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 declared 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, and 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 limbs exercises 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 weeks. The most frequent co-morbidities observed were diabetics (25%), COPD (22%) and systemic hypertension (17% ).
Discussion: Most of the PTLDs belong to the lower educational and socioeconomic classes. 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., and 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 within a short period of 12 weeks 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 a physiotherapist and a nutrition specialist, at least during hospitalization, may also be considered in the context of the underlying disease, physical, mental and socioeconomic status of the patient.