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COPD Risk is Increased in TB Survivors

<乌鸦传媒視頻 class="dek">—Heads up: These investigators found that TB survivors had a higher incidence of COPD and were more likely than control subjects to be hospitalized for COPD-related complications.

By Candy Gulko
Reviewed by Sejal Makhvana Bhavsar, MD

鈥淥ur population-based matched cohort study revealed that tuberculosis (TB) survivors exhibited a notably higher incidence of chronic obstructive pulmonary disease (COPD) compared to controls,鈥� Hyun Lee, MD, PhD, co-corresponding author of a study recently published in the Journal of Korean Medical Science, told 乌鸦传媒視頻.

鈥淔urthermore,鈥� added Prof. Lee, 鈥淭B survivors were significantly more prone to hospitalization for COPD-related complications.鈥� 

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Study details

Lee and colleagues used the Korean National Health Insurance Service database to identify a cohort of 62,066 individuals, comprising 31,033 survivors of TB and an equal number of age and sex matched controls. Mean age of both groups was 57.2 卤 11.2 years. The TB survivor group included more individuals who smoked, were heavy alcohol drinkers, were less active physically and had more medical comorbidities. 

The study revealed that TB survivors had a significantly higher incidence of COPD (36.7 cases per 1,000 person-years, n = 3841) compared to controls (18.8 cases per 1,000 person-years, n = 2103), P < 0.001. The adjusted hazard ratio (aHR) for developing COPD was also higher among those with a history of TB than among controls. [aHR 1.63, 95% confidence interval (CI) 1.54 to 1.73] 

In addition, TB survivors were significantly more likely than controls to be hospitalized for COPD-related complications (10.7 versus 4.3 per 1,000 person-years, n = 1203 vs. 504, P < 0.001). The aHR was similarly higher for those in the TB survivor group than controls. (aHR, 2.03, 95% CI 1.81 to 2.27).

Although respiratory diseases were the most common cause of hospitalization in both cohorts, the proportion of respiratory disease related hospitalizations was significantly higher among those in the TB survivor group than in the control group. (P < 0.001). 

Finally, those with post-TB COPD had a higher hospitalization rate than those with non-TB COPD (aHR 1.84, CI 1.17 to 2.92.)

Implications for patient management

鈥淥ur findings suggest that proactive measures are essential for the prevention and early detection of COPD in these patients,鈥� Prof. Lee said in response to a question from 乌鸦传媒視頻 about the clinical implications for physicians treating patients with current or a history of TB. 

鈥淚t is crucial to conduct pulmonary function tests (PFTs) in TB patients; however, due to the risk of infection, PFTs should be performed after the infectious period has subsided, such as at least two weeks following anti-TB treatment or upon confirmation of an acid-fast bacillus (AFB) stain or culture conversion. Additionally, routine PFTs post-TB treatment can be instrumental in identifying COPD in patients who may otherwise go unrecognized,鈥� Prof. Lee added.

Prof. Lee lamented the lack of official guidance. 鈥淒espite the increased risk of comorbidities such as COPD, lung cancer, osteoporosis, stroke, and ischemic heart disease, as well as heightened mortality rates, current WHO (World Health Organization) and ATS/CDC/IDSA (American Thoracic Society, Centers for Disease Control, Infectious Disease Society of America) guidelines do not recommend any specific interventions for TB survivors.鈥� Prof. Lee stressed that, 鈥淚t is, therefore, imperative for healthcare providers to consider these risks and tailor their follow-up assessments accordingly.鈥�

A view from the U.S.

What are the clinical implications for physicians treating patients in countries with lower rates of TB, such as the United States? 乌鸦传媒視頻 asked independent expert MeiLan Han, MD, MS volunteer medical spokesperson for the American Lung Association, to comment.

鈥淕lobally TB is an important risk factor for COPD, but it is a much less common cause of COPD in the US,鈥� said Dr. Han, professor of internal medicine and chief of the division of pulmonary and critical care at the University of Michigan in Ann Arbor.

That said, since COPD is so prevalent in the US, what might the clinician consider if the patient with COPD has a history of TB? 鈥淚n such patients it would be reasonable to obtain chest imaging and determine extent of prior disease, obtain history on any prior treatment for the TB and decide whether treatment for latent TB should be considered if the patient had never received it,鈥� said Dr. Han.

And what about the clinical implications for possible risk reduction for COPD in patients with TB? 鈥淔or clinicians who are treating TB, early diagnosis and treatment is always a goal for multiple reasons. We would hope that earlier detection and treatment of TB would lead to lower rates of COPD developing later."

The last word

Prof. Lee concluded: 鈥淧atients with COPD who have a history of TB tend to experience poorer treatment outcomes, including increased rates of hospitalization. Consequently, it is imperative for clinicians to provide more intensive care and closely monitor these patients to manage their condition effectively.鈥� 

Published:

Candy Gulko, a freelance medical writer, has been writing for 乌鸦传媒視頻 since 2014. She is author of a chapter on medical writing ethics and of two career books.

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