Spirometry and radiological sequelae in post pulmonary tuberculosis: A systematic review

<b>Introduction:</b> In spite of effective antitubercular therapy (ATT), most patients with Pulmonary Tuberculosis (PTB) end up with variable long-term sequelae, showing the transition of a curable communicable disease into a chronic comorbid state. <b>Objectives:</b> A systematic review was conducted to determine the proportion of patients with residual radiological lesions or abnormal spirometry after completing ATT for PTB. <b>Methods:</b> An electronic search identified studies in PubMed and Embase. Articles published in English between January 1990-April 2021 were included. <b>Results:</b> 10267 potentially relevant articles were identified, finally including 81 articles in the review, comprising a total of 14112 patients (including 622 HIV positive and 327 MDR-TB patients). 40-86.2% of patients showed some radiographic abnormalities. Cavitation and bronchiectasis were observed in 1.5-52.9% and 4.3-17% of patients on chest radiography, and in 7.3-36.7% and 35-86.4% on CT respectively. While almost all patients with MDR-TB had residual radiological lesions, HIV-positive patients showed lesser sequelae and cavitation in only 2-8.3% of them. More than 70% of the studies showed at least 40% of patients developing some abnormality on spirometry. Obstructive impairment was the predominant pattern (26 studies, 53%). 60% of studies showed 10-40% of the patients developed obstructive impairment. While less than 40% of MDR TB patients had normal lung function, more than 60% of HIV-TB co-infected patients had a normal spirometry profile after treatment completion. <b>Conclusion:</b> Our study emphasizes the need for long-term clinic-radiological follow-up after ATT to identify and prevent debilitating pulmonary sequelae.