Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis?

Abstract

The role of tuberculosis as a public health care priority and the availability of diagnostic tools to evaluate functional status (spirometry, plethysmography, and DLCO determination), arterial blood gases, capacity to perform exercise, lesions (chest X-ray and CT), and quality of life justify the effort to consider what needs to be done when patients have completed their treatment. To our knowledge, no review has ever evaluated this topic in a comprehensive manner. Our objective was to review the available evidence on this topic and draw conclusions regarding the future role of the "post-tuberculosis treatment" phase, which will potentially affect several million cases every year. We carried out a non-systematic literature review based on a PubMed search using specific keywords (various combinations of the terms "tuberculosis", "rehabilitation", "multidrug-resistant tuberculosis", "pulmonary disease", "obstructive lung disease", and "lung volume measurements"). The reference lists of the most important studies were retrieved in order to improve the sensitivity of the search. Manuscripts written in English, Spanish, and Russian were selected. The main areas of interest were tuberculosis sequelae following tuberculosis diagnosis and treatment; "destroyed lung"; functional evaluation of sequelae; pulmonary rehabilitation interventions (physiotherapy, long-term oxygen therapy, and ventilation); and multidrug-resistant tuberculosis.The evidence found suggests that tuberculosis is definitively responsible for functional sequelae, primarily causing an obstructive pattern on spirometry (but also restrictive and mixed patterns), and that there is a rationale for pulmonary rehabilitation. We also provide a list of variables that should be discussed in future studies on pulmonary rehabilitation in patients with post-tuberculosis sequelae.

Post tuberculosis treatment infectious complications

“…Cigarette smoking is a risk factor for pulmonary infections, as well as a co-factor contributing to rapid lung function deterioration, reduced exercise tolerance, and impaired QoL (Muñoz-Torrico et al, 2016;Spruit, 2014;Spruit et al, 2013). A number of studies have demonstrated a reduction in frequency and severity of exacerbations in individuals with established chronic lung disease (Willemse et al, 2004;Au et al, 2009).…”

Chronic Respiratory Symptoms and Lung Abnormalities Among People With a History of Tuberculosis in Uganda: A National Survey

“…They are likely to benefit most from interventions including smoking cessation, patient education for self-management, pulmonary rehabilitation and bronchodilator therapy. [9,28] The tremendous expense and disability associated with chronic lung diseases in North America and Europe has important implications for the future of low resource countries like Uganda. [29] Even though international guidance is lacking, Uganda has very recently included the issue of post-TB lung disorders into its national TB programme guidelines.…”

Post-Tuberculosis (TB) Treatment: The Role of Surgery and Rehabilitation

“…A baseline examination with functional evaluation can be performed safely when the patient is smear and culture negative (on at least two samples two weeks apart) and is undergoing effective treatment; otherwise, infection control measures are necessary [13]. As the patient might need a different approach when resting and when making exercise (e.g., walking), a careful evaluation should be ideally performed both at rest and under exercise conditions [43,44].…”