Ratnakumar, S;
Hayward, SE;
Denneny, EK;
Goldsmith, LP;
Evans, R;
Checkley, W;
Goletti, D;
... Porter, JC; + view all
(2025)
Post-pulmonary tuberculosis lung function: a systematic review and meta-analysis.
The Lancet Global Health
, 13
(6)
e1020-e1029.
10.1016/S2214-109X(25)00105-6.
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Abstract
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 (FEV1), forced vital capacity (FVC), FEV1 as a percentage of the predicted value (FEV1%), FVC as a percentage of the predicted value (FVC%), and FEV1/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, FEV1%, FVC%, and FEV1/FVC ratio). Between-study heterogeneity was estimated with I2. 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: FEV1 –0·41 L (95% CI –0·51 to –0·32, I2=90·4%), FVC –0·25 L (–0·33 to –0·17, I2=80·6%), and FEV1/FVC ratio –0·37 (–0·54 to –0·19, I2=92·0%). In those studies, using reference values to derive FEV1% and FVC %, prior pulmonary tuberculosis had a pooled standardised mean difference of –0·44 (–0·60 to –0·28, I2=95·6%) and –0·33 (–0·54 to –0·13, I2=91·3%), respectively, compared with controls. // Interpretation: People who recover from pulmonary tuberculosis have significantly decreased lung function compared with controls, with FEV1 more affected than FVC, giving a mixed obstructive and restrictive picture with predominantly airflow obstruction. // Funding: Breathing Matters.
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