Comprehensive pulmonary rehabilitation for post-tuberculosis lung disease: a narrative review

Around 155 million people worldwide are tuberculosis (TB) survivors, many of whom experience post-tuberculosis lung disease (PTLD), characterized by structural lung abnormalities, impaired pulmonary function, persistent respiratory symptoms, reduced exercise capacity, and poorer quality of life. The burden of PTLD is particularly important in low- and middle-income countries (LMICs), where access to pulmonary rehabilitation (PR) and long-term post-TB care remains limited. This narrative review synthesizes current evidence on comprehensive PR for PTLD and considers its implementation across diverse healthcare settings. Available studies suggest that PR can improve exercise capacity, respiratory symptoms, functional status, and health-related quality of life in individuals with post-TB pulmonary impairment, although PTLD-specific evidence remains limited and heterogeneous. Comprehensive rehabilitation extends beyond exercise training to include breathing and airway-clearance strategies, nutritional support, psychological and psychosocial care, patient education, and tele-rehabilitation. Where direct PTLD-specific evidence is limited, established evidence and principles from rehabilitation in other chronic respiratory diseases may inform the adaptation of these components to post-TB care. Key implementation challenges in resource-constrained settings include limited rehabilitation infrastructure, workforce and financial constraints, geographical barriers, and poor integration of rehabilitation into routine TB services. Context-adapted approaches, including simplified, community-based, home-based, and digitally supported models, may improve accessibility and feasibility. Integrating multidisciplinary rehabilitation into post-TB care may help address the long-term physical, psychological, and social consequences of TB; however, further PTLD-specific trials and implementation research are needed to establish optimal programme components, delivery models, and long-term effectiveness.