Tuberculosis-associated respiratory impairment and disability in children and adolescents: a systematic review

Background: While the immediate effects of pulmonary tuberculosis are well-documented, respiratory impacts persisting beyond treatment, particularly in children and adolescents, are less understood. This systematic review aimed to evaluate the current evidence on tuberculosis-associated respiratory impairment and disability in children and adolescents following tuberculosis treatment. Methods: We searched MEDLINE, Embase, CENTRAL, Global Index Medicus, and preprints from January 1, 2004, to December 5, 2024, to identify studies enrolling children (0-9 years old) or adolescents (10-19 years old) who completed treatment for microbiologically confirmed or clinically diagnosed pulmonary tuberculosis. Eligible studies measured at least one tuberculosis-associated respiratory impairment or disability outcome. Data were analyzed descriptively and stratified into three age groups based on median age of tuberculosis diagnosis: <5 years, 5-10 years, and >10 years. This study was prospectively registered (PROSPERO CRD42024529906). Findings: We identified 117 studies reporting tuberculosis-associated respiratory impairment or disability outcomes. Of those, five met our inclusion criteria, as over 80% of the identified studies excluded children and adolescents. Following tuberculosis treatment, children and adolescents exhibited significant respiratory impairments. In children <5 years of age, impairment included reduced tidal volume and peak tidal expiratory flow. Among those 5-10 years, approximately 40% exhibited abnormal lung function post-treatment, increasing to 65% in adolescents >10 years. Disability was frequently reported, with 35-50% of children and adolescents experiencing respiratory symptoms and children <10 years showing reduced growth metrics and a diminished quality of life. Interpretation: Even after successful tuberculosis treatment, children and adolescents can experience respiratory impairments and disability that may reduce their quality of life, ability to participate in activities, and growth potential. The epidemiology and clinical manifestations of these impairments vary by age, reflecting distinct biological and behavioural differences. Future research should prioritize these younger populations to ensure their unique needs and challenges are adequately represented. Funding: The Robert E. Leet & Clara Guthrie Patterson Trust; Canadian Institutes of Health Research.