Long term management of people with post-tuberculosis lung disease

Korean J Intern Med. 2024 Jan;39(1):7-24. doi: 10.3904/kjim.2023.395. Epub 2024 Jan 1.

Abstract

Post-tuberculosis lung disease (PTLD) is emerging as a significant area of global interest. As the number of patients surviving tuberculosis (TB) increases, the subsequent long-term repercussions have drawn increased attention due to their profound clinical and socioeconomic impacts. A primary obstacle to its comprehensive study has been its marked heterogeneity. The disease presents a spectrum of clinical manifestations which encompass tracheobronchial stenosis, bronchiectasis, granulomas with fibrosis, cavitation with associated aspergillosis, chronic pleural diseases, and small airway diseases-all persistent consequences of PTLD. The spectrum of symptoms a patient may experience varies based on the severity of the initial infection and the efficacy of the treatment received. As a result, the long-term management of PTLD necessitates a detailed and specific approach, addressing each manifestation individually-a tailored strategy. In the immediate aftermath (0-12 months after anti-TB chemotherapy), there should be an emphasis on monitoring for relapse, tracheobronchial stenosis, and smoking cessation. Subsequent management should focus on addressing hemoptysis, managing infection including aspergillosis, and TB-associated chronic obstructive pulmonary disease or restrictive lung function. There remains a vast expanse of knowledge to be discovered in PTLD. This review emphasizes the pressing need for comprehensive, consolidated guidelines for management of patients with PTLD.

Keywords: Aspergillosis; Bronchiectasis; Chronic obstructive pulmonary disease; Tuberculosis.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aspergillosis* / complications
  • Chronic Disease
  • Constriction, Pathologic
  • Humans
  • Lung Diseases*
  • Tuberculosis* / complications
  • Tuberculosis, Pulmonary* / complications
  • Tuberculosis, Pulmonary* / diagnosis
  • Tuberculosis, Pulmonary* / drug therapy