Clinical Standards for the assessment, management and rehabilitation of Post TB Lung Diseases

Standard 1

Every patient completing treatment should be clinically evaluated for PTLD.

•Clinical Examination {Height, Weight, Vital signs, BP, SpO2 (if <94%, ABGA should be done), JVP}

•History

•Chest X-ray

•PFT/Forced Oscillometry

•6 Minute Walk Test

•Symptoms Score

•QOL questionnaire

•Multiple breath washout

Standard 2

Indications for Pulmonary Rehabilitation

  • Impaired exercise capacity (CPET/6MWT)

  • Respiratory symptoms

  • Co-morbidities(COPD, Bronchial Asthma, Bronchiectasis, Pulmonary fibrosis, PHT)

  • One hospitalization or 2 exacerbations within last 12 months

  • Obstruction/ Restriction/ Mixed pulmonary function impairment

  • Abnormal blood gases (PaO2 <80mmhg and/or PaCO2 >45mmhg)

  • Ineffective cough and difficult to clear bronchial secretions

  • Impaired QOL 

    • Functional:

PR includes comprehensive package of interventions which include

•Exercise, education, nutrition, self-management activities and psycho- social support

Standard 3

PR programme should be organized according to feasibility, effectiveness, cost-effectiveness based on the local organization of health services to the individual patient’s needs

To qualify as PR, programmes must include

1)Comprehensive baseline and post PR outcome measurements

2)A structured and supervised exercise training programme

3)An educational or behavioral programme intended to foster long term health enhancing behaviors.

4)Provisions of recommendations for homebased and self or supervised physical activity programmes

Core components of PR

•Aerobic exercise endurance training

•Strength training upper and lower extremities

•Inspiratory muscle Training

•Airway Clearance Techniques

•LTOT

•NIV

•Nutritional support

•Psychological support

Standard 4

Evaluating the effectiveness of PR for former TB patients

•Lung function

•Gas transfer

•Exercise capacity

  • TB specific:

•HQOL

•Self-reported symptoms

  • Generic:

•Acute infectious exacerbations

•Hospitalizations

•Mortality

Standard 5

Each patient completing PR should undergo counseling or health education including follow up plan to maintain or improve the results achieved, organized according to feasibility and cost effectiveness criteria based on the local organization of a health services and tailored to the individual patient needs

Standard 6

Patient with permanent sequelae and disability need to be supported by social protection schemes whenever possible