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TB and COPD in low-income settings: a collision of old foes
  1. Jamilah Meghji1,2,
  2. Kevin Mortimer1,3,
  3. Stellah Mpangama4
  1. 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
  2. 2 Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  3. 3 Department of Respiratory Medicine, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
  4. 4 Kibong'oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
  1. Correspondence to Dr Jamilah Meghji, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; jamilah.meghji{at}

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Tuberculosis (TB) remains a major global public health challenge, with 10 million incident cases estimated in 2019. Historically, national TB programmes and international TB policy frameworks have focused on the need to identify active TB cases, improve access to care and ensure treatment completion, in order to achieve microbiological cure and improve disease survival. However, in recent years as TB survival has slowly improved, there has been a growing focus on residual post-TB morbidity, with calls for TB programmes to consider the long-term physical, psychosocial and socioeconomic well-being of TB survivors even after TB treatment completion.1 Residual lung damage after pulmonary TB disease—or post-TB lung disease—is a particular concern in TB endemic settings. For patients with TB in low-income and middle-income countries (LMICs) residual respiratory symptoms may be highly stigmatising, interfere with work and livelihoods, and lead to costly health seeking after TB treatment completion. For healthcare providers the lack of access to respiratory diagnostics, treatment guidelines and established care pathways make patients with post-TB lung disease particularly challenging to manage.

The study by Kamenar et al 2 highlights the relationship between previous TB and residual chronic obstructive pulmonary disease (COPD) in LMICs. This paper is a pooled analysis of five population-based studies in LMICs, which include data from 12 396 adults from thirteen resource-poor settings in six countries, of whom 332 (2.7%) reported a history of previous TB disease. It examines the relationship between COPD—defined as a post-bronchodilator forced expiratory volume in …

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  • Contributors All authors conceptualised this work, approved the final version for publication and agree to be accountable for all aspects of the work. JM drafted the document, with revisions by KM and SM.

  • Funding This work was supported by an MRC Skills Development Fellowship to JM (MR/S02042X/1) and the NIHR Global Health Research Unit on Lung Health and TB in Africa at LSTM (16/136/35) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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