Pulmonary rehabilitation in Uganda

Chronic lung disease (CLD) 

  • affects around one in five adults in Africa
  • arises from respiratory infections such as TB and HIV, tobacco smoking and nutritional impairment.

Patients with breathlessness related to CLD create damage to the economy through lost productivity and disability, and direct health service costs with frequent and prolonged hospital admissions.

People with CLD are prone to breathlessness, inactivity, de-conditioning, declining health status and prognosis.

CLDs are disproportionately prevalent in deprived populations and many sufferers can neither afford the drugs nor transport to medical clinics.

While medication may improve lung function and symptoms in some patients, for those with irreversible damage pulmonary rehabilitation (PR) is the only treatment and can be very effective.

PR is a programme of exercise, education and self-management. PR involves existing local resources such as nurses, doctors, physiotherapists and clinic staff. PR allows patients to help each other and themselves, without major capital outlay or equipment.

We are running a development project in which we set up and ran a PR programme in Mulago Hospital, Kampala. A multidisciplinary team of doctors, nurses, physiotherapists and others have run five groups with around 40 patients with chronic lung damage secondary to pulmonary TB. Preliminary results confirm that the programme is feasible and acceptable to patients and to the hospital staff at all levels. Major improvements were seen in exercise capacity and health status. In many patients the experience was life changing, allowing severely incapacitated patients who were entirely dependent on others to now function normally in work and social activities.

The objective of the development project is to develop PR to a point where it may be deployed widely in East Africa and assessed in a large trial.


Funding

MRC Wellcome and DFID Joint Global Health Trials £162,880.


The future

Our pilot study is showing that in small numbers of patients, unexpected improvements in chest pains, haemoptysis and night sweats occurred and this may open the door to research into physiotherapy approaches to post-TB morbidity, a subject receiving little attention in TB research and guidelines.

If the development study is successful we will progress to a major roll-out study through East Africa (Kenya, Tanzania and Zambia). The rehab programme is also an element within the Horizon 2020 funded programme of research – Fresh Air.

A patient's story (provided with consent)

"Two years ago our patient, an 18 year old woman, developed pulmonary TB. She became unwell with cough, fever, haemoptysis, breathlessness and weight loss. She had TB treatment but did not recover properly as she suffered with recurrent infection in cavitating lesions and was given repeated courses of antibiotics. These made little difference; she remained weak, tired, unable to attend school, very breathless, could only walk short distances and could not carry anything heavy."

 

"She had severe chest pains, especially at night. She became very depressed and worried for the future. Eventually she saw Dr WK in 2013, who referred her to the pulmonary rehabilitation programme and she attended throughout. She is now back to normal, attending school, and feels strong again "I have so strong muscles and bones". She has gained weight, her chest pains and haemoptysis have gone. She was so pleased that she came especially to thank me. She wants to be a doctor."

Pulmonary rehabilitation in Uganda

“Our patients are very excited about the programme, they love it so much, especially after the improvements they have seen in the first few sessions. They don’t want to stop, they want to continue coming and they are feeling so much better.” – Dr Wincey Katagira

The preceding pilot study and this film were funded by the International Primary Care Respiratory Group.