Pulmonary Rehabilitation in Patients with Chronic Lung Impairment from Pulmonary Tuberculosis

Abstract

SettingOur study was conducted at a tertiary care center for respiratory illnesses (Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi, Delhi, India). Patients were enrolled in the study from the outpatient clinic.ObjectiveTo assess the effects of pulmonary rehabilitation (PR) in patients with chronic lung impairment from previously treated tuberculosis (CLIPTB), on exercise capacity (six-minute walk distance), pulmonary function tests, quality of life and markers of systemic inflammation.DesignProspective cohort study including 29 patients who had finished anti-tubercular therapy and currently had symptoms of dyspnea with or without cough secondary to CLIPTB.ResultSignificant improvement in six-minute walk distance (488 meters at baseline vs 526 meters post PR intervention, p-value 0.033) and chronic respiratory questionnaire score (17.21 at baseline vs 18.96 post PR intervention, p-value 0.025) with pulmonary rehabilitation was noted. Pulmonary function tests, inflammatory markers and mid-thigh muscle mass trended towards improvement with pulmonary rehabilitation but were not statistically significant.ConclusionOur study shows that pulmonary rehabilitation is an effective intervention in post-tuberculosis patients and should be recommended.

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

“…Before initiating a specific rehabilitation programme, patients should undergo a complete lung functional assessment, including spirometry and exercise capacity testing to enable an appropriate exercise training regime. Exercise capacity is usually based on cardiopulmonary exercise testing or walking tests (6MWT, incremental shuttle walking test (ISWT)) in order to set physical training sessions that exceed the physical loads of daily life activities [45,[51][52][53][54][55][56][57][58]. Some studies documented the positive role of aerobic training on symptoms, anxiety, depression, and QoL [45,[51][52][53][54][55][56][57][58].…”

“…In the vast majority of the studies, the spirometry parameters, oxygen saturation, and exercise capacity tests (6MWT or ISWT, range 35-110 m) improved significantly. When QoL tests were performed, they also improved significantly [45,[51][52][53][54][55][56][57][58]. Unfortunately the different studies reported different parameters, making a meta-analytic evaluation difficult.…”

Pulmonary rehabilitation and tuberculosis: a new approach for an old disease

“…The exercise programme consisted of daily walking in the hospital corridor, and the results were positive: increase of maximum oxygen uptake (from 13. (29). By resuming, for the evaluation of PR programmes results in patients with TB, the parameters used were as follows:…”

“…-exercise tolerance with 6MWT (22,23,29), ISWT 7and CPET (28). -QOL with SGRQ (St George Respiratory Questionnaire) (22,28), CCQ (Clinical COPD Questionnaire) (7), WHOQOL-100 (quality of life of the World Health Organization) (5), CRQ (29).…”

“…In the active phase, when the patient is contagious, the hospital PR programmes are more suitable (5,27). In post TB sequelae, the majority of rehabilitation programmes were conducted in outpatient settings (7,23,29). One pilot study performed in South Africa showed the utility of a 6-week home-based PR programme, in patients with TB (30), while other programme used home-based care programme for multi drug resistant (MDR)-TB patients with TB (32).…”