Community-based pulmonary rehabilitation for post-TB lung disease - a programmatic intervention.

Background: Many survivors of pulmonary TB struggle with poor lung health and poor quality of life.

Methods: We designed and implemented a culturally appropriate, low-cost, community-based pulmonary rehabilitation (PR) program, and measured its effect on health and wellbeing. We identified former TB patients with pulmonary complaints in 9 districts in Malawi. Those who met the inclusion criteria were divided into groups and given a tailored training program with an educational component and guided through sessions twice per week for 12 weeks. Data on 13 health variables was collected before and after the PR.

Results: 467 former TB patients were enrolled. 285 (61%) were female. The mean age was 45 years (16-81). After the 12-week PR, chest pain reduced from 66.4% (310) to 8.8% (41) and cough from 47.5% (222) to 9.6% (45). Moderate and severe dyspnea disappeared, and no one scored below 80 on the Karnofsky Index scale after the PR ended. Endurance and functional capacity measured by 6-minute walk test (6MWT) increased by 15.5%.

Conclusion: The 12-week course of PR had a positive effect on people's health and well-being, and it is now integrated into the National TB strategy in Malawi. The benefits of such programs are highly significant for the individual and the broader community. We strongly encourage other countries to implement similar PR programs.