Post-Tuberculosis Lung Function in Children

Key Takeaways

• The review included nine studies involving 875 children with prior PTB; in the seven-study pooled post-treatment z-score analysis, lower FEV₁ and FVC were observed, with relative preservation of the FEV₁/FVC ratio.
• Children with prior PTB also had lower FEV₁ and FVC than controls in case-control comparisons, with only a modest reduction in the FEV₁/FVC ratio.
• Heterogeneity remained substantial, subgroup and sensitivity analyses generally did not overturn the overall direction for FEV₁ and FVC, although some comparative estimates were unstable, and the discussion noted respiratory follow-up and spirometry as ways to detect persistent impairment.

The analysis centered on post-treatment spirometric outcomes rather than acute disease measurements. That pattern aligned with the authors’ interpretation of impairment that appeared more restrictive or growth-related than clearly obstructive.

Published in Frontiers in Pediatrics on April 23, 2026, the PROSPERO-registered review followed PRISMA 2020 and searched PubMed, Embase, Web of Science, and Scopus through October 23, 2025. It carried registration number CRD420251166413 and included nine studies published from 2019 to 2025. Those reports covered 875 children with prior PTB and 322 controls where applicable, using prospective cohort, cross-sectional, and retrospective cohort designs. Most came from sub-Saharan Africa, with one from South Korea, and spirometry occurred from 6 months to more than 2 years after treatment. The evidence base was limited to nine studies and was concentrated in sub-Saharan Africa.

Across pooled post-treatment analyses, mean z-scores were −1.51 for FEV₁ and −1.36 for FVC. Their 95% confidence intervals were −2.38 to −0.64 for FEV₁ and −2.60 to −0.12 for FVC, with I² values of 98.1% and 98.6%. The pooled FEV₁/FVC z-score was 0.04, with a 95% CI of −1.29 to 1.37 and I² of 97.4%, so it was not significantly different from zero. Across pooled estimates, the reductions were concentrated in FEV₁ and FVC, with very high between-study variability.

Four case-control comparisons showed lower FEV₁ in previously treated children than in controls, with Hedges’ g of −0.46 and a 95% CI of −0.78 to −0.13. FVC was also lower, with Hedges’ g of −0.29 and a 95% CI of −0.50 to −0.08. The FEV₁/FVC ratio was modestly lower as well, with Hedges’ g of −0.32 and a 95% CI of −0.58 to −0.06. Heterogeneity was moderate to high, at about 55% for FEV₁ and roughly 60% to 70% for FVC and FEV₁/FVC.

Subgroup analyses examined location, study design, age category, HIV positivity rate, and microbiological confirmation rate. Reductions in FEV₁ and FVC generally persisted across most categories, but substantial variability remained and small subgroup sizes limited interpretation of effect modifiers. Bacteriological confirmation ranged from 13.7% to 100%, and HIV co-infection ranged from 0% to 100%, reflecting broad clinical and methodological diversity. Sensitivity analyses did not materially change the direction of the main findings; the pooled post-treatment FEV₁ and FVC results remained significant, whereas some comparative estimates—especially the FEV₁/FVC ratio and one FVC analysis—were less stable. Egger’s test was non-significant, and the overall pattern stayed consistent despite unstable magnitude across strata.

Socioeconomic status, malnutrition, household air pollution, passive smoke exposure, HIV infection, baseline lung function, and spirometry timing were inconsistently reported or incompletely adjusted for. Several studies relied on clinical or radiographic diagnosis rather than microbiological confirmation, broader lung function testing beyond spirometry was usually unavailable, and drug-sensitive and drug-resistant TB were not differentiated. The discussion mentioned routine respiratory follow-up and spirometry as potential ways to identify persistent impairment and cited pulmonary rehabilitation as an example of an intervention. The paper closed by calling for additional prospective, microbiologically confirmed, age-specific pediatric studies.