ORIGINAL ARTICLE History of pulmonary tuberculosis affects the severity and clinical outcomes of COPD HYE JUNG PARK, 1 MIN KWANG BYUN, 2 HYUNG JUNG KIM, 2 CHUL MIN AHN, 2 DEOG KYEOM KIM, 3 YU IL KIM, 4 JIN YOUNG OH, 5 HYOUNG KYU YOON, 6 KWANG-HA YOO 7 AND KI SUCK JUNG 8 1 Department of Internal Medicine, Yong-in Severance Hospital, Yonsei University College of Medicine, Yong-in; 2 Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; 3 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul; 4 Pulmonary Division, Department of Internal Medicine, Chonnam National University Hospital, Gwangju; 5 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang; 6 Pulmonary Division, Department of Internal Medicine, Yeouido St Mary’s Hospital, Seoul; 7 Department of Internal Medicine, Konkuk University School of Medicine, Seoul; 8 Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Republic of Korea ABSTRACT Background and objective: Although an association between pulmonary tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) has been sug- gested, studies on the effect of TB in COPD patients have not been conducted. We aimed to investigate the severity and clinical outcomes of COPD in patients with and without a history of TB. Methods: We retrospectively reviewed the data of 1784 patients with COPD in the Korean COPD Subtype Study cohort collected from December 2011 to January 2017 and followed up for 3 years. Results: Among the 1784 patients at baseline, the COPD assessment test (CAT) scores and total St George’s Res- piratory Questionnaire for COPD (SGRQc) scores were significantly higher in the prior TB group (n = 468) than in the non-TB group (n = 1316). Lung function and exacerbation prevalence were significantly poorer and higher, respectively, in the prior TB group than in the non-TB group. In a small-sized follow-up study, CAT scores (n = 318), SGRQc scores (n = 295) and lung function (n = 182) remained poorer, and exacerbation prevalence (n = 256) remained higher in the prior TB group over 3 years. The forced expiratory volume in 1 s in the prior TB group declined (-0.57%/year), whereas it improved (+0.93%/year) in the non-TB group (P for changes between the groups = 0.076). In the prior TB group, patients showed poorer lung function compared with the non-TB group regardless of having lung lesions visible or not on chest radiographs. Conclusion: TB history negatively affected the severity of COPD, and a small-sized follow-up study showed that the changes were sustained for several years. Key words: chronic obstructive pulmonary disease, lung function, quality of life, tuberculosis. Abbreviations: ANOVA, analysis of variance; CAT, COPD assessment test; CXR, chest X-ray; DL CO , diffusing capacity of the lung for carbon monoxide; FEF 25–75% , forced expiratory flow during the middle half of the FVC; FEV 1 , forced expiratory volume in 1 s; FVC, forced vital capacity; KOCOSS, Korean COPD Subtype Study; SGRQc, St George’s Respiratory Questionnaire for COPD; TB, pulmonary tuberculosis; VA, alveolar volume. INTRODUCTION Chronic obstructive pulmonary disease (COPD) is considered a serious health problem worldwide. COPD morbidity and mortality have been increasing because of ageing societies, increased smoking prev- alence and air pollution, and lead to high health costs. 1–5 COPD is characterized by chronic inflamma- tion induced by toxic particles and gases resulting in progressive and irreversible airway obstruction char- acterized by bronchitis and emphysema. Cigarette smoking and ageing are well-known major risk fac- tors for the development of COPD. 6–9 In addition, recent studies have reported that biomass smoke, 10 the microbiome, 11 nutritional absorption, 12 mito- chondrial damage 13 and even genetic factors 14 con- tribute to and/or aggravate COPD. Correspondence: Min Kwang Byun, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro Gangnam-gu, Seoul 135-720, Korea. Email: littmann@yuhs.ac Received 20 March 2017; invited to revise 7 May, 12 and 22 June 2017; revised 25 May, 13 and 22 June 2017; accepted 22 June 2017 (Associate Editor: Cynthia Chee). SUMMARY AT A GLANCE We demonstrated that chronic obstructive pulmo- nary disease (COPD) patients with a history of tuberculosis (TB) had more severe symptoms, poorer lung function and more frequent exacerba- tions. The differences were sustained for 3 years compared with those with no TB history. © 2017 Asian Pacific Society of Respirology Respirology (2018) 23, 100–106 doi: 10.1111/resp.13147