[Post-tuberculosis lung disease: a neglected disease]

Abstract

Globally, the number of patients with post-tuberculosis lung disease (PTLD) is huge, with high morbidity and mortality. PTLD is defined as chronic respiratory abnormality that affects large and small airways (bronchiectasis and obstructive lung disease), lung parenchyma, pulmonary vasculature, and pleura and may be complicated, with or without symptoms, attributable at least in part to previous pulmonary tuberculosis. The aforementioned chronic respiratory abnormality may be complicated due to coinfection such as fungi and nontuberculosis mycobacteria. Risk factors for PTLD include multiple episodes of tuberculosis, drug-resistant tuberculosis, delays in diagnosis, smoking, and possible diabetes. Empirical expert opinion advocates preventive anti-tuberculosis treatment for high-risk groups of tuberculosis, early diagnosis and treatment of tuberculosis, surgical treatment for specific groups, pulmonary rehabilitation for patients after tuberculosis treatment, early identification and treatment of co-infection. It is effective to prevent the occurrence of PTLD, improve the treatment effect, and prevent the deterioration of the disease. As a high TB burden country, PTLD has been seriously neglected in China. Internationally, there is currently a lack of epidemiological survey data on post-TB pulmonary disease, and there are few studies on its clinical characteristics, risk factors, prevention, and treatment. With an emerging literature on PTLD, collaborative research is urgently needed to inform our understanding of the natural history, prevention, and treatment of PTLD, and to allow for the development of much needed evidence-based guidelines.