Interventions to reduce the impact of post-tuberculosis lung disease: a scoping review of the literature

Abstract

BACKGROUND: Post tuberculosis lung disease (PTLD) is an increasingly recognized contributor of long-term morbidity among the estimated 155 million survivors of Mycobacterium tuberculosis disease. While a range of interventions may influence PTLD risk, the full spectrum has not been systematically reviewed. METHODS: We conducted a scoping review following Joanna Briggs Institute methodology to identify interventions delivered during or after TB treatment with potential to affect PTLD outcomes. Embase was searched from inception to March 31, 2025, for seven intervention categories: host-directed therapy (HDT), therapeutic drug monitoring (TDM), inhaled pharmacotherapy, antimicrobials beyond TB treatment, treatment shortening, thoracic surgery, and microbiome-altering interventions. Outcomes were grouped into disability, lung function, radiology, biomarkers, and histopathology, and categorized as showing improvement, worsening, or no effect on PTLD. RESULTS: Of 7,965 records screened, 87 studies were included. Most were small, uncontrolled, and designed to assess microbiological cure rather than post-TB sequelae. Radiology and unstructured symptom reports were the most common outcomes, while validated disability tools and advanced lung function measures were rarely used. Corticosteroids and several HDTs showed signals of radiological or spirometric benefit, but the findings were inconsistent. Doxycycline and metformin improved cavity resolution in small trials. Inhaled bronchodilators demonstrated short-term spirometric gains in two studies and a survival benefit in one retrospective cohort. Antifungals for chronic pulmonary aspergillosis improved symptoms, radiology, and inflammatory biomarkers, whereas evidence for antibacterial or NTM-directed therapy was lacking. TDM was associated with faster culture conversion in some studies but was not linked to PTLD-specific outcomes. Microbiome studies consistently reported reduced diversity and altered composition during TB treatment, but no direct associations with PTLD. CONCLUSION: Evidence for interventions to prevent or mitigate PTLD remains sparse, heterogeneous, and largely incidental. High-quality studies using standardized, person-centered outcomes are urgently needed to guide care for TB survivors worldwide.