Speaker's Highlight

• Don Sin University of British Columbia, St. Paul Hospital (Canada)
  Kenneth R. Chapman Toronto General Hospital Research Institute (Canada)
• Parameswaran Nair McMaster University (Canada)
  Carolyn Calfee UCSF (U.S.A.)
• Gregory P. Downey University of Colorado School of Medicine (U.S.A.)
  David A. Schwartz University of Colorado School of Medicine (U.S.A.)
• Neil Schluger Tuberculosis Control Branch, California Department of Public Health (U.S.A.)
  Nick Kim Critical Care & Sleep Medicine, University of California San Diego (U.S.A.)
• Nicola Hananiah Baylor College of Medicine (U.S.A.)
  Jae-Joon Yim Seoul National University College of Medicine (Republic of Korea)
• Koichiro Asano Tokai University School of Medicine (Japan)
  Diahn-Warng Perng Taipei Veterans General Hospital (Taiwan)
• Konstantinos Kostikas University of Ioannina (Greece)
  Karin Klooster University Medical Center Groningen (Kingdom of the Netherlands)

• Living with post-tuberculosis lung disease: sequelae and management

  Tuberculosis remains one of the most consequential infectious diseases in human history, and although Australia records far fewer active cases than many neighbouring countries in the Asia-Pacific region, the legacy of past infection continues to shape respiratory health for thousands of patients. Historic cohorts treated decades ago still present to general practices in Sydney, Melbourne, and Adelaide with chronic cough, breathlessness, and reduced exercise tolerance that trace back to childhood or young-adult tuberculosis.

  In regions such as Far North Queensland, the Kimberley, and parts of northern Western Australia, notification rates among Aboriginal and Torres Strait Islander communities remain higher than the national average, reflecting broader social determinants as much as pathogen exposure. Clinicians working in Townsville, Cairns, or Darwin are therefore more likely to see active disease and its long tail of post-infectious damage, while tertiary centres in Perth, Brisbane, and Melbourne regularly review patients whose tuberculosis was diagnosed overseas.

  Post-tuberculosis lung disease, often shortened to PTLD, covers a spectrum of structural and functional abnormalities that persist after microbiological cure. The Thoracic Society of Australia and New Zealand has increasingly called for PTLD to be treated as a distinct clinical entity given its contribution to chronic respiratory morbidity worldwide.

  The overview below brings together current thinking on the sequelae of pulmonary tuberculosis, the diagnostic steps available in Australian practice, and the practical considerations for long-term follow-up in primary and specialist care.

  The spectrum of post-tuberculosis lung disease

  PTLD is best understood as a heterogeneous group of disorders rather than a single condition. Patients may present with predominantly obstructive physiology, mimicking chronic obstructive pulmonary disease, or with restrictive patterns reflecting fibrotic destruction of parenchyma. The distribution depends on the location and intensity of the original infection, the timeliness of treatment, and host factors such as smoking history.

  In Australian cohorts reviewed at metropolitan centres, obstructive PTLD is the most frequently documented functional pattern, particularly among patients with a smoking history. Where obstructive disease overlaps with chronic obstructive pulmonary disease, this APSR resource supports evidence-based decisions about anticholinergic bronchodilator use and escalation pathways.

  Common structural and functional sequelae

  The radiological footprint of healed tuberculosis is broad. Fibrotic bands, traction bronchiectasis, calcified granulomata, and cavitary remodelling appear in varying combinations, often visible decades after the original episode. Lobar or segmental bronchiectasis is a particularly common finding, frequently localised to the upper lobes where reactivation disease classically occurs.

  Other recognised sequelae include airway stenosis from healed endobronchial disease, pleural thickening that restricts chest wall mechanics, and pulmonary artery narrowing that predisposes to chronic exertional symptoms. Aspergilloma formation within residual cavities, secondary infection with non-tuberculous mycobacteria, and chronic bacterial colonisation each add further complexity. The cumulative effect on quality of life can be substantial, with reduced six-minute walk distance and persistent fatigue interfering with work and family life.

  Diagnostic approach in Australian practice

  A structured assessment usually begins with a detailed history covering the year of original diagnosis, treatment regimen, and duration of therapy, alongside smoking exposure and occupational dust history. Spirometry with bronchodilator response, combined with measurement of lung volumes and diffusing capacity, helps characterise physiology and guides the choice of subsequent imaging.

  High-resolution CT is the cornerstone of imaging review, often supplemented by microbiological screening for non-tuberculous mycobacteria when symptoms suggest active infection. In public hospitals covered by Medicare, access to pulmonary function testing and CT is generally straightforward, although waitlists in rural and remote areas can delay assessment. Telehealth respiratory clinics used across Queensland Health and the Western Australian Country Health Service offer an effective bridge when travel is difficult.

  Pharmacologic and supportive management

  Bronchodilator therapy, inhaled corticosteroids where indicated, and targeted treatment of secondary infection form the pharmacologic backbone. Pulmonary rehabilitation delivered through community or hospital programs has a strong evidence base for improving exercise capacity, and Australian public hospitals typically offer an eight-week supervised course. Smoking cessation support remains essential and is fully covered under the Medicare Benefits Schedule for eligible patients.

  Vaccination is another component that clinicians sometimes overlook. Annual influenza immunisation, pneumococcal vaccination aligned with ATAGI guidance, and COVID-19 boosters all reduce the risk of acute exacerbations that can be devastating in compromised lungs. Nutritional assessment, mental health review for coexisting anxiety or depression, and social work input for housing or financial pressures round out a comprehensive package of care.

  Practical recommendations for clinicians

  Embedding PTLD review into a routine consultation is easier with a condensed checklist that prompts consistent action across practices:

  • Request baseline spirometry with bronchodilator response within three months of first review.
  • Arrange high-resolution CT when symptoms persist or spirometry is abnormal.
  • Screen annually for non-tuberculous mycobacterial infection when bronchiectasis is present.
  • Refer early to a local pulmonary rehabilitation program rather than reserving it for advanced disease.
  • Confirm immunisation against influenza, pneumococcus, and COVID-19 at least once per year.
  • Schedule regular primary-care review to catch late complications such as aspergilloma.

  Adopting even most of these steps within the first year of follow-up substantially raises the likelihood of catching new complications before they progress.

  Looking beyond microbiological cure

  Recognition of PTLD as a chronic, treatable condition is steadily changing how Australian clinicians plan long-term care. Embedding post-tuberculosis review into existing chronic respiratory pathways allows patients to benefit from the same multidisciplinary infrastructure used for chronic obstructive pulmonary disease and bronchiectasis, rather than being managed as a residual afterthought.

  A practical takeaway is to ask every patient with a tuberculosis history how far they can walk on the flat without stopping, and to act on the answer with targeted investigation, rehabilitation referral, and vaccination review. Even modest interventions delivered consistently can shift the trajectory of life after tuberculosis.

  Richard Russell Nuffield Department of Clinical Medicine, University of Oxford (United Kingdom)
• Mona Bafadhel King’s College London (United Kingdom)
  David Jackson Guy’s and St Thomas’ Hospital, King’s College London (United Kingdom)
• James Chalmers University of Dundee (United Kingdom)
  David Price University of Aberdeen (United Kingdom)