Long-term Sequelae of Pulmonary Tuberculosis: A Narrative Review

Despite effective chemotherapy, tuberculosis (TB) survivors experience excess morbidity and mortality associated with long-term sequelae. Ventilatory defects, such as airflow obstruction, restriction, and mixed patterns, have been reported in over half of treated pulmonary TB cases. Spirometry alone underestimates burden, with impaired diffusing capacity, gas trapping, heterogeneous airway, and parenchymal damage on lung imaging, functional impairment, and persistent respiratory symptoms commonly reported. Bronchiectasis and chronic pulmonary aspergillosis are also common and occur in approximately one-third of TB survivors. Beyond the lungs, observational data consistently link TB to elevated cardiovascular disease risk, including myocardial infarction, stroke, and peripheral arterial disease, during and after TB treatment. Tuberculosis is also associated with increased lung cancer risk independent of smoking exposure, with adenocarcinoma, squamous cell, and small cell carcinomas commonly reported. While ongoing research suggests a key role of a dysfunctional host inflammatory response in the pathogenesis of TB sequelae, several knowledge gaps persist. Key among them include identifying individuals at highest risk of TB sequelae, defining clinically relevant phenotypes, endotypes, and natural history trajectories, and identifying prognostic biomarkers and potentially modifiable targets for immunomodulatory therapies. In this narrative review, we discuss key long-term sequelae of pulmonary TB, highlight research priorities, and propose a way forward through new research initiatives such as the "Long TB Study."