Aim: This study aimed to evaluate the long-term pulmonary pathological changes in patients who have completed treatment for chest tuberculosis (TB) and to assess the recovery and complications that arise post-treatment. Materials and Methods: A total of 100 patients with a confirmed diagnosis of pulmonary TB were enrolled in this prospective, observational study at a tertiary care hospital. The follow-up period lasted for 3 years, during which patients underwent regular clinical evaluations, chest X-rays, high-resolution computed tomography (HRCT), spirometry, and sputum analysis. Histopathological assessments were performed on patients with persistent abnormalities. Statistical analysis was conducted using descriptive statistics and appropriate tests to evaluate the data. Results: At the end of the study, 45% of the patients showed fibrotic changes, 35% had resolved disease, and 12% exhibited bronchiectasis. Significant improvements were observed in pulmonary function, with Forced Expiratory Volume in 1 second (FEV1) increasing from 2.6 ± 0.5 liters at baseline to 3.0 ± 0.5 liters by the end of the study (p=0.03). Radiological findings revealed fibrotic lesions in 55% of patients, and histopathological findings identified tuberculous granulomas in 4% and pulmonary fibrosis in 5% of cases. Conclusion: This study confirms that fibrotic changes and bronchiectasis are common long-term pulmonary sequelae following TB treatment, though most patients show gradual improvement in lung function over time. Continuous monitoring is essential to manage post-TB pulmonary complications and promote long-term lung health.