{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:58:17Z","timestamp":1791845897795,"version":"4.3.4"},"reference-count":54,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background\/Objective: Chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) are among the most prevalent respiratory disorders worldwide and frequently coexist in the same patient. However, the contribution of active TB and post-tuberculosis lung disease to COPD exacerbations and long-term prognosis remains incompletely defined. This paper aim to evaluate the prevalence, clinical correlates, and prognostic significance of tuberculosis and its sequelae in patients with COPD. Materials and methods: We conducted a population-based retrospective cohort study using de-identified data from the regional healthcare information system. The cohort included all adults aged 18 years or older with a recorded diagnosis of COPD (ICD-10 code J44). Tuberculosis was identified by codes A15\u2013A19 and B90. The primary outcomes were COPD exacerbations and all-cause mortality. Group comparisons, cluster analysis, Kaplan\u2013Meier survival analysis, Cox proportional hazards modeling, and multivariable logistic regression were performed. Results: Tuberculosis and\/or its sequelae were identified in 267 of 16,714 patients (1.60%): post-TB sequelae (B90) in 197 (73.8%), active TB (A15\u2013A19) in 22 (8.2%), and both in 48 (18.0%). Compared with patients without TB, those with COPD-TB were younger (63.5 \u00b1 14.2 vs. 65.7 \u00b1 14.7 years; p = 0.018), more often male (75.3% vs. 52.0%; p &lt; 0.001), and had higher mortality (16.5% vs. 10.6%; p = 0.003). COPD-TB was associated with bronchiectasis (OR = 6.07; 95% CI, 3.03\u201312.16), pulmonary fibrosis (OR = 5.67; 95% CI, 3.40\u20139.45), and pneumonia (OR = 2.01; 95% CI, 1.50\u20132.71), but with lower prevalences of obesity, diabetes mellitus, and hypertension. Patients with TB experienced more COPD exacerbations, including recurrent exacerbations. In multivariable models, tuberculosis was associated with COPD exacerbations after adjustment for age and sex (adjusted OR = 1.43; 95% CI, 1.05\u20131.96); this association was attenuated and lost significance after further adjustment for post-tuberculosis structural lung disease, indicating that it is largely mediated by post-TB sequelae. Tuberculosis remained associated with mortality after adjustment for available covariates, both in logistic regression (adjusted OR = 1.61; 95% CI, 1.14\u20132.28) and in Cox analysis (hazard ratio = 1.37; 95% CI, 1.01\u20131.85). Conclusions: Tuberculosis and post-tuberculosis lung disease are clinically accessible risk markers associated with COPD exacerbations and mortality. These findings support recognizing patients with COPD and a history of TB as a high-risk subgroup requiring intensified follow-up, proactive exacerbation prevention, and prioritized vaccination counseling. In the context of personalized medicine, a documented history of tuberculosis and post-tuberculosis lung changes represents a clinically accessible marker that can be used to stratify individual risk and to tailor monitoring and prevention in patients with COPD.<\/jats:p>","DOI":"10.3390\/jpm16070351","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:27:37Z","timestamp":1782746857000},"page":"351","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tuberculosis and Post-Tuberculosis Lung Changes Are Associated with Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease: A Population-Based Retrospective Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8966-2702","authenticated-orcid":false,"given":"Dmitry","family":"Oskin","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Phthisiology, Ryazan State Medical University, 390026 Ryazan, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7083-2692","authenticated-orcid":false,"given":"Stanislav","family":"Kotlyarov","sequence":"additional","affiliation":[{"name":"Department of Nursing, Ryazan State Medical University, 390026 Ryazan, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e069679","DOI":"10.1136\/bmj-2021-069679","article-title":"Burden of Chronic Obstructive Pulmonary Disease and Its Attributable Risk Factors in 204 Countries and Territories, 1990\u20132019: Results from the Global Burden of Disease Study 2019","volume":"378","author":"Safiri","year":"2022","journal-title":"BMJ"},{"key":"ref_2","first-page":"49","article-title":"Analiz zabolevaemosti khronicheskoy obstruktivnoy bolezni legkikh v Respublike Kazakhstan [Analysis of the Incidence of Chronic Obstructive Pulmonary Disease in the Republic of Kazakhstan]","volume":"2","author":"Zhamakurova","year":"2024","journal-title":"Farm. Kaz."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/S2213-2600(21)00511-7","article-title":"Global, Regional, and National Prevalence of, and Risk Factors for, Chronic Obstructive Pulmonary Disease (COPD) in 2019: A Systematic Review and Modelling Analysis","volume":"10","author":"Adeloye","year":"2022","journal-title":"Lancet Respir. Med."},{"key":"ref_4","first-page":"375","article-title":"Mortality in COPD: Causes, Risk Factors, and Prevention","volume":"7","author":"Berry","year":"2010","journal-title":"COPD J. Chronic Obstr. Pulm. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"180022","DOI":"10.1183\/16000617.0022-2018","article-title":"Precision Medicine in COPD: Where Are We and Where Do We Need to Go?","volume":"27","author":"Sidhaye","year":"2018","journal-title":"Eur. Respir. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"104318","DOI":"10.1016\/j.lpm.2025.104318","article-title":"Personalizing COPD Care: Phenotypes, Endotypes, GETomics, the Trajectome, Syndemics and Treatable Traits","volume":"55","author":"Agusti","year":"2026","journal-title":"La Presse M\u00e9dicale"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e001816","DOI":"10.1136\/bmjresp-2023-001816","article-title":"Characteristics and Phenotypes of a COPD Cohort from Referral Hospital Clinics in Uganda","volume":"11","author":"Alupo","year":"2024","journal-title":"BMJ Open Respir. Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Cioboata, R., Vlasceanu, S.G., Mitroi, D.M., Zlatian, O.M., Balteanu, M.A., Andrei, G.M., Biciusca, V., and Olteanu, M. (2025). History of Pulmonary Tuberculosis Accelerates Early Onset and Severity of COPD: Evidence from a Multicenter Study in Romania. J. Clin. Med., 14.","DOI":"10.3390\/jcm14175980"},{"key":"ref_9","unstructured":"Tobin, E.H., and Tristram, D. (2025). Tuberculosis Overview. StatPearls, StatPearls Publishing."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.2147\/COPD.S523732","article-title":"Incidence and Risk Factors of Tuberculosis-Associated Chronic Obstructive Pulmonary Disease","volume":"20","author":"Joo","year":"2025","journal-title":"Int. J. Chron. Obs. Pulmon Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.pccm.2024.08.008","article-title":"Advances in the Awareness of Tuberculosis-Associated Chronic Obstructive Pulmonary Disease","volume":"2","author":"Gai","year":"2024","journal-title":"Chin. Med. J. Pulm. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1097\/MCP.0000000000000938","article-title":"Interrelationships between Tuberculosis and Chronic Obstructive Pulmonary Disease","volume":"29","author":"Zavala","year":"2023","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e4219","DOI":"10.1097\/MD.0000000000004219","article-title":"Factors Associated with Bronchiectasis in Patients with Moderate\u2013Severe Chronic Obstructive Pulmonary Disease","volume":"95","author":"Jin","year":"2016","journal-title":"Medicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1183\/13993003.02325-2014","article-title":"Tuberculosis Associates with Both Airflow Obstruction and Low Lung Function: BOLD Results","volume":"46","author":"Amaral","year":"2015","journal-title":"Eur. Respir. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.arbres.2025.09.017","article-title":"Charting the Course in Post-Tuberculosis Lung Disease: From Inflammation to Intervention","volume":"61","author":"Thu","year":"2025","journal-title":"Arch. Bronconeumol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"390","DOI":"10.21037\/atm-20-4576","article-title":"Pulmonary Tuberculosis as a Risk Factor for Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis","volume":"9","author":"Fan","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1136\/thoraxjnl-2020-216500","article-title":"Previous Tuberculosis Disease as a Risk Factor for Chronic Obstructive Pulmonary Disease: A Cross-Sectional Analysis of Multicountry, Population-Based Studies","volume":"77","author":"Kamenar","year":"2022","journal-title":"Thorax"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Feng, J., Hu, M., and Duan, H. (2025). Bidirectional Association Between Tuberculosis and Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14217639"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1093\/aje\/kwad042","article-title":"Burden of Chronic Obstructive Pulmonary Disease Attributable to Tuberculosis: A Microsimulation Study","volume":"192","author":"Sy","year":"2023","journal-title":"Am. J. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"67","DOI":"10.5588\/ijtld.12.0351","article-title":"Clinical Characteristics of Patients with Tuberculosis-Destroyed Lung","volume":"17","author":"Rhee","year":"2013","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/crj.12621","article-title":"Tuberculosis Associated Chronic Obstructive Pulmonary Disease","volume":"11","author":"Sarkar","year":"2017","journal-title":"Clin. Respir. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.2147\/COPD.S219731","article-title":"Transition from Restrictive to Obstructive Lung Function Impairment During Treatment and Follow-Up of Active Tuberculosis","volume":"15","author":"Allwood","year":"2020","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"17534666241239455","DOI":"10.1177\/17534666241239455","article-title":"Associations of Prior Pulmonary Tuberculosis with the Incident COPD: A Prospective Cohort Study","volume":"18","author":"Zeng","year":"2024","journal-title":"Ther. Adv. Respir. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1016\/S2213-2600(24)00413-2","article-title":"GOLD COPD Report: 2025 Update","volume":"13","author":"Venkatesan","year":"2025","journal-title":"Lancet Respir. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Kotlyarov, S., and Lyubavin, A. (2025). Structure of Comorbidities and Causes of Death in Patients with Atrial Fibrillation and Chronic Obstructive Pulmonary Disease. J. Clin. Med., 14.","DOI":"10.3390\/jcm14145045"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/CM9.0000000000003370","article-title":"Cluster Analysis of Comorbidity Profiles Reveals Heterogeneity in Hospitalized Patients with Chronic Obstructive Pulmonary Disease","volume":"138","author":"Chen","year":"2025","journal-title":"Chin. Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Mariniello, D.F., D\u2019Agnano, V., Cennamo, D., Conte, S., Quarcio, G., Notizia, L., Pagliaro, R., Schiattarella, A., Salvi, R., and Bianco, A. (2024). Comorbidities in COPD: Current and Future Treatment Challenges. J. Clin. Med., 13.","DOI":"10.3390\/jcm13030743"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e63660","DOI":"10.2196\/63660","article-title":"Long-Term Monitoring of Individuals with Chronic Obstructive Pulmonary Disease Using Digital Health Technology: Qualitative Study","volume":"27","author":"Chien","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1159\/000512531","article-title":"Post-Tuberculosis Lung Disease: Clinical Review of an Under-Recognised Global Challenge","volume":"100","author":"Allwood","year":"2021","journal-title":"Respiration"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"00104","DOI":"10.1183\/23120541.00104-2025","article-title":"Characteristics and Real-World Health Clinical Outcomes of Uncontrolled COPD Patients: Population-Based Study in France","volume":"11","author":"Roche","year":"2025","journal-title":"ERJ Open Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"142","DOI":"10.21518\/2079-701X-2021-14-142-148","article-title":"Cardiovascular Pathology in Patients with Newly Diagnosed Tuberculosis and Chronic Obstructive Pulmonary Disease","volume":"14","author":"Bagisheva","year":"2021","journal-title":"Med. Sov."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"174","DOI":"10.19163\/1994-9480-2020-2(74)-174-177","article-title":"Chronic obstructive pulmonary disease and comorbidity","volume":"17","author":"Uryasyev","year":"2020","journal-title":"J. Volgogr. State Med. Univ."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2539","DOI":"10.15829\/1728-8800-2021-2539","article-title":"Comorbidity in Chronic Obstructive Pulmonary Disease and Cardiovascular Disease","volume":"20","author":"Chaulin","year":"2021","journal-title":"Cardiovasc. Ther. Prev."},{"key":"ref_34","first-page":"65","article-title":"Vozmozhnosti kardioprotektivnoy terapii: V fokuse patsienty s tuberkulezom i khronicheskoy obstruktivnoy bolezn\u2019yu legkikh [Possibilities of Cardioprotective Therapy: Focus on Patients with Tuberculosis and Chronic Obstructive Pulmonary Disease]","volume":"1","author":"Bagisheva","year":"2021","journal-title":"Becth\u0438\u043a \u0426H\u0418\u0418T"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1097\/MCP.0000000000001026","article-title":"Burden, Clinical Features, and Outcomes of Post-Tuberculosis Chronic Obstructive Lung Diseases","volume":"30","author":"Sehgal","year":"2024","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.arbres.2022.09.004","article-title":"Pathophysiology of Chronic Bronchial Infection in Bronchiectasis","volume":"59","author":"Solarat","year":"2023","journal-title":"Arch. Bronconeumol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ijid.2014.12.016","article-title":"Tuberculosis and Chronic Respiratory Disease: A Systematic Review","volume":"32","author":"Byrne","year":"2015","journal-title":"Int. J. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"220221","DOI":"10.1183\/16000617.0221-2022","article-title":"Post-Tuberculosis Lung Impairment: Systematic Review and Meta-Analysis of Spirometry Data from 14621 People","volume":"32","author":"Ivanova","year":"2023","journal-title":"Eur. Respir. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3381","DOI":"10.2147\/COPD.S177371","article-title":"Difference in Systemic Inflammation and Predictors of Acute Exacerbation between Smoking-Associated COPD and Tuberculosis-Associated COPD","volume":"13","author":"Oh","year":"2018","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1136\/thoraxjnl-2019-213808","article-title":"Patient Outcomes Associated with Post-Tuberculosis Lung Damage in Malawi: A Prospective Cohort Study","volume":"75","author":"Meghji","year":"2020","journal-title":"Thorax"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Charles, T., Eckardt, M., Karo, B., Haas, W., and Kr\u00f6ger, S. (2021). Seasonality in Extra-Pulmonary Tuberculosis Notifications in Germany 2004\u20132014- a Time Series Analysis. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-10655-6"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"19013","DOI":"10.1073\/pnas.1111825108","article-title":"Reciprocal Seasonal Variation in Vitamin D Status and Tuberculosis Notifications in Cape Town, South Africa","volume":"108","author":"Martineau","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1097\/EDE.0000000000000877","article-title":"Drivers of Seasonal Variation in Tuberculosis Incidence: Insights from a Systematic Review and Mathematical Model","volume":"29","author":"Tedijanto","year":"2018","journal-title":"Epidemiology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"323","DOI":"10.2147\/COPD.S116086","article-title":"The Role of Tuberculosis in COPD","volume":"12","author":"Yakar","year":"2017","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"250148","DOI":"10.1183\/16000617.0148-2025","article-title":"Post-Tuberculosis Morbidities and Their Associated Mortality: Moving from Challenges to Solutions","volume":"34","author":"Wang","year":"2025","journal-title":"Eur. Respir. Rev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e973","DOI":"10.1093\/cid\/ciac411","article-title":"Long-Term Mortality of Tuberculosis Survivors in Korea: A Population-Based Longitudinal Study","volume":"76","author":"Choi","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/S1473-3099(19)30309-3","article-title":"Long-Term All-Cause Mortality in People Treated for Tuberculosis: A Systematic Review and Meta-Analysis","volume":"19","author":"Romanowski","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_48","unstructured":"WHO (2022). WHO Operational Handbook on Tuberculosis. Module 4: Treatment\u2014Tuberculosis Care and Support, World Health Organization. [1st ed.]."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"797","DOI":"10.5588\/ijtld.21.0425","article-title":"Clinical Standards for the Assessment, Management and Rehabilitation of Post-TB Lung Disease","volume":"25","author":"Migliori","year":"2021","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/S2213-2600(24)00429-6","article-title":"Post-Tuberculosis Lung Disease: Towards Prevention, Diagnosis, and Care","volume":"13","author":"Meghji","year":"2025","journal-title":"Lancet Respir. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"4","DOI":"10.56871\/MTP.2024.61.67.001","article-title":"The Structure of Mortality and Concomitant Pathology in Patients with Chronic Obstructive Pulmonary Disease: Parallels with Pathomorphological Pulmonary Changes","volume":"9","author":"Tayutina","year":"2024","journal-title":"Med. Theory Pract."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1164\/rccm.202411-2213OC","article-title":"Contribution of Posttuberculosis Sequelae to Life-Years Lost from Tuberculosis Disease in the United States, 2015\u20132019","volume":"211","author":"Menzies","year":"2025","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_53","unstructured":"WHO (2022). Global Tuberculosis Report 2022, World Health Organization. [1st ed.]."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1038\/s41598-025-86426-9","article-title":"Change in Exacerbation Rate of COPD Patients before and after COVID-19 Infection","volume":"15","author":"Choi","year":"2025","journal-title":"Sci. Rep."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/7\/351\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:28:05Z","timestamp":1783528085000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/7\/351"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":54,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jpm16070351"],"URL":"https:\/\/doi.org\/10.3390\/jpm16070351","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]}}}