Abstract
SettingThe study was conducted at Mulago Hospital, Kampala, Uganda.ObjectiveAs chronic respiratory disease (CRD) is a huge, growing burden in Africa, with few available treatments, we aimed to design and evaluate a culturally appropriate pulmonary rehabilitation (PR) program in Uganda for people with post-tuberculosis lung disorder (p-TBLD).DesignIn a pre–post intervention study, a 6-week, twice-weekly PR program was designed for people with p-TBLD. Outcome measures included recruitment, retention, the Clinical COPD Questionnaire (CCQ), tests of exercise capacity, and biometrics. Given this was a developmental study, no formal statistical significance testing was undertaken.ResultsIn all, 34 participants started PR and 29 (85%) completed all data collection. The mean age of the 29 participants was 45 years, and 52% were female. The mean (95% confidence interval) CCQ score at baseline was 1.8 (1.5, 2.0), at the end of PR was 1.0 (0.8, 1.2), and at 6 weeks after the end of PR was 0.8 (0.7, 1.0). The Incremental Shuttle Walking Test (ISWT) was 299 m (268.5, 329.4) at baseline, 377 (339.6, 413.8) at the end of PR, and 374 (334.2, 413.5) at 6 weeks after the end of PR. Improvements were seen in measures of chest pain; 13/29 (45%) participants reported chest pain at baseline but only 7/29 (24%) at the end of PR, and in those with persistent pain, the mean pain scores decreased. Mild hemoptysis was reported in 4/29 (17%) participants at baseline and in 2/29 (7%) at the end of PR.ConclusionPR for people with p-TBLD in Uganda was feasible and associated with clinically important improvements in quality of life, exercise capacity, and respiratory outcomes. PR uses local resources, requires little investment, and offers a new, sustainable therapy for p-TBLD in resource-limited settings. With the rising global burden of CRD, further studies are needed to assess the value of PR in p-TBLD and other prevalent forms of CRD.
Highlights
This study shows that pulmonary rehabili tation (PR) is a potentially important treatment option for many people with post-tuberculosis lung disorder (p-TBLD), a finding that requires confirmation from larger controlled trials
Conclusion p-TBLD is a widespread problem in many LMICs and affects people of all ages
There are no effective treatments currently available. For the young, this is a huge problem in terms of disability, loss of income, and social isolation
Summary
One major cause of CRD is post-tuberculosis lung disorder (p-TBLD). In a study in the USA, the long-term sequelae of pulmonary tuberculosis (PTB) dwarf the costs and disease burden of acute infection.. In Africa, the problem may be worse; permanent extensive lung damage after PTB is common and is associated with delayed diagnosis, multidrug resistance, and nonadherence to treatment.. Air pollution (both indoor and outdoor) and tobacco smoking are pervasive problems that add to damage to lung parenchyma from repeated infections.. The range of clinical features included dyspnea, chest pain, and hemoptysis, similar to patients seen in Rwanda. Currently, there is little or no effective treatment for people with p-TBLD in Africa
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