Characterisation and risk factors of post-tuberculosis lung disease in a high-tuberculosis-burden setting: a prospective cohort study

SUMMARY BACKGROUND Pulmonary tuberculosis (TB) is the leading infectious cause of death globally, and it is estimated that half of TB survivors develop post-TB lung disease (PTLD). Given limited prospective data, we evaluated the prevalence, lung function, risk factors, and quality of life (QoL) of PTLD in a Ugandan cohort. METHODS Adults with pulmonary TB were enrolled from Ugandan referral hospitals. Socio-demographic characteristics, exposures, QoL, chest radiography (CXR), and TB care variables were collected at enrolment. Post-TB treatment and 1-year follow-up visits included repeat CXR, pulmonary function testing (PFT), and questionnaires. PTLD was defined as post-treatment DLCO <80%, total lung capacity <80%, or post-bronchodilator FEV1/FVC z-score <−1.64 using Global Lung Function Initiative reference equations. Multivariable logistic regression evaluated factors associated with PTLD. RESULTS Of 109 participants who completed post-TB treatment follow-up, 40% met PFT criteria for PTLD. In adjusted analyses, lower body mass index (BMI), barriers to TB care, and high-risk pulmonary exposures were associated with PTLD. Participants with PTLD had greater radiographic disease burden and higher St. George’s Respiratory Questionnaire scores at end of treatment. Lung function improved over 1 year among PTLD participants. CONCLUSIONS Among Uganda TB survivors, functional lung impairment was high and 40% had PTLD. Modifiable risk factors, including BMI, TB care, and respiratory exposures, highlight opportunities for intervention.