Comorbidity of chronic obstructive pulmonary disease and pulmonary tuberculosis: a bibliometric analysis (2011-2025) with narrative review.

BACKGROUND

Chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis (PTB) are major global respiratory diseases that frequently coexist, particularly in low- and middle-income countries. This study combined bibliometric analysis with a narrative review to explore research trends, hotspots, and advancements in COPD-PTB comorbidity.

METHODS

We analyzed studies from the Web of Science (2011-2025) using VOSviewer and CiteSpace for bibliometric visualization, alongside a narrative review of key studies covering epidemiology, diagnosis, pulmonary function, biomarkers, mechanisms, and imaging.

RESULTS

Publications peaked in 2024, with China contributing the most papers (n=242) and the United States receiving the most citations (n=7,977). The most prolific journal was the International Journal of Chronic Obstructive Pulmonary Disease, and the Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 was the most cited. Epidemiological data confirm that prior PTB increases COPD risk, and vice versa, with overlapping geographical burden. Diagnostic approaches are heterogeneous-varied combinations of spirometry, imaging, and clinical history-resulting in underdiagnosis. In the exploration of biomarkers, inflammation-related indicators such as interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), systemic inflammatory response index (SIRI), myeloperoxidase (MPO), as well as metabolites including aspartic acid and asparagine, have demonstrated promising potential. However, their clinical applicability remains limited due to a lack of dynamic threshold criteria and multicenter validation. Mechanistically, cigarette smoke and Mycobacterium tuberculosis synergistically drive inflammatory responses. Innovative imaging methods such as artificial intelligence (AI)-assisted computed tomography (CT) and dual-energy CT (DECT) show potential for early detection.

CONCLUSIONS

This study highlights the significant comorbidity between COPD and PTB, with both conditions exacerbating each other's severity and worsening patient prognosis. Epidemiological data confirm that a history of PTB increases the risk of developing COPD, and vice versa. Advances in biomarkers and imaging techniques, such as AI-assisted CT and DECT, offer promising avenues for early diagnosis and better management. Future work should focus on multimodal diagnostic frameworks, disease-specific biomarkers, and radiomics-based imaging to improve recognition and management of COPD-PTB comorbidity.