Post-tuberculosis Lung Disease

The burden of long-term functional impairment following curative treatment for tuberculosis (TB) constitutes a significant global health problem. By some estimates, chronic respiratory impairment, or post-tuberculosis lung disease (PTLD), is present in just over half of all patients who have completed TB therapy. Despite this high prevalence and substantial associated morbidity, discussion of PTLD is essentially absent from international and national TB policies and guidelines. Clear and ambitious clinical standards should be established for the diagnosis and management of PTLD, including the stipulation that all patients completing TB therapy should be screened for PTLD. Patients diagnosed with PTLD should receive linkage to chronic care, with access to inhalers and home oxygen, as indicated based on individual symptoms and pathophysiology. Leveraging their considerable influence, major funders, such as The Global Fund, could help close the gap in PTLD care by including PTLD in their strategic vision and funding streams. Immediate action is needed to address the substantial burden of disease associated with PTLD. This will require expanding the global approach to TB to include a commitment to diagnosing and treating long-term complications following initial curative therapy.

Introduction

Sequelae from tuberculosis (TB) infection account for a substantial proportion of the overall morbidity associated with tuberculosis, contributing up to 47% of the disease burden in terms of Disability-Adjusted Life Years (DALYs). The disease can take a physical, economic, and social toll on its patients, who are frequently already vulnerable. Providing both medical and social support is necessary for appropriate care.

Post-TB lung disease (PTLD) is an increasingly recognized complication of tuberculosis, The First International Post-Tuberculosis Symposium (2019) established the minimum case definition for PTLD as “evidence of chronic respiratory abnormality, with or without symptoms, attributable at least in part to previous tuberculosis”.

Despite increasing recognition of the problem among clinicians and academics, screening for the disease after curative therapy rarely happens in practice. The term “post-tuberculosis lung disease” is not included in the recently launched Global Tuberculosis Dictionary and international organizations provide little, if any, guidance. The WHO consolidated TB guidelines contain no mention of PTLD. At the national level, clear strategies for addressing PTLD are absent from National Tuberculosis Programs (NTPs), even in the countries with the highest burden of TB.

What are clinicians on the front-line to do? PTLD’s prevalence and morbidity demand a more prominent place in international guidelines and national policy.