Association between history of pulmonary tuberculosis and chronic obstructive pulmonary disease: a systematic review and meta-analysis.

BACKGROUND

Survivors of pulmonary tuberculosis (TB) frequently report chronic respiratory symptoms; however, the magnitude of the association with chronic obstructive pulmonary disease (COPD) and the reciprocal burden of COPD and TB in each population remain unclear. Hence, this review was conducted to determine the association between a history of pulmonary tuberculosis and chronic obstructive pulmonary disease.

METHODS

Following PRISMA 2020, we searched MEDLINE, Embase, Web of Science, and Scopus from inception to August 2025 for analytical observational studies comparing individuals with and without a history of pulmonary TB. Odds ratios (ORs) were pooled using random-effects inverse-variance models (DerSimonian-Laird). Heterogeneity (I 2 and τ 2) and small-study effects (using Egger's test) were assessed. Prevalence meta-analyses were conducted to estimate the following: (i) COPD among pulmonary TB survivors and (ii) the prevalence of prior pulmonary TB among people with COPD.

RESULTS

Forty studies met the inclusion criteria. Twenty-six studies (n = 1,044,562) contributed to the association analysis: prior pulmonary TB was associated with higher odds of COPD (pooled OR = 2.65, 95% CI: 2.14-3.28), with substantial heterogeneity (I 2 = 94.9%). When stratified by study design, pooled ORs were 4.92 for case-control studies, 2.64 for cross-sectional studies, and 2.46 for cohort studies. Across regions, positive associations were found in Asia (2.21), Africa (9.36), the Americas (3.60), and Europe (2.77). Egger's test indicated small-study effects (p = 0.013), but sensitivity analyses showed that the pooled estimates were reliable. The pooled prevalence of COPD among survivors of pulmonary TB was 34% (95%CI: 28-40%). Among COPD patients, 17% (95% CI: 10-24%) reported a history of pulmonary TB.

CONCLUSION

A history of pulmonary TB was found to be a strong and consistent risk factor for COPD across different designs and regions, with a significant bidirectional burden. Integrating post-TB lung assessment (including spirometry), targeted COPD management, and risk-reduction strategies into TB programs is required.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261415397, PROSPERO registration number is CRD420261415397.