Background Risk factors for COPD in high-income settings are well understood; however, less attention has been paid to contributors of COPD in low-income and middle-income countries (LMICs) such as pulmonary tuberculosis. We sought to study the association between previous tuberculosis disease and COPD by using pooled population-based cross-sectional data in 13 geographically diverse, low-resource settings.
Methods We pooled six cohorts in 13 different LMIC settings, 6 countries and 3 continents to study the relationship between self-reported previous tuberculosis disease and lung function outcomes including COPD (defined as a postbronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) below the lower limit of normal). Multivariable regressions with random effects were used to examine the association between previous tuberculosis disease and lung function outcomes.
Results We analysed data for 12 396 participants (median age 54.0 years, 51.5% male); 332 (2.7%) of the participants had previous tuberculosis disease. Overall prevalence of COPD was 8.8% (range 1.7%–15.5% across sites). COPD was four times more common among those with previous tuberculosis disease (25.7% vs 8.3% without previous tuberculosis disease, p<0.001). The adjusted odds of having COPD was 3.78 times higher (95% CI 2.87 to 4.98) for participants with previous tuberculosis disease than those without a history of tuberculosis disease. The attributable fraction of COPD due to previous tuberculosis disease in the study sample was 6.9% (95% CI 4.8% to 9.6%). Participants with previous tuberculosis disease also had lower prebronchodilator Z-scores for FEV1 (−0.70, 95% CI −0.84 to −0.55), FVC (−0.44, 95% CI −0.59 to −0.29) and the FEV1:FVC ratio (−0.63, 95% CI −0.76 to −0.51) when compared with those without previous tuberculosis disease.
Conclusions Previous tuberculosis disease is a significant and under-recognised risk factor for COPD and poor lung function in LMICs. Better tuberculosis control will also likely reduce the global burden of COPD.
- COPD epidemiology
Data availability statement
Data are available in a public, open access repository. Data are available through BIOLINCC or upon reasonable request.
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Contributors KK, SH and WC conceived the study idea and wrote the first draft of the manuscript. SH and WC performed data analysis and interpretation and designed the figures. ANG, TS, SP, MC, ALR, VEI, LG, JJM, AB-O, DA, BK, RCJ, FvG and RAW contributed to the study design, data collection and manuscript writing. All coauthors were involved in manuscript development, performed a full review of the article, approved the final version of the manuscript and were responsible for all content. WC accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding This study was sponsored and funded by the National Heart, Lung, and Blood Institute, a division of the National Institute of Health in the United States, under contracts HHSN268200900029C, HHSN26820900032C and HHSN268200900033C.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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