COPD), yet its clinical and radiological features remain undercharacterized Methods In this prospective cohort study, patients with active pulmonary TB were enrolled from Beijing Geriatric Hospital between 2017 to 2019. All received standard anti-TB therapy and were followed during treatment, at treatment completion, and five years post-treatment. Follow-up assessments included lung function, chest CT, and routine blood test, with a focus on longitudinal trends in lung function over five years and risk factors associated with airflow obstruction. Results Among 53 patients (mean age 36.9±13.9 years; 64.2% male), initial lung function test showed an average FEV1/FVC ratio of 80.23%±11.02%, with 7 patients (13.2%) exhibiting airflow obstruction. At the 5 years follow-up, the mean FEV1/FVC declined significantly (76.27±12.04 vs 80.23±11.02, P 0.001). Overall, 9 patients (17.0%) exhibited airflow obstruction at the 5 years follow-up (mean age 54.7±13.5 years; 66.7% male; 44.4% smokers). Seven of these patients predominantly showed air trapping consistent with small airway disease on chest CT, aligning with TB-COPD phenotype. Notably, four younger patients (60 years old) had persistent obstruction over the five years. Univariate logistic regression identified older age and higher CT scores as significant predictors of airflow decline. Conclusions Approximately 17.0% of patients developed airflow obstruction after five years post-treatment, with most cases demonstrating imaging findings aligning with TB-COPD, even among younger, non-smoking individuals. These findings emphasize the importance of long-term follow-up and routine lung function assessments in TB survivors. This abstract is funded by: no
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