Lung function impairment in children post-tuberculosis treatment: a systematic review and meta-analysis

Background Pulmonary tuberculosis (PTB) in childhood can result in persistent lung function impairment in adults, but data among children remain limited. This systematic review and meta-analysis aimed to summarize and update current evidence on pulmonary function outcomes after PTB treatment in children. Methods We searched PubMed, Embase, Web of Science, and Scopus up to October 23, 2025. Eligible studies included children (≤18 years) with PTB who underwent post-treatment spirometry. Pooled mean z-scores for FEV₁, FVC, and FEV1/FVC ratio were calculated using random-effects models. For comparative studies, standardised mean differences (Hedges' g) were derived to compare post-PTB children with healthy controls. Results Nine studies were included. The pooled post-treatment mean z-scores indicated significant reductions in both FEV₁ (-1.51, 95% CI -2.38 to -0.64) and FVC (-1.36, 95% CI -2.60 to -0.12), while the FEV1/FVC ratio showed no significant deviation (0.04, 95% CI -1.29 to 1.37). In case-control comparisons, post-PTB children had significantly lower FEV₁ (Hedges' g = -0.46, 95% CI -0.78 to -0.13) and FVC (Hedges' g = -0.29, 95% CI -0.50 to -0.08) compared with controls, while the FEV1/FVC ratio (Hedges' g = -0.32, 95% CI -0.58 to -0.06) showed only a marginal decline. Heterogeneity across analyses was moderate to high (I 2 = 55%-98%). Conclusions This updated systematic review and meta-analysis indicates that children who have completed PTB treatment frequently exhibit FEV₁ and FVC values below age matched reference levels, although estimates vary substantially across studies. Pooled effect sizes should be interpreted as indicative of association rather than precise estimates of magnitude. Additional prospective, microbiologically confirmed, and age-specific studies are necessary to better understand the long-term effects of childhood TB on lung development. Systematic review registration https://www.crd.york.ac.uk/prospero/, PROSPERO CRD420251166413.