A72-08 The Ghost of Tuberculosis (TB) Past - Post-Tuberculosis Obstructive Lung Disease Following Childhood TB

Abstract Introduction Post-tuberculosis (post-TB) lung disease has emerged as a significant contributor to the global burden of chronic lung disease. Recent studies suggest that more than half of individuals who complete TB therapy continue to experience lasting impairments in lung function. It remains an underrecognized cause of chronic respiratory morbidity, even in high-income countries. In nonsmokers, it may mimic chronic obstructive pulmonary disease (COPD) or asthma but often shows poor reversibility and limited response to standard therapy. Case A 55-year-old Kenyan-born woman, a lifelong nonsmoker, presented with chronic cough, sputum production, and exertional dyspnea decades after successfully treated childhood pulmonary tuberculosis. Imaging revealed right upper lobe scarring, traction bronchiectasis, and calcified nodules, consistent with post-Tuberculosis lung disease (PTLD). Serial pulmonary function tests (PFTs) over 17 years demonstrated stable, moderate airflow obstruction (FEV1 61-67% predicted, FEV1/FVC ≈58%) without bronchodilator reversibility or interval decline. Despite multiple prior therapies, including nasal steroids and short-acting bronchodilators, her symptoms persisted. She was initiated on inhaled triple therapy (budesonide/glycopyrrolate/formoterol). Within four months, she experienced complete resolution of cough and dyspnea, returning to baseline exercise tolerance and daily activities. Follow-up spirometry and imaging remained unchanged, indicating clinical improvement without measurable physiologic or radiographic change. Discussion This case highlights the dissociation that may occur between symptom burden and spirometric parameters in PTLD-related airflow obstruction. While irreversible structural changes from prior TB such as airway fibrosis and bronchiectasis, limit measurable improvement in lung function, inhaled therapy may still alleviate dynamic airway narrowing, inflammation, and cough reflex hypersensitivity. Symptomatic response in the absence of spirometric reversibility highlights the potential role of inhaled therapy, including inhaled corticosteroid/long-acting bronchodilator combinations, in this population. Conclusion Inhaled triple therapy can yield symptomatic relief in patients with post-TB obstructive lung disease, even when pulmonary function remains stable. Clinicians should consider a therapeutic trial of inhaled agents in symptomatic PTLD patients, particularly nonsmokers, with fixed obstruction guided by patient-reported outcomes rather than spirometric change alone. This abstract is funded by: None