title: A systematic review of the association between pulmonary tuberculosis and the development of chronic airflow obstruction in adults.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a major public health concern, accounting for 3 million deaths annually, 90% of which occur in low- and middle-income countries. Pulmonary tuberculosis (PTB) as a contributory factor in the aetiology of COPD is under debate, with most epidemiologic evidence suggesting a positive association.
  
  
  OBJECTIVE
  To compile a systematic review of evidence for an association between PTB and the development of chronic airflow obstruction (CAO).
  
  
  METHODS
  We performed a systematic review of original English-language, peer-reviewed literature using the PubMed/MEDLINE database. CAO was defined by spirometry [FEV1:FVC ratio <0.70 or <LLN (lower limit of normal) for age].
  
  
  RESULTS
  Nineteen studies (1 case series, 3 case-control studies, 4 cohort studies, 8 single-centre cross-sectional studies and 3 multi-centre cross-sectional studies) met the eligibility criteria. All but 2 reported a positive association between PTB and CAO. Three of 4 large population-based surveys (n = 4,291-8,066) confirmed a significant association between PTB and CAO (OR 1.37 - 2.94). A formal meta-analysis was not possible owing to marked heterogeneity between studies.
  
  
  CONCLUSIONS
  This systematic review confirms evidence for a positive association between a past history of tuberculosis and the presence of CAO. The association is independent of cigarette smoking. Causality is likely but cannot be assumed.
authors: Lung Institute School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. brianallwood@gmail.com
authors: Brian W
authors: BW
authors: Allwood
authors: Landon
authors: L
authors: Myer
authors: Eric D
authors: ED
authors: Bateman
mesh_terms: D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*