Lung health and well-being after TB: treating – and preventing – long-term health consequences
Message from the Executive Director, José Luis Castro
Tuberculosis (TB) is curable. In fact, in this past decade, nearly 100 million people have been cured – each one of them a success story.
But we have the tendency to end the conversation there – along with our health systems and TB programmes.
Too often, a person arrives at the end of their TB treatment “cured” – but only of TB. Yet, pulmonary TB is an important risk factor for long-term lung damage and chronic respiratory disorders.
This means that people successfully cured of TB regularly find themselves with long-term health conditions – including persistent cough and shortness of breath among others – and little information about what comes next or where to go. This is not helped by the vertical, siloed approach to TB treatment.
In addition to direct damage to the lung, TB is also an important predictor of chronic obstructive pulmonary disease (COPD), now the third leading cause of death globally. Systematic reviews and international surveys suggest that TB can increase the odds of COPD threefold – and even more in countries with a high TB burden.
These respiratory conditions – called post-TB lung disease – manifest in a substantial proportion of all TB survivors, impairing their quality of life and placing a continued and sustained financial burden upon them and their families.
And yet, post-TB lung disease is omitted from our TB elimination strategies, international TB guidelines fail to address its importance, and programmatic interventions to address patients’ needs following TB treatment are severely lacking.
Our registries and reporting mechanisms are not designed to look past the period of TB treatment, leading to a dearth in available data, and scientific research into causes and potential treatments is limited.
The impact of this on individual lives is immense. For all the faults in our TB response mechanisms – and there are many – they do manage with some level of success, to accompany a patient through treatment, assist with the management of side effects or other issues, and, in most high-burden countries, provide services free of charge.
Despite all that, the physical, psychological, social and economic burden of TB on individuals is enormous.
Compared to the services and systems we have in place to detect, diagnose and treat people with post-TB lung disease, our TB response is an aspirational standard. Post-TB lung disease is not managed with anything near the investment, level of attention or support system that our TB programmes provide, and TB survivors regularly finish TB treatment to find themselves once again struggling with health problems and searching for answers.
How can we blame them if they feel abandoned by a health system that claims to have cured them?
We must invest in universal, holistic systems that treat the person, not the disease, and are equipped to manage each step, ensuring those in need receive the information and care they seek.
The universal health coverage (UHC) agenda is essential to this effort. It is the only way to ensure that health conditions that are commonly linked with TB are treated as part of a core package of care, available and accessible to everyone. This is essential to addressing our most pressing public health concerns and ensuring early diagnosis to minimise lasting effects.
But I’d like to suggest we push even further. TB – along with the residual health conditions and the financial hardship it causes – is preventable.
We must invest urgently in prevention if we have any hope of ending the TB epidemic – and ending the unnecessary and inexcusable death and suffering that TB causes. By systematically providing preventive therapy to everyone in contact with a person with TB disease – with a particular focus on high-risk groups like children, people living with HIV or diabetes, tobacco users and other vulnerable populations – we not only stand to curb the tide of new infections annually, we can significantly reduce the number of people suffering from chronic lung conditions as a result.
As we approach the United Nations High-Level Meeting on UHC, to be held at the General Assembly in September, I hope to see plans for more robust, collaborative solutions with the aim to prevent initially, treat holistically and cure – completely.