Chronic obstructive pulmonary disease (COPD) is a leading cause of respiratory morbidity and mortality, most often linked to smoking. However, growing evidence indicates that previous tuberculosis (TB) infection is also a critical risk factor for COPD. This review aimed at providing a comprehensive perspective on TB-COPD, covering its epidemiologic significance, pathogenesis, clinical characteristics, and current management approaches. Tuberculosis-associated chronic obstructive pulmonary disease (TB-COPD) is characterized by persistent inflammatory responses, altered immune pathways, and extensive structural lung damage—manifested as cavitation, fibrosis, and airway remodeling. Multiple epidemiologic studies have shown that individuals with a history of TB have a significantly higher likelihood of developing COPD and experiencing worse outcomes, such as increased breathlessness and frequent exacerbations. Key pathogenic mechanisms include elevated matrix metalloproteinase activity and excessive neutrophil-driven inflammation, which lead to alveolar destruction, fibrotic scarring, and the development of bronchiectasis. Treatment generally follows current COPD guidelines, advocating the use of long-acting bronchodilators and the selective application of inhaled corticosteroids. Studies have demonstrated that indacaterol significantly improves lung function and respiratory symptoms, while long-acting muscarinic antagonists have shown survival benefits.

Citations

• Beyond the Lungs: Cardiovascular Risk in COPD Patients with a History of Tuberculosis—A Narrative Review
  Ramona Cioboata, Mihai Olteanu, Denisa Maria Mitroi, Simona-Maria Roșu, Maria-Loredana Tieranu, Silviu Gabriel Vlasceanu, Simona Daniela Neamtu, Eugen Nicolae Tieranu, Rodica Padureanu, Mara Amalia Balteanu
  Journal of Clinical Medicine.2026; 15(2): 661.     CrossRef
• Profile of Proteases with Elastolytic Activity and Functional Respiratory Disorders in the Pathogenesis of Pulmonary Tuberculosis
  D. S. Esmedlyaeva, N. P. Alekseeva, L. D. Kiryukhina, M. E. Dyakova, P. V. Gavrilov, I. V. Grigoriev, P. K. Yablonsky
  Bulletin of Siberian Medicine.2026; 25(3): 101.     CrossRef
• Pulmonary tuberculosis during the developmental period contributes to COPD and pre-COPD in mid-to-late adulthood: a retrospective cohort study
  Wei-ping Hu, Jian-cheng Zhu, Yue Ren, Yixing Wu, Li Liu, Xia Wang, Xiao Wang, Kehan Song, Jie Wu, Jing Zhang
  Therapeutic Advances in Respiratory Disease.2026;[Epub]     CrossRef
• Irisin in airway remodeling in COPD: Regulatory mechanisms from epithelial barrier to smooth muscle
  Xiaoying Yang, Xilong Wang
  Respiratory Medicine.2026; 261: 109020.     CrossRef
• Analysis of tuberculosis and multiple diseases as co-morbidities: a narrative review
  Yaqi Sun, Kaixin Zhou, Wenhui Wang, Qian Gao, Yan Lin
  Annals of Medicine.2026;[Epub]     CrossRef
• Association between documented tuberculosis history and chronic obstructive pulmonary disease (COPD) among patients attending respiratory clinics in Jember, Indonesia: A multicenter cross-sectional study
  Adistha Eka Noveyani, Ahmad Putra Hadaetana, Angga Mardro Raharjo
  Population Medicine.2026; 8(3): 1.     CrossRef
• Recent advances in pulmonary tuberculosis, the application of deep learning to medical topics, and highlights from this issue of Ewha Medical Journal
  Hae-Sun Chung
  Ewha Medical Journal.2025; 48(2): e16.     CrossRef
• History of Pulmonary Tuberculosis Accelerates Early Onset and Severity of COPD: Evidence from a Multicenter Study in Romania
  Ramona Cioboata, Silviu Gabriel Vlasceanu, Denisa Maria Mitroi, Ovidiu Mircea Zlatian, Mara Amalia Balteanu, Gabriela Marina Andrei, Viorel Biciusca, Mihai Olteanu
  Journal of Clinical Medicine.2025; 14(17): 5980.     CrossRef
• Bidirectional Association Between Tuberculosis and Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis
  Jingyuan Feng, Minghao Hu, Hongfei Duan
  Journal of Clinical Medicine.2025; 14(21): 7639.     CrossRef
• Immune Mechanisms of the Comorbid Course of Chronic Obstructive Pulmonary Disease and Tuberculosis
  Stanislav Kotlyarov, Dmitry Oskin
  BIOCELL.2025; 49(9): 1631.     CrossRef
• Chronic Obstructive Pulmonary Disease in Never-Smokers—A Distinct Entity Within the COPD Spectrum
  Andreea-Nicoleta Mălăescu, Florin-Dumitru Mihălțan, Ancuța-Alina Constantin
  Life.2025; 16(1): 43.     CrossRef