Pulmonary tuberculosis during the developmental period contributes to COPD and pre-COPD in mid-to-late adulthood: a retrospective cohort study

BACKGROUND: The effect of non-smoking factors on Chronic Obstructive Pulmonary Disease (COPD) is gaining attention. Long-term contributions of pulmonary tuberculosis (PTB) during the developmental period to COPD development in later adulthood remain poorly understood. OBJECTIVES: To investigate the impact of PTB during the developmental period of COPD and pre-COPD. DESIGN: Retrospective cohort studyMethods:This retrospective cohort study analyzed 496,534 participants using the UK Biobank cohort. PTB during the developmental period was defined as a diagnosis at age ⩽25 years. Outcomes were COPD and pre-COPD stages, including preserved ratio impaired spirometry (PRISm) and impaired spirometry (below Lower Limit of Normal (LLN) thresholds). Associations were evaluated using the multivariable logistic regression, adjusting for age, sex, body mass index, smoking, asthma, bronchiectasia, and air pollution. RESULTS: Among 10,178 patients (62 (9) years old) diagnosed with COPD, PTB during the developmental period was statistically associated with increased COPD risk across four models, showing a fully adjusted odds ratio (aOR) of 1.82 (95% CI: 1.45-2.26), and remained significant regardless of sex or smoking status. Critically, PTB was also independently associated with both PRISm and airflow obstruction (aOR = 1.52, 95% CI: 1.35-1.71) and impaired spirometry below LLN (aOR = 1.32, 95% CI: 1.14-1.52). Sensitivity analyses further reinforced the robustness of these findings. CONCLUSION: PTB during the developmental period is an independent risk factor for COPD and pre-COPD status in mid-to-late adulthood, necessitating long-term respiratory monitoring in PTB during the developmental period survivors and the implementation of targeted public health strategies.