Anatomical and functional characteristics of symptomatic post-TB lung disease

BACKGROUND: Many of the 150 million global TB survivors continue to experience chronic respiratory problems as TB-related anatomical and functional deficits often persist beyond treatment. METHODS: Individuals who completed TB treatment for pulmonary TB in the Improving Retreatment Success Study (NCT02114684) were screened 6 months after treatment for persistent respiratory symptoms. Symptomatic individuals were evaluated by clinical interviews, pulmonary function testing, chest radiographs, chest computed tomography (CT) scans, positron emission tomography (PET) scans, and bronchoalveolar lavage. RESULTS: Persistent respiratory symptoms were reported in 20/96 (20.8%) participants. Median age was 47 years, 60% were men, and 45% reported a history of smoking. All had at least two prior episodes of TB, and 70% were living with HIV. Pulmonary function testing identified 25% (5/20) of individuals with restriction, 15% (3/20) with obstruction, and 20% (4/20) with mixed physiology. Air-trapping was present in 35% (7/20). CT revealed that fibrosis, bronchiectasis, and pulmonary nodules occurred in 100% (20/20), 75% (15/20), and 65% (13/20), respectively. On PET, [¹⁸F]FDG-avid lesions were found in 75%.CONCLUSION: We identified the complex and heterogeneous anatomical and functional characteristics of post-TB lung disease. Robust studies are urgently needed to assess TB's biological, economic, and psychosocial impact beyond treatment in high-burden settings.