PULMONARY REHABILITATION ON PATIENT’S WITH TB MDR/XDR

SITTI NURUN NIKMAH, SPKFR, M.KES

INSTALASI REHABILITASI MEDIK

RS PARU ROTINSULU

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BACKGROUND

• The main factors that may affect the pulmonary function of patients who are treated for TB:

• the lack of adherence to drug therapy• residual post-treatment lesions• treatment duration• the presence of other pulmonary diseases such as

emphysema, COPD, asthma, and bronchiectasis

• There is no consensus concerning the predominant type of ventilatory disorder found in patients treated for TB

BACKGROUND

Ramos et al

• recommended the early treatment of TB cases, which contributes to a decrease in sequelae and improves the patients’ quality of life.

Dhuria et al

• impact that TB has on patients’ quality of life, showing scores that were significantly lower than a control group

Guo et al

• TB has a substantial negative impact on the patients’ quality of life, even after the microbiological cure.

BACKGROUND

• the main impaired domains • the physical domain the ability to perform daily activities

• the psychological domain

• There is that none of functional assessment was specific for TB patient’s, making it difficult to understand the impact of the disease in such a group of patients

• MDR-TB cured patients with present impaired respiratory function and a mildly reduced functional capacity and quality of life, suggesting that a portion of these patients may require a pulmonary rehabilitation approach

BENEFIT OF PULMONARY REHABILITATION

• Patients with sequelae of pulmonary tuberculosis and its treatment underwent a rehabilitation programmewhich included respiratory muscle training as well as relaxation and exercise training .

• Improvements were seen in FEV1, FVC, PO2, maximal inspiratory mouth pressure, 6-min walking distance and quality of life.

• The principle of specific respiratory muscle training is that skeletal muscle deconditioning is reversible and that the contractile properties of the muscles can be improved by training

PULMONARY REHABILITATION

• Airway Clearance:

• Nebulization

• Postural drainage

• Effective cough : manual or machine assisted

• Breathing Exercise:

• breathing relaxation, breathing retraining, breathing pattern

• respiratory muscle training

• Physical Training:

• Flexibility exercise

• upper and lower limb strengthening

• aerobic exercise: treadmill, ergocycle

• Educational support: lifestyle and environment modification

• LTOT

FUNCTIONAL ASSEMENT

• 6MWT/D : because it reflects the patients performance of daily activities

• Respiratory Muscle Strength

• Nutritional Status

• Spirometry

• VO2 peak

• Quality of life questioners (e.i SF-36, SGRQ)

Reference

• Godoy, M., Mello, F., Lopes, A., Costa, W., Guimarães, F., Pacheco, A., Castanho, I. and Menezes, S. (2012). The Functional Assessment of Patients With Pulmonary Multidrug-Resistant Tuberculosis. Respiratory Care, 57(11), pp.1949-1954

• De Grass, D., Manie, S. and Amosum, S. (2015). Effectiveness of a home-based pulmonary rehabilitation programme in pulmonary function and health related quality of life for patients with pulmonary tuberculosis: a pilot study. African Health Sciences, 14(4), p.866.

• Donner, C., Ambrosino, N. and Goldstein, R. (2005). Pulmonary rehabilitation. London: Hodder Arnold.

• Muñoz-Torrico, M., Rendon, A., Centis, R., D'Ambrosio, L., Fuentes, Z., Torres-Duque, C., Mello, F., Dalcolmo, M., Pérez-Padilla, R., Spanevello, A. and Migliori, G. (2016). Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis?. Jornal Brasileiro de Pneumologia, 42(5), pp.374-385.

GEDUNG MDR TB LAMA ( PS RANAP)

GEDUNG MDR TB LAMA ( PS RANAP)

GEDUNG MDR TB LAMA ( PS RANAP)

Ps Tb ICU

GEDUNG MDR TB BARU ( PS RAJAL)

GEDUNG MDR TB BARU ( PS RAJAL)