Effect of Radiological Patterns on Response to Pulmonary Rehabilitation in Post-tuberculosis Lung Sequelae: A Prospective Observational Study.

BACKGROUND

Post-tuberculosis sequelae (PTBS) are increasingly recognized as a significant cause of long-term respiratory morbidity, manifesting with dyspnea, reduced pulmonary function, impaired exercise capacity, and diminished quality of life. Despite their burden, PTBS patients often lack access to structured rehabilitation. Pulmonary rehabilitation (PR), well-established in COPD, may offer functional and psychological benefits in PTBS, but its implementation in India and comparison across radiological phenotypes remains understudied.

OBJECTIVES

To evaluate the impact of a 24-week pulmonary rehabilitation program on clinical, functional, psychological, and radiological outcomes in patients with PTBS, and to compare the response among different radiological subtypes-fibrosis, fibrocavitary lesions, bronchiectasis, and combined lesions.

MATERIALS AND

METHODS

In this prospective observational study, 60 patients with PTBS underwent hospital- or home-based PR. Assessments were conducted at baseline, 12 weeks, and 24 weeks and included spirometry (FEV1, FVC, FEV1/FVC, FEF25-75), 6-minute walk test (6MWT), body mass index (BMI), St. George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnea grade, DASS-21 scale for psychological health, and radiological classification. Statistical analysis was performed to assess within-group and between-group changes over time.

RESULTS

Significant improvements were observed in BMI (p < 0.005), 6MWT (mean improvement >150 m in most groups), and DASS-21 scores across all radiological subtypes. FEV1% predicted improved significantly (p < 0.05), especially in patients with fibrosis and bronchiectasis (>60% by week 24), while those with fibrocavitary + bronchiectasis showed the least gain (38%). Quality of life (SGRQ) improved in all groups, though intergroup differences were not statistically significant. Bronchodilator reversibility was rare (5%) and did not vary with lesion type.

CONCLUSION

Pulmonary rehabilitation significantly improves nutritional status, exercise capacity, psychological well-being, and spirometric parameters in PTBS patients, with variable responses depending on radiological pattern. Despite greater impairment, patients with fibrocavitary lesions derived meaningful benefit, highlighting PR's role as an essential component of post-TB care. Tailored PR strategies should be integrated into national TB programs to address the long-term sequelae of TB in high-burden settings such as India.