Post-Tuberculosis Lung Disease: Clinical Spectrum, Management Principles, and Lifelong Consequences

Post-tuberculosis lung disease (PTLD) is an increasingly recognized consequence of pulmonary tuberculosis (TB) disease, affecting millions of survivors worldwide and imposing substantial clinical, functional, and socioeconomic burdens. This narrative review synthesizes current evidence across epidemiology, definitions, clinical phenotypes, assessment, and management, with dedicated consideration of children and adolescents. PTLD is common: Studies report abnormal spirometry in ∼60% of TB survivors and persistent, activity-limiting dyspnea in a sizeable minority. Outcomes are generally worse in low- and middle-income settings. The 2019 international consensus definition-"evidence of chronic respiratory abnormality attributable at least in part to prior TB"-has catalyzed research and service development; a newer research definition proposes a structured, three-domain approach (symptoms, radiology, lung function) and introduces "post-TB lung abnormality" for single-domain findings. PTLD encompasses heterogeneous patterns, including fibrosis, cavitation with chronic pulmonary aspergillosis risk, bronchiectasis, airflow obstruction, tracheobronchial stenosis, pleural disease, vascular complications, and pulmonary hypertension. Assessment should integrate symptom review, exercise capacity, oximetry, spirometry (with Global Lung Initiative [GLI] reference standards), and context-appropriate imaging, alongside targeted microbiology and echocardiography where indicated. Evidence for disease-modifying therapy remains limited; however, pulmonary rehabilitation improves function and symptoms, and selected patients may benefit from inhaled bronchodilators or surgical interventions. A "treatable traits" framework-spanning pulmonary, extrapulmonary, and behavioral risk domains-offers a pragmatic, person-centered strategy while high-quality trials mature. In children, TB during critical periods of lung development confers lasting functional and growth impacts, underscoring the need for age-specific screening and follow-up. We outline key research priorities: embedding PTLD outcomes in TB trials, standardizing measurement, elucidating mechanisms, evaluating host-directed therapies, and integrating post-TB care into routine health services.