A qualitative study on the development of pulmonary rehabilitation for patients with chronic lung disease in Kampala, Uganda

Introduction: Respiratory infections such as tuberculosis (TB) HIV and tobacco smoking has led to an epidemic of chronic lung disease (CLD). Many CLD patients in Africa have poor health status, and there is no affordable treatment. Aim: To investigate the acceptability of pulmonary rehabilitation (PR) in Kampala, for patients with CLD including post-TB. Objectives to investigate barriers and facilitators to patient recruitment and retention to the programme. the impact of CLD and PR on patients, suggestions for improvements to PR and exercise maintenance Methods With Ugandan clinicians we adapted an exercise regime based on conventional PR and developed a new education programme delivered twice weekly for 6 weeks. Interviews were conducted with patients at baseline and six weeks post completion, plus group discussions and ethnographic observations. Data were analysed thematically. Results: 45 patients commenced and 40 completed PR; 25 baseline and 19 six week post completion interviews were conducted, plus 5 group discussions, and ethnographic observations, across 4 PR groups. Patients reported being debilitated by their condition before PR. Although exercises were hard to complete at first, PR was acceptable and was often continued at home. Improvements in functional ability, social and intimate relationships and less stigma were reported. In many individuals PR was life transforming. Conclusion: PR offers a new option for treatment for a neglected group of patients, who saw major improvements in their quality of life; they were less dependent and more engaged in society. A large implementation study is planned for Zambia, Kenya and Tanzania.