“I have to breathe”: A mixed-methods pilot study to assess the feasibility, acceptability, cost, and effectiveness of an intervention for post-tuberculosis lung disease

Abstract Background Many tuberculosis patients who are successfully treated according to microbiologic endpoints experience sequelae that adversely affect quality of life and increase mortality. Prior research in Peru revealed an important burden of respiratory symptoms after successful treatment of tuberculosis. Here, we present a pilot intervention of 8 weeks of pulmonary rehabilitation and inhaled pharmacotherapy for people with respiratory symptoms after successful tuberculosis treatment. We examine the feasibility, acceptability, and cost of the intervention, “Libre Post-TB”. Methods This was a mixed methods study conducted in Lima, Peru. We recruited adults with respiratory symptoms within three months of successful completion of TB treatment. At baseline, we recorded demographic characteristics, vital signs, medical history, and chest X-ray findings. At baseline and end of study, we evaluated respiratory symptoms, quality of life, lung function, fitness, strength, and fatigue. We surveyed participants on direct medical, non-medical and indirect costs of participation in the intervention and estimated its cost in the public health system. We assessed feasibility with senior health system personnel (N = 4) and primary care workers (N = 10) and acceptability with intervention participants (N = 14). We report the number of pulmonary rehabilitation sessions completed and integrated these results with those from the qualitative acceptability component. Results We enrolled 40 participants. Spirometry-defined COPD was detected in 3 (7.5%). In 10 (25%) and 9 (22.5%) participants, FEV1 and FVC, respectively, was below age-, sex-, height- standardized lower limits of normal. Participants completed 11 (IQR: 5,15) of 16 pulmonary rehabilitation sessions. Participants generally appreciated the virtual intervention and associated flexibility; for some this was inadequate to guarantee completion. Differences in lung function were not apparent while improvement in quality-of-life was detected after intervention. Some providers normalized post-TB symptoms. Feasibility findings included that limited guidance and facilities for post TB lung disease should not preclude its implementation. Conclusions A brief pulmonary rehabilitation intervention was feasible and acceptable for people with respiratory symptoms following successful TB treatment in Peru. There is some evidence for improved symptomatology. With an estimated 155 million TB survivors, and high prevalence of PTLD, the potential impact of improved interventions is enormous.