Post-pulmonary tuberculosis lung function: a systematic review and meta-analysis.

BACKGROUND: Although post-tuberculosis lung disease poses a substantial threat to individuals who have recovered from pulmonary tuberculosis, data showing objective functional impairment in such people are scarce. We did a systematic review and meta-analysis to estimate respiratory impairment after pulmonary tuberculosis disease and examine differences in ventilatory defects.

METHODS: We systematically searched Embase, MEDLINE, and CINAHL from Jan 1, 2000, to Dec 13, 2024. We included any study design with data on lung function tests in individuals with a previous diagnosis of pulmonary tuberculosis versus healthy controls. Outcomes extracted from eligible studies included forced expiratory volume in 1 s (FEV), forced vital capacity (FVC), FEVas a percentage of the predicted value (FEV%), FVC as a percentage of the predicted value (FVC%), and FEV/FVC ratio. Pre-bronchodilator values were preferentially selected. Random effects mean difference models were used when possible and standardised mean difference where it was necessary to standardise to a single scale (ie, FEV%, FVC%, and FEV/FVC ratio). Between-study heterogeneity was estimated with I. This study was prospectively registered with PROSPERO (CRD42021248838).

FINDINGS: Of the 5594 publications found, data from 19 studies were included for meta-analyses, reporting on 75 960 individuals of whom 7447 had past pulmonary tuberculosis. All studies reporting absolute values, using various levels of adjustment or standardisation, showed that previous pulmonary tuberculosis had a negative effect across all spirometric values: FEV-0·41 L (95% CI -0·51 to -0·32, I=90·4%), FVC -0·25 L (-0·33 to -0·17, I=80·6%), and FEV/FVC ratio -0·37 (-0·54 to -0·19, I=92·0%). In those studies, using reference values to derive FEV% and FVC %, prior pulmonary tuberculosis had a pooled standardised mean difference of -0·44 (-0·60 to -0·28, I=95·6%) and -0·33 (-0·54 to -0·13, I=91·3%), respectively, compared with controls.

INTERPRETATION: People who recover from pulmonary tuberculosis have significantly decreased lung function compared with controls, with FEVmore affected than FVC, giving a mixed obstructive and restrictive picture with predominantly airflow obstruction.

FUNDING: Breathing Matters.