Previous tuberculosis infection associated with increased frequency of asthma and respiratory symptoms in a Nordic-Baltic multicentre population study

Sanjay Gyawali; Juan Pablo López-Cervantes; Nils Oskar Jõgi; Tehmina Mustafa; Ane Johannessen; Christer Janson; Mathias Holm; Lars Modig; Christine Cramer; Thorarinn Gislason; Cecilie Svanes; Rajesh Shigdel

doi:10.1183/23120541.00011-2023

Previous tuberculosis infection associated with increased frequency of asthma and respiratory symptoms in a Nordic-Baltic multicentre population study

ERJ Open Res. 2023 May 22;9(3):00011-2023. doi: 10.1183/23120541.00011-2023. eCollection 2023 May.

Authors

Sanjay Gyawali^{1

2}, Juan Pablo López-Cervantes^{1

2}, Nils Oskar Jõgi², Tehmina Mustafa^{1

3}, Ane Johannessen¹, Christer Janson⁴, Mathias Holm⁵, Lars Modig⁶, Christine Cramer^{7

8}, Thorarinn Gislason^{9

10}, Cecilie Svanes^{1

2

11}, Rajesh Shigdel^{12

11}

Affiliations

¹ Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
² Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
³ Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
⁴ Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
⁵ Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁶ Department of Public Health and Clinical Medicine, Sustainable health, Umeå University, Umeå, Sweden.
⁷ Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark.
⁸ Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.
⁹ Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland.
¹⁰ University of Iceland, Medical faculty, Reykjavik Iceland.
¹¹ These authors contributed equally to this work as senior authors.
¹² Department of Clinical Science, University of Bergen, Bergen, Norway.

Abstract

Background: Tuberculosis (TB) infection induces profound local and systemic, immunological and inflammatory changes that could influence the development of other respiratory diseases; however, the association between TB and asthma is only partly understood. Our objective was to study the association of TB with asthma and respiratory symptoms in a Nordic-Baltic population-based study.

Methods: We included data from the Respiratory Health in Northern Europe (RHINE) study, in which information on general characteristics, TB infection, asthma and asthma-like symptoms were collected using standardised postal questionnaires. Asthma was defined based on asthma medication usage and/or asthma attacks 12 months prior to the study, and/or by a report of ≥three out of five respiratory symptoms in the last 12 months. Allergic/nonallergic asthma were defined as asthma with/without nasal allergy. The associations of TB with asthma outcomes were analysed using logistic regressions with adjustments for age, sex, smoking, body mass index and parental education.

Results: We included 8379 study participants aged 50-75 years, 61 of whom reported having had TB. In adjusted analyses, participants with a history of TB had higher odds of asthma (OR 1.99, 95% CI 1.13-3.47). The associations were consistent for nonallergic asthma (OR 2.17, 95% CI 1.16-4.07), but not for allergic asthma (OR 1.20, 95% CI 0.53-2.71).

Conclusion: We found that in a large Northern European population-based cohort, persons with a history of TB infection more frequently had asthma and asthma symptoms. We speculate that this may reflect long-term effects of TB, including direct damage to the airways and lungs, as well as inflammatory responses.