Impact of extent of lung disease on nutritional, physiological, functional, and psychosocial outcomes of pulmonary rehabilitation in patients with post-tuberculosis sequelae: A prospective study from Western India.

BACKGROUND

Post-tuberculosis lung disease (PTLD) is increasingly recognized as a major cause of chronic respiratory morbidity in tuberculosis (TB) survivors. Pulmonary rehabilitation (PR) improves functional outcomes in PTLD, but the influence of disease extent on response to rehabilitation is underexplored, particularly in high-burden settings such as India.

METHODS

This prospective interventional study was conducted at our center, over 6 months. Sixty patients with radiologically confirmed post-tuberculosis sequelae were enrolled and stratified into mild ( n = 27), moderate ( n = 24), and severe ( n = 9) groups based on chest radiograph (CXR) classification. All patients underwent a structured 24-week PR program, delivered either as hospital-based supervised sessions or home-based rehabilitation with reinforcement. Outcomes assessed at baseline, 12 weeks, and 24 weeks included nutritional status (body mass index [BMI]), pulmonary function (spirometry), dyspnea (mMRC scale), functional capacity (6-min walk test [6MWT]), health-related quality of life (St. George's Respiratory Questionnaire [SGRQ]), and psychological status (Depression Anxiety Stress Scale, DASS-21).

RESULTS

At baseline, patients with severe disease had significantly lower BMI (16.5 vs. 22.1 kg/m 2 ), poorer lung function (FEV 1 % predicted 21.3 vs. 54.1), and shorter 6MWT distances (196.9 vs. 344.4 m) compared with mild disease (all p < 0.001). Over 24 weeks, significant improvements were observed in all groups across nutritional, physiological, functional, and psychosocial outcomes ( p < 0.05 for within-group comparisons). However, intergroup differences persisted, with patients with mild disease achieving the greatest absolute gains, while severe disease patients remained at a relative disadvantage.

CONCLUSION

The extent of lung disease strongly influences the degree of improvement with PR in PTLD. Early initiation of rehabilitation in patients with mild-to-moderate disease yields the greatest benefits, although meaningful improvements are also achievable in severe cases, underscoring the role of rehabilitation as a cornerstone of PTLD management.