Post-Tuberculosis Lung Disease: Clinicopathologic Insights, Diagnosis, Prevention, and Management.

Post-tuberculosis lung disease (PTLD) encompasses a spectrum of chronic pulmonary abnormalities arising from tuberculosis (TB)-associated tissue injury and maladaptive repair, and is emerging as a major contributor to long-term respiratory disability among TB survivors. In this review, we position PTLD within the broader continuum of TB pathobiology, from initial host-pathogen interactions to chronic structural and functional lung sequelae. We examine current definitions, epidemiology, and clinical burden, and present mechanistic insights into the inflammatory, proteolytic, fibrotic, immunometabolic, and vascular pathways that drive persistent lung damage. We further discuss the heterogeneous clinical phenotypes of PTLD, including airflow obstruction, bronchiectasis, restrictive lung disease, pleural complications, chronic pulmonary aspergillosis, and nontuberculous mycobacterial disease, highlighting practical approaches to diagnosis, risk stratification, and management across diverse healthcare settings. We discuss PTLD in children and adolescents, prevention opportunities throughout the TB care cascade, and health-system strategies for integrating post-TB care. Finally, we identify key knowledge gaps in PTLD nosology, biomarkers, therapeutic development, clinical trial design, and implementation science. Recognition of PTLD as a continuation rather than an endpoint of TB is essential for advancing survivorship-focused care and reducing the global burden of chronic respiratory disease after TB.