Integrated Physiotherapy and Pulmonary Rehabilitation for Post-Tubercular Chronic Obstructive Pulmonary Disease: A Case-Based Approach
Tuberculosis (TB), caused by Mycobacterium tuberculosis, has affected humans for thousands of years [1]. According to the Global Tuberculosis Report 2018, there are an estimated 10 million incident cases of tuberculosis, equivalent to 133 cases/100,000 population [2]. India accounts for 27% of all estimated incident cases worldwide [5]. Although successful treatment prevents death, many TB survivors experience long-term sequelae, including chronic obstructive pulmonary disease (COPD), bronchiectasis, and pulmonary hypertension [6,7]. COPD, defined by GOLD as persistent airflow limitation with chronic inflammation, remains a major cause of morbidity and mortality, with nearly 65 million people affected globally and 32% of global DALYs due to COPD occurring in India [4,5]. Post-tubercular lung disease significantly increases the risk of COPD, termed tuberculosis-associated obstructive pulmonary disease (TOPD) [10–14]. These patients exhibit severe airflow limitation, higher symptom burden, and reduced quality of life compared to smoking-related COPD [9].
Pulmonary rehabilitation, one of the most effective non-pharmacological strategies, includes breathing retraining, airway clearance, aerobic and resistance exercises. Evidence shows structured programs improve exercise tolerance, reduce dyspnea, and enhance functional independence [12]. A case-based physiotherapy protocol, combining education, airway clearance techniques, diaphragmatic breathing, and endurance training, improved six-minute walk distance (198 m to 440 m) and CAT score (26 to 20), underscoring its clinical value. Comprehensive physiotherapy-driven rehabilitation should be an integral component of post-TB COPD management [13,14].
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