Pulmonary rehabilitation and inspiratory muscle training in post-tuberculosis lung disease: A randomized controlled trial assessing functional capacity, respiratory muscle strength, and quality of life.

BACKGROUND AND OBJECTIVES: Even after microbiological cure is achieved, a considerable proportion of patients treated for tuberculosis continue to experience lasting respiratory impairment - a condition now termed post-tuberculosis lung disease (PTLD). This randomized controlled trial (RCT) tested whether a structured pulmonary rehabilitation (PR) program, augmented with inspiratory muscle training (IMT), could improve exercise tolerance, inspiratory muscle strength, and health-related quality of life (HRQoL) in adults with confirmed PTLD, relative to standard care. METHODS: We enrolled 120 adults with microbiologically confirmed PTLD and spirometric evidence of ventilatory impairment (FEV1/FVC below 70%, or FVC below 80% predicted). Participants were randomly assigned in equal numbers to a 12-week supervised PR program that included IMT (n = 60), or to standard pharmacological management paired with a sham IMT device (n = 60). Three endpoints were designated co-primary: 6-min walk distance (6MWD), maximal inspiratory pressure (MIP), and total score on the St. George's Respiratory Questionnaire (SGRQ). Additional endpoints comprised FEV1, FVC, the modified Medical Research Council (mMRC) dyspnea scale, post-walk-test Borg dyspnea ratings, and the PRAISE self-efficacy index. Outcomes were captured at enrollment, 12 weeks, and 24 weeks. RESULTS: By the 12-week mark, participants receiving rehabilitation had gained considerably more ground than controls on 6MWD (adjusted difference 87.4 m; 95% CI 74.2-100.6; p < 0.001), MIP (adjusted difference 18.6 cmH2O; 95% CI 15.1-22.1; p < 0.001), and SGRQ total score (adjusted difference -14.8; 95% CI -17.3 to -12.3; p < 0.001). These advantages held through the 24-week assessment. Spirometric values also diverged between arms (FEV1 +0.21 L; FVC +0.29 L), as did dyspnea ratings. The trial recorded no serious adverse events. CONCLUSION: A 12-week, physiotherapy-led rehabilitation program incorporating IMT produced improvements in exercise capacity, inspiratory muscle function, and quality of life that were both statistically robust and clinically durable in a PTLD cohort. The findings support considering rehabilitation-based care as part of routine post-tuberculosis management in India.