Improving Outcome in Post TB Sequelae with Pulmonary Rehabilitation

Abstract

Introduction: One third of the global TB cases prevail in India and among them 50% continue to experience persistent symptoms even after being declare cured under the NTEP and are collectively called post TB lung diseases (PTLD). These post TB sequelae cases present in various forms with physical, mental, functional deficits that could greatly be benefited with a rehabilitation plan.

Results: The pulmonary rehabilitation programme (PRP) with planned physical activity consisting of upper and lower limb sexercises with breathing exercise were carried out in 60 patients. The improvement was observed in almost all the parameters e.g. spirometry, mMRC dyspnea scale, 6MWT, BODE index, Borg scale and BMI after an interval of 12 week. The most frequent co-morbidity observed were diabetics (25%), COPD (22%) and systemic hypertension (17% ).

Discussion: The most of the PTLD belong to lower educational and socioeconomic class. These cases had architectural distortion and destruction of airways and lung parenchyma with residual fibro-cavitory/ Fibro-calcified lesions or destroyed lung and bronchiectasis etc were not going to regain the required lung capacity so they continued to suffer and live with poor functional deficit. The pulmonary rehabilitation programme (PRP) including the Yoga exercises and meditation practice was the best option for them to improve physical endurance by developing muscle strength and self confidence. The reassessed positive changes with in a short period of 12 week may further boost sustained action, self reliance, and enable to resolve cognitive illness. Patients need to be educated for protection against recurrent secondary infection and scheduled prophylactic vaccination.

Conclusion : A patient friendly, tailored PRP should preferably be started along with anti TB Treatment. A support of physiotherapist and nutrition specialist at least during hospitalization may also be considered in context to the underlying disease, physical, mental and socioeconomic status of the patient.