J Korean Med Sci.  2024 Mar;39(11):e105. 10.3346/jkms.2024.39.e105.

Increased Risk of Incident Chronic Obstructive Pulmonary Disease and Related Hospitalizations in Tuberculosis Survivors: A PopulationBased Matched Cohort Study

• Kim T
• Choi H
• Kim SH
• Yang B
• Han K
• Jung JH
• Kim BG
• Park DW
• Moon JY
• Kim SH
• Kim TH
• Yoon HJ
• Shin DW
• Lee H

• KMID: 2554203
• DOI: http://doi.org/10.3346/jkms.2024.39.e105

Abstract

Background
Tuberculosis (TB) survivors have an increased risk of developing chronic obstructive pulmonary disease (COPD). This study assessed the risk of COPD development and COPD-related hospitalization in TB survivors compared to controls.
Methods
We conducted a population-based cohort study of TB survivors and 1:1 age- and sex-matched controls using data from the Korean National Health Insurance Service database collected from 2010 to 2017. We compared the risk of COPD development and COPD-related hospitalization between TB survivors and controls.
Results
Of the subjects, 9.6% developed COPD, and 2.8% experienced COPD-related hospitalization. TB survivors had significantly higher COPD incidence rates (36.7/1,000 vs. 18.8/1,000 person-years, P < 0.001) and COPD-related hospitalization (10.7/1,000 vs. 4.3/1,000 person-years, P < 0.001) than controls. Multivariable Cox regression analyses revealed higher risks of COPD development (adjusted hazard ratio [aHR], 1.63; 95% confidence interval [CI], 1.54–1.73) and COPD-related hospitalization (aHR, 2.03; 95% CI, 1.81–2.27) in TB survivors. Among those who developed COPD, the hospitalization rate was higher in individuals with post-TB COPD compared to those with non-TB COPD (10.7/1,000 vs. 4.9/1,000 person-years, P < 0.001), showing an increased risk of COPD-related hospitalization (aHR, 1.84; 95% CI, 1.17–2.92).
Conclusion
TB survivors had higher risks of incident COPD and COPD-related hospitalization compared to controls. These results suggest that previous TB is an important COPD etiology associated with COPD-related hospitalization.

Keyword

Pulmonary Tuberculosis; Chronic Obstructive Pulmonary Disease; Hospitalization; Observational Study

Figure

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  Fig. 1 Flowchart of study subject selection.NHIS = Korean National Health Insurance Service, MDR = multi-drug resistant, TB = tuberculosis, COPD = chronic obstructive pulmonary disease.

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  Fig. 2 Cumulative incidence probability (%) of COPD incidence (A) and COPD-related hospitalization (B) according to the presence or absence of a previous TB history.TB = tuberculosis, COPD = chronic obstructive pulmonary disease.

Reference

1. World Health Organization. The top 10 causes of death. Updated 2020. Accessed December 12, 2023. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death .

2. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006; 3(11):e442. PMID: 17132052.

3. Kim SH, Lee H, Kim Y, Rhee CK, Min KH, Hwang YI, et al. Recent prevalence of and factors associated with chronic obstructive pulmonary disease in a rapidly aging society: Korea National Health and Nutrition Examination Survey 2015-2019. J Korean Med Sci. 2023; 38(14):e108. PMID: 37038644.

4. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (2023 report). Updated 2023. Accessed December 12, 2023. www.goldcopd.org .

5. Lee H, Sin DD. GETting to know the many causes and faces of COPD. Lancet Respir Med. 2022; 10(5):426–428. PMID: 35427529.

6. Amaral AF, Coton S, Kato B, Tan WC, Studnicka M, Janson C, et al. Tuberculosis associates with both airflow obstruction and low lung function: BOLD results. Eur Respir J. 2015; 46(4):1104–1112. PMID: 26113680.

7. Menezes AM, Hallal PC, Perez-Padilla R, Jardim JR, Muiño A, Lopez MV, et al. Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America. Eur Respir J. 2007; 30(6):1180–1185. PMID: 17804445.

8. Byrne AL, Marais BJ, Mitnick CD, Lecca L, Marks GB. Tuberculosis and chronic respiratory disease: a systematic review. Int J Infect Dis. 2015; 32:138–146. PMID: 25809770.

9. Fan H, Wu F, Liu J, Zeng W, Zheng S, Tian H, et al. Pulmonary tuberculosis as a risk factor for chronic obstructive pulmonary disease: a systematic review and meta-analysis. Ann Transl Med. 2021; 9(5):390. PMID: 33842611.

10. Park HJ, Byun MK, Kim HJ, Ahn CM, Kim DK, Kim YI, et al. History of pulmonary tuberculosis affects the severity and clinical outcomes of COPD. Respirology. 2018; 23(1):100–106. PMID: 28845558.

11. Celli BR. Predictors of mortality in COPD. Respir Med. 2010; 104(6):773–779. PMID: 20417082.

12. Lee H, Kim J, Park G, Choi H. Global burden of tuberculosis in 2021 - global tuberculosis report 2022. Public Health Wkly Rep. 2023; 16:578–594.

13. Shin DW, Cho B, Guallar E. Korean National Health Insurance Database. JAMA Intern Med. 2016; 176(1):138.

14. Shin DW, Cho J, Park JH, Cho B. National General Health Screening Program in Korea: History, current status, and future direction. Precis Future Med. 2022; 6(1):9–31.

15. Moon SM, Choi H, Kim SH, Kang HK, Park DW, Jung JH, et al. Increased lung cancer risk and associated risk factors in tuberculosis survivors: a Korean population-based study. Clin Infect Dis. 2023; 77(9):1329–1339. PMID: 37345907.

16. Lee HR, Yoo JE, Choi H, Han K, Lim YH, Lee H, et al. Tuberculosis and the risk of ischemic heart disease: a nationwide cohort study. Clin Infect Dis. 2023; 76(9):1576–1584. PMID: 36519336.

17. Choi H, Han K, Jung JH, Park SH, Kim SH, Kang HK, et al. Long-term mortality of tuberculosis survivors in Korea: a population-based longitudinal study. Clin Infect Dis. 2023; 76(3):e973–e981. PMID: 35616107.

18. Yoo JE, Choi H, Han K, Park SH, Park J, Lee H, et al. Tuberculosis and risk of Parkinson’s disease: a nationwide cohort study. Pulmonology. 2023; 29(3):250–252. PMID: 36473828.

19. Kim T, Choi H, Lee H, Han K, Park DW, Park TS, et al. Impact of allergic disease on the risk of mycobacterial disease. J Allergy Clin Immunol Pract. 2023; 11(9):2830–2838.e4. PMID: 37178766.

20. Yeo Y, Yoo JE, Han K, Jung JH, Choi H, Park J, et al. Risk of dementia in survivors of active tuberculosis in Korea: a nationwide cohort study. J Infect Public Health. 2024; 17(2):286–292. PMID: 38142633.

21. Choi H, Yoo JE, Han K, Choi W, Rhee SY, Lee H, et al. Body mass index, diabetes, and risk of tuberculosis: a retrospective cohort study. Front Nutr. 2021; 8:739766. PMID: 34926543.

22. Choi H, Han K, Yang B, Shin DW, Sohn JW, Lee H. Female reproductive factors and incidence of nontuberculous mycobacterial pulmonary disease among postmenopausal women in Korea. Clin Infect Dis. 2022; 75(8):1397–1404. PMID: 35165686.

23. Kim SH, Han K, Park J, Park DW, Moon JY, Sim YS, et al. Association between non-cystic fibrosis bronchiectasis and the risk of incident dementia: a nationwide cohort study. Chron Respir Dis. 2023; 20:14799731231222282. PMID: 38100725.

24. Yang B, Kim BG, Han K, Jung JH, Kim JH, Park DW, et al. Systemic sclerosis and risk of bronchiectasis: a nationwide longitudinal cohort study. Arthritis Res Ther. 2023; 25(1):209. PMID: 37872606.

25. Kim BG, Lee H, Kang MG, Kim JS, Moon JY. Risk of ischemic heart disease in chronic obstructive pulmonary disease: a nationwide cohort study. J Korean Med Sci. 2023; 38(42):e344. PMID: 37904657.

26. Kim Y, Yoon JH, Ryu J, Yang B, Chung SJ, Kang HK, et al. Gastroesophageal reflux disease increases susceptibility to nontuberculous mycobacterial pulmonary disease. Chest. 2023; 163(2):270–280. PMID: 36087796.

27. Khan NF, Perera R, Harper S, Rose PW. Adaptation and validation of the Charlson Index for Read/OXMIS coded databases. BMC Fam Pract. 2010; 11(1):1. PMID: 20051110.

28. Pan WH, Yeh WT. How to define obesity? Evidence-based multiple action points for public awareness, screening, and treatment: an extension of Asian-Pacific recommendations. Asia Pac J Clin Nutr. 2008; 17(3):370–374. PMID: 18818155.

29. Choi H, Kim SH, Han K, Park TS, Park DW, Moon JY, et al. Association between exercise and risk of cardiovascular diseases in patients with non-cystic fibrosis bronchiectasis. Respir Res. 2022; 23(1):288. PMID: 36258193.

30. Lee H, Ryu J, Chung SJ, Park DW, Park TS, Moon JY, et al. Overall and respiratory mortality reduction with physical activity in subjects with and without asthma. Allergy. 2023; 78(6):1677–1680. PMID: 36602280.

31. Idolor LF, DE Guia TS, Francisco NA, Roa CC, Ayuyao FG, Tady CZ, et al. Burden of obstructive lung disease in a rural setting in the Philippines. Respirology. 2011; 16(7):1111–1118. PMID: 21801277.

32. Lee SW, Kim YS, Kim DS, Oh YM, Lee SD. The risk of obstructive lung disease by previous pulmonary tuberculosis in a country with intermediate burden of tuberculosis. J Korean Med Sci. 2011; 26(2):268–273. PMID: 21286020.

33. Ehrlich RI, White N, Norman R, Laubscher R, Steyn K, Lombard C, et al. Predictors of chronic bronchitis in South African adults. Int J Tuberc Lung Dis. 2004; 8(3):369–376. PMID: 15139477.

34. Yakar HI, Gunen H, Pehlivan E, Aydogan S. The role of tuberculosis in COPD. Int J Chron Obstruct Pulmon Dis. 2017; 12:323–329. PMID: 28176901.

35. Aggarwal D, Gupta A, Janmeja AK, Bhardwaj M. Evaluation of tuberculosis-associated chronic obstructive pulmonary disease at a tertiary care hospital: A case-control study. Lung India. 2017; 34(5):415–419. PMID: 28869224.

36. Swain S, Pothal S, Behera A, Manjhi R, Dutta P, Pradhan G. Treatment outcome among Post TB obstructive airways diseases and COPD: a prospective cohort study. J Family Med Prim Care. 2021; 10(9):3411–3416. PMID: 34760766.

37. Di Stefamo F, Conti V, Petroianni A, Terzano C. Comorbidity, Hospitalization and Mortality in COPD: Results From a Longitudinal Study. Sheffield, UK: European Respiratory Society;2012.

38. Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet. 2007; 370(9589):786–796. PMID: 17765528.

39. Ugarte-Gil CA, Elkington P, Gilman RH, Coronel J, Tezera LB, Bernabe-Ortiz A, et al. Induced sputum MMP-1, -3 & -8 concentrations during treatment of tuberculosis. PLoS One. 2013; 8(4):e61333. PMID: 23613834.

40. Riou C, Perez Peixoto B, Roberts L, Ronacher K, Walzl G, Manca C, et al. Effect of standard tuberculosis treatment on plasma cytokine levels in patients with active pulmonary tuberculosis. PLoS One. 2012; 7(5):e36886. PMID: 22606304.

41. Su WL, Perng WC, Huang CH, Yang CY, Wu CP, Chen JH. Association of reduced tumor necrosis factor alpha, gamma interferon, and interleukin-1β (IL-1β) but increased IL-10 expression with improved chest radiography in patients with pulmonary tuberculosis. Clin Vaccine Immunol. 2010; 17(2):223–231. PMID: 20007364.

42. Malherbe ST, Shenai S, Ronacher K, Loxton AG, Dolganov G, Kriel M, et al. Persisting positron emission tomography lesion activity and Mycobacterium tuberculosis mRNA after tuberculosis cure. Nat Med. 2016; 22(10):1094–1100. PMID: 27595324.

43. Salgame P. MMPs in tuberculosis: granuloma creators and tissue destroyers. J Clin Invest. 2011; 121(5):1686–1688. PMID: 21519148.

44. Allwood BW, Myer L, Bateman ED. A systematic review of the association between pulmonary tuberculosis and the development of chronic airflow obstruction in adults. Respiration. 2013; 86(1):76–85. PMID: 23652030.

45. Ravimohan S, Kornfeld H, Weissman D, Bisson GP. Tuberculosis and lung damage: from epidemiology to pathophysiology. Eur Respir Rev. 2018; 27(147):170077. PMID: 29491034.