Bidirectional Association Between Tuberculosis and Chronic Obstructive Pulmonary Disease: A Systematic Review and...

Background: Tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) are major respiratory diseases contributing to high global morbidity and mortality. Recent studies suggest a potential bidirectional association between them; however, the overall evidence has not been systematically integrated. This study aims to comprehensively evaluate the bidirectional epidemiological association between TB and COPD through a systematic review and meta-analysis. Methods: We systematically searched observational studies published from database inception to 31 August 2025, in PubMed, Embase, Web of Science, and other databases. Data were extracted from studies examining the risk of COPD development in individuals with a history of TB and the risk of TB development in COPD patients. Pooled effect sizes were calculated using random-effects models, including pooled odds ratios (ORs) and prevalence rates, with assessments of heterogeneity and publication bias. Results: A total of 32 studies were included, involving over 670,000 participants. Meta-analysis revealed that individuals with a history of TB had a significantly increased risk of developing COPD (pooled OR = 2.46, 95% CI: 1.95-3.10). Similarly, COPD patients had a significantly elevated risk of developing TB (pooled OR = 2.21, 95% CI: 1.57-3.11). The pooled prevalence of COPD among TB patients was 15.95% (95% CI: 11.61-21.53), while the pooled prevalence of TB among COPD patients was 5.57% (95% CI: 2.24-13.18). Significant heterogeneity was observed, but no substantial publication bias was detected. Conclusions: A significant and robust bidirectional association exists between TB and COPD, with each being an important independent risk factor for the other. These findings underscore the necessity of integrated screening and comorbidity management for both diseases in clinical practice and public health strategies, particularly in high TB burden regions. Prospective studies are warranted to further elucidate causal mechanisms and evaluate interventions.