Skip to main content

Main menu

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • ERS Guidelines
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • Peer reviewer login
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • ERS Guidelines
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • Peer reviewer login
  • Alerts
  • Subscriptions

Pulmonary rehabilitation is effective in patients with tuberculosis pulmonary sequelae

Dina Visca, Elisabetta Zampogna, Giovanni Sotgiu, Rosella Centis, Laura Saderi, Lia D'Ambrosio, Valentina Pegoraro, Patrizia Pignatti, Marcela Muňoz-Torrico, Giovanni Battista Migliori, Antonio Spanevello
European Respiratory Journal 2019 53: 1802184; DOI: 10.1183/13993003.02184-2018
Dina Visca
1Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
2Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
7Contributed equally
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Elisabetta Zampogna
1Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
7Contributed equally
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Giovanni Sotgiu
3Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy
7Contributed equally
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Giovanni Sotgiu
Rosella Centis
1Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
7Contributed equally
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Rosella Centis
Laura Saderi
3Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lia D'Ambrosio
4Public Health Consulting Group, Lugano, Switzerland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Lia D'Ambrosio
Valentina Pegoraro
2Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Patrizia Pignatti
5Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marcela Muňoz-Torrico
6Tuberculosis Clinic, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Giovanni Battista Migliori
1Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Giovanni Battista Migliori
Antonio Spanevello
1Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
2Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

The majority of patients completing anti-tuberculosis treatment have sequelae and benefit from pulmonary rehabilitation http://ow.ly/WyOH30nFQLV

To the Editor:

We read with interest the study reported by Collin et al. [1], who carried out a survey on organisation and priorities of national tuberculosis (TB) programmes in Europe. With an estimated annual incidence of 10 million cases, TB is considered one of the three global infectious disease priorities, together with HIV/AIDS and malaria. However, TB incidence has significantly declined in the general European population during the past two decades, with a relative increase in vulnerable groups [2, 3].

Traditional TB control is focused on the rapid diagnosis and effective treatment of infectious cases, in order to break the transmission chain, and to cure individual patients. As TB mainly affects low income countries, little research has been conducted to determine whether medical interventions should be considered complete when a patient is “successfully treated” [4], or if potential sequelae should be investigated and pulmonary rehabilitation (PR) performed.

Although mainly focused on chronic obstructive pulmonary disease (COPD), the American Thoracic Society (ATS)/European Respiratory Society (ERS) rehabilitation guidelines discuss the potential usefulness of PR in other respiratory diseases. TB is not mentioned, although recent evidence shows that obstructive and/or restrictive functional sequelae could occur, potentially affecting quality of life (QoL) [5, 6]. To date, no guidance on indications and procedures for TB sequelae is available [5].

We retrospectively investigated if patients with sequelae detected after anti-TB treatment had any benefits from PR in a low TB incidence setting.

Patients with a history of pulmonary TB and successful treatment, admitted between 2004 and 2017 in the PR reference centre of Tradate, Italy, were selected for the study. The institutional ethical committee approved the study (2215 CE, June 19, 2018).

Only patients with clinical stability and able to perform >80% of the training sessions with a physiotherapist, as well as 6-min walking test (6MWT) before and after PR, were selected. The following information was collected:

  • 1) Clinical data (i.e. anthropometric data, medical history, comorbidities and concomitant medications);

  • 2) Lung function tests based on ATS guidelines at admission and pre-discharge [7], using a body plethysmograph (Masterlab Body; Jaeger, Würzburg, Germany) and ERS predicted values [8];

  • 3) Diffusing capacity of the lung for carbon monoxide according to the ATS/ERS guidelines [9] (MasterScreen PFT System; Jaeger, VIASYS Healthcare, Hoechberg, Germany);

  • 4) Arterial blood gases from radial artery (ABL 820 Radiometer Medical, Brønshøj, Denmark) in patients breathing room air in the sitting position for at least 20 min;

  • 5) Overnight oximetry monitoring (Nonin Handheld 8500; Nonin, Tilburg, the Netherlands);

  • 6) 6MWT;

  • 7) Symptoms (Borg dyspnoea and fatigue scores before and after the 6MWT).

Patients underwent a comprehensive 3-week PR programme including: specialist nurse training (inhalation techniques and/or oxygen-therapy when prescribed); 18 aerobic-training sessions by cycle ergometer supervised by a respiratory therapist (five sessions per week, 30 min each: 5 min warm-up, 20 min training and 5 min warm-down) at constant load (calculated with Hill equation [10]). Optional PR components included: inspiratory muscle conditioning (using a threshold-loading device [4]), breathing exercises, airways clearance, psychological support (three sessions per week), relaxation (five sessions per week) and nutritional counselling (personalised diet). Patients attended two educational group sessions, managed by a respiratory therapist, on lifestyle, physical activity and maintenance programmes.

A pre-discharge evaluation (including lung function tests, blood gases analysis, 6MWT and symptom assessment) was performed at the end of the PR programme. Pre-PR data were compared with post-PR both in patients with and without functional impairment. QoL data pre- and post-PR was available for two patients only and, then, no data were provided.

Out of 111 patients with previous history of pulmonary TB, admitted between 2004 and 2017, 43 (39%) met the criteria required to be included in the study (i.e. >80% of the training sessions and 6MWT before and after PR), whereas 68 (31%) were excluded because data on 6MWT both before or after PR were not available.

43 cases (24 males, median age 75 years) were selected; 54.8% and 41.9% had a diagnosis of COPD and respiratory failure, respectively; 23.3% required long-term oxygen therapy and 31% underwent noninvasive mechanical ventilation. 46.5% were former and 11.6% current smokers. 11 (25.6%), five (11.6%), and 18 (41.9%) cases had an obstructive, restrictive and mixed pattern respectively, whereas nine (20.9%) had normal spirometry (table 1).

View this table:
  • View inline
  • View popup
TABLE 1

Clinical characteristics and pulmonary function in patients admitted between January 1, 2004 and December 31, 2017

Respiratory function was assessed in 20 smokers versus nine nonsmokers with airflow obstruction: no major differences were found, with the only exception of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) absolute values (table 1).

Subjects with impaired lung function showed a significant improvement in 6-min walking distance (p=0.01), in final Borg dyspnoea (p=0.006) and fatigue (p=0.009) scores, as well as of FEV1 (p<0.0001), FVC (p=0.003), mean partial pressure of arterial oxygen (p=0.009), and median oxygen saturation in arterial blood (p=0.01).

Although several co-factors might have contributed, our findings support those of a previous study [6] showing that airway obstruction in patients with a history of TB was not associated with smoking history.

No pre- versus post-PR changes were observed among patients with normal respiratory pattern.

Preliminary data suggest that PR is effective in patients with a previous history of TB and with lung function impairment. As more and more countries can potentially manage PR in patients with TB sequelae, well-designed prospective studies are necessary to identify patients needing clinical assessment, as well as to clarify which PR models can be implemented to ensure a functional recovery.

Acknowledgements

This article belongs to the scientific activities of the WHO Collaborating Centre for Tuberculosis and Lung Diseases, Tradate, ITA-80, 2017-2020- GBM/RC/LDA and of the GTN (Global Tuberculosis Network) Working Group on TB and Pulmonary Rehabilitation, TB Treatment Committee (Chair: Marcela Muňoz Torrico).

Footnotes

  • Conflict of interest: D. Visca has nothing to disclose.

  • Conflict of interest: E. Zampogna has nothing to disclose.

  • Conflict of interest: G. Sotgiu has nothing to disclose.

  • Conflict of interest: R. Centis has nothing to disclose.

  • Conflict of interest: L. Saderi has nothing to disclose.

  • Conflict of interest: L. D'Ambrosio has nothing to disclose.

  • Conflict of interest: V. Pegoraro has nothing to disclose.

  • Conflict of interest: P. Pignatti has nothing to disclose.

  • Conflict of interest: M. Muňoz-Torrico has nothing to disclose.

  • Conflict of interest: G.B. Migliori has nothing to disclose.

  • Conflict of interest: A. Spanevello has nothing to disclose.

  • Received November 16, 2018.
  • Accepted January 26, 2019.
  • Copyright ©ERS 2019
https://www.ersjournals.com/user-licence

References

  1. ↵
    1. Collin SM,
    2. de Vries G,
    3. Lönnroth K, et al.
    Tuberculosis in the European Union and European Economic Area: a survey of national tuberculosis programmes. Eur Respir J 2018; 52: 1801449.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Lönnroth K,
    2. Migliori GB,
    3. Abubakar I, et al.
    Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J 2015; 45: 928–952.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    World Health Organization. Global Tuberculosis Report 2018. WHO/CDS/TB/2018.20. Geneva, World Health Organization, 2018.
  4. ↵
    1. Spruit MA,
    2. Singh SJ,
    3. Garvey C, et al.
    An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. 2013. Am J Respir Crit Care Med 2013; 188: e13–e64.
    OpenUrlCrossRefPubMedWeb of Science
  5. ↵
    1. Muñoz-Torrico M,
    2. Rendon A,
    3. Centis R, et al.
    Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis? J Bras Pneumol 2016; 42: 374–385.
    OpenUrl
  6. ↵
    1. Amaral AFS,
    2. Coton S,
    3. Kato B, et al.
    Tuberculosis associates with both airflow obstruction and low lung function: BOLD results. Eur Respir J 2015; 46: 1104–1112.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Celli BR,
    2. MacNee W
    . Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23: 932–946.
    OpenUrlFREE Full Text
  8. ↵
    1. Pellegrino R,
    2. Viegi G,
    3. Brusasco V, et al.
    Interpretative strategies for lung function tests. Eur Respir J 2005; 26: 948–968.
    OpenUrlFREE Full Text
  9. ↵
    1. Graham BL,
    2. Brusasco V,
    3. Burgos F, et al.
    2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J 2017; 49: 1600016.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Hill K,
    2. Jenkins SC,
    3. Cecins N, et al.
    Estimating maximum work rate during incremental cycle ergometry testing from six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2008; 89: 1782–1787.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top
View this article with LENS
Vol 53 Issue 3 Table of Contents
European Respiratory Journal: 53 (3)
  • Table of Contents
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Pulmonary rehabilitation is effective in patients with tuberculosis pulmonary sequelae
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Citation Tools
Pulmonary rehabilitation is effective in patients with tuberculosis pulmonary sequelae
Dina Visca, Elisabetta Zampogna, Giovanni Sotgiu, Rosella Centis, Laura Saderi, Lia D'Ambrosio, Valentina Pegoraro, Patrizia Pignatti, Marcela Muňoz-Torrico, Giovanni Battista Migliori, Antonio Spanevello
European Respiratory Journal Mar 2019, 53 (3) 1802184; DOI: 10.1183/13993003.02184-2018

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Pulmonary rehabilitation is effective in patients with tuberculosis pulmonary sequelae
Dina Visca, Elisabetta Zampogna, Giovanni Sotgiu, Rosella Centis, Laura Saderi, Lia D'Ambrosio, Valentina Pegoraro, Patrizia Pignatti, Marcela Muňoz-Torrico, Giovanni Battista Migliori, Antonio Spanevello
European Respiratory Journal Mar 2019, 53 (3) 1802184; DOI: 10.1183/13993003.02184-2018
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Abstract
    • Acknowledgements
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

Agora

  • Airway immune responses to COVID-19 vaccination in COPD patients
  • Wider access to rifapentine-based regimens is needed for TB care globally
  • Screening for PVOD in heterozygous EIF2AK4 variant carriers
Show more Agora

Correspondence

  • GOLD 2023 taxonomy: new tool to determine COPD etiotypes
  • Latent COPD: a proposed new term in the disease nomenclature
  • Empiric anti-anaerobic antibiotics are associated with adverse clinical outcomes
Show more Correspondence

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About the ERJ

  • Journal information
  • Editorial board
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Instructions for authors
  • Publication ethics and malpractice
  • Submit a manuscript

For readers

  • Alerts
  • Subjects
  • Podcasts
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Print ISSN:  0903-1936
Online ISSN: 1399-3003

Copyright © 2023 by the European Respiratory Society