Nearly two-thirds of pulmonary tuberculosis (TB) patients have respiratory sequelae after treatment. Neutrophils are associated with TB pathology, but the relevance to post-TB lung disease is unknown. We hypothesized that higher baseline blood neutrophil counts would be associated with worse lung function and imaging in adults even after treatment for pulmonary TB.Design/Methods: We conducted a longitudinal cohort study of 259 TB patients initiating standard four-drug therapy for rifampin-susceptible pulmonary TB in Johannesburg, South Africa. We used Wilcoxon rank-sum testing to compare neutrophil groups with respect to forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), total lung capacity (TLC), and diffusing capacity of the lung for carbon monoxide (DLCO), and high-resolution CT (HRCT) scores for lung abnormality, consolidation and fibrosis. These were assessed at baseline (within 2 weeks of treatment), month 6 (end of treatment), and month 12. Race-neutral Global Lung Initiative reference standards measured lung function, which adjust for age, gender, and height. Linear regression adjusted for HIV, antiretroviral therapy, smoking and alcohol.Results: Table 1 shows that participants in the baseline top neutrophil tertile cohort had lower baseline FEV₁, FVC, and DLCO z-scores (p<0.05), indicating worse lung function and gas exchange, and more consolidation and fibrosis on HRCT (p<0.05). Imaging differences persisted at 12 months (p<0.05), but lung function differences did not.Conclusions: The baseline top neutrophil tertile cohort had significantly worse baseline lung obstruction, impaired gas exchange, and greater consolidation and fibrosis. At month 12, significant differences in consolidation and fibrosis persisted, while lung function differences were attenuated. Baseline neutrophils can be an important marker for persistent lung damage.