Background

Tuberculosis is a major contributor to the pool of individuals who have respiratory insufficiency due to destruction of lung tissue. It has been shown that 65% of patients completing their TB treatment have abnormal lung functions and residual symptoms.

Pulmonary rehabilitation aims to restore the affected individual to an independent, productive and lead a satisfying life and prevent further clinical deterioration to the maximum extent compatible with the stage of the disease. This goal may be accomplished, without materially improving lung function, by helping the patients to become more aware of their disease, more actively involved in their own health care and more independent in performing daily care activities, attempting to reverse the disability from disease.

Pulmonary rehabilitation is a comprehensive intervention, based on a thorough patient assessment followed by patient-tailored therapies, that include but are not limited to exercise training, education and behaviour change. It is designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviours. Pulmonary rehabilitation provided to individuals with chronic respiratory diseases other than COPD (i.e., interstitial lung disease, bronchiectasis, cystic fibrosis, asthma, pulmonary hypertension, lung cancer, lung volume reduction surgery, and lung transplantation) has demonstrated improvements in symptoms, exercise tolerance, and quality of life. This effort is in the direction to incorporate rehabilitation early in the management of tuberculosis so that the patients in addition to being cured are holistically managed.

USAID India funded, and The Union led iDEFEAT project is supporting the CoE RBIPMT, New Delhi in establishing a centre of excellence in pulmonary rehabilitation for people affected with TB. The purpose of this SOP is to integrate pulmonary rehabilitation in the standard of care for individuals with TB, with a specific focus on improving overall well-being of the affected individual. This document will be a guide to all healthcare professionals, including physicians, nurses, physical therapists, and other staff involved in the care and rehabilitation of patients with TB as well as chronic respiratory diseases.

 

The aims of pulmonary rehabilitation are:

1. Decrease of physical and psychological impairment due to the disease
2. Increase in physical and mental fitness and performance
3. Maximal social reintegration of the patient and self-sufficiency.

 

Pulmonary rehabilitation is implemented by a dedicated, interdisciplinary team including physicians/health care professionals, physiotherapists/respiratory therapists, nurses, psychologists, nutritionists, occupational therapists, and social workers. The intervention should be individualized to the unique needs of the patient, based on initial and ongoing assessments, including disease severity, complexity, and comorbidities. Although pulmonary rehabilitation is a defined intervention, its components should be integrated throughout the clinical course of a patient’s disease. Pulmonary rehabilitation may be initiated at any stage of the illness. The programme is good for one-to-one guidance, but group exercises can be incorporated on the need basis.