Tuberculosis, often abbreviated as TB is a bacterial, infectious disease caused by the microbe mycobacterium tuberculosis. It is highly contagious, particularly in crowded areas and if left untreated can prove fatal in half of all instances. There are currently three active strains of TB, the general, which is treatable with ordinary medication, the MDR (Multiple Drug Resistant), which is partially resistant to antidotes, and XDR (Extensively Drug Resistant) strain, which highly resistant to all forms of treatment and requires specialised drugs.

TB is identified through its symptoms, which include persistent cough, chest pain, coughing with bloody sputum, urine discoloration or cloudy or reddish urine, fever with chills and fatigue. The disease was at its peak during the 19^th century, however there has been a rise in cases in recent times, owing to the HIV epidemic.  Here are some other interesting facts about TB:

1. TB Doesn’t Just Affect the Lungs

While TB is known primarily as a pulmonary (lung) disease, it can also affect other parts of the body, including the kidneys, brain, and spine. These extra-pulmonary infections are even more lethal than an infection of the lungs, and require immediate treatment.

2. Up To 10% of People with Latent TB Develop Active Tuberculosis

As an airborne disease, TB is so contagious, it infects a third of the world’s population, however only 10% actually develop an active infection. Since the initial symptoms are mild, most patients are completely unaware of their infection, meaning they can each infect between 15-20 other people a year.

3. TB Is an Airborne Disease

TB is spread through expelled droplets, every time an infected person coughs, sneezes, or spits. Anyone who breathes in these particles is susceptible to an infection.

4. Smokers Are More Likely To Contract TB

Smokers are more than twice more likely to contract TB, while alcoholics and diabetics are also at a greater risk than the general population.

5. There Is a Vaccine against TB

The Bacillus Calmette-Guerin (BCG) vaccine is recommended for healthy babies, to be administered as soon as possible after they’re born. However, infants who are HIV+ cannot be vaccinated. This vaccine can just as easily be administered to adults as well.

Prime Minister Modi’s vision to end TB in India by 2025 will implement a national strategic plan (NSP) with funding of over Rs. 12,000 crore for the next three years to safeguard every TB patient and provide access to treatment, quality diagnosis and abundant support.

It has been witnessed that Tuberculosis is a leading contagious killer in India with over 4 lakh people surrendering to the disease. The estimated new cases in the country recorded were beyond 25 lakhs. Under the Revised National Tuberculosis Control Programme (RNTCP), a proposal of Rs.500/month per patient for the nutritional support of TB-affected patients during the course of the treatment will be given as an incentive.

A big challenge India is facing is the lack of a proper protocol for either diagnosis or treatment. Any person with symptoms of TB should undergo diagnostic tests. If they are found to have the disease, they should be given drug resistance tests.

Awareness is the first step towards good health. In infections such as tuberculosis, it is important that patients are fully aware of the burden of the disease, the types of tests needed, the drugs used for treatment, duration of treatment, disease monitoring and treatment progression.

Dr. Anita Suryanarayan

Vice President, Operations (South India &  Sri Lanka),

Metropolis Healthcare Ltd

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25 September, World Lung Day (WLD),is a day for lung health encouragement and exploit a prospect for all to unite and endorse better lung health worldwide. People are suffering respiratory infections from a very long period and will remain to be a foremost cause of human suffering and death.

Virus, bacteria, fungi and other organisms can infect respiratory system and cause infections which interfere the normal breathing causing common cold, sinusitis, pharyngitis, epiglottitis, laryngotracheitis, bronchitis, pneumonia, etc. Pneumonia is the leading cause of death in children and in the elderly. Nearly 80 percent of deaths are in children under 2 years and adults above 65 years.  Majority of demises occur in low and middle-income nations.

Every year approximately there are 10 million new patients of  Tuberculosis (TB) and 1.5 million deaths. Deaths from TB happen typically in children below 5 years and adults in the 20-35 year age array. Above 95 % of TB deaths happen in low – and middle-income nations. COVID-19 is one among viral respiratory infection that has posh over 25 million people in the world and approximately 860,000 have expired by the start of September 2020.

Patients experience persistent respiratory symptoms

The burden is likely to increase exponentially in the near future. Apart from the initial morbidity and mortality, recently long term consequences are also being increasingly recognized. The degree and cruelty of the long term respiratory problems of covid-19 infection remain to be seen, but evolving statistics specify that many patients experience tenacious respiratory signs for months their initial illness. As per a recent study, 3-months after discharge, residual abnormalities of pulmonary function were observed in 25.45% of the cohort, mostly demonstrated diffusion reductions in DLCO.

It is necessary to follow up these patients, performing comprehensive assessment and early rehabilitation exercise for detection and appropriate management of any persistent or emerging long-term sequelae of COVID-19. Pulmonary rehabilitation takes a central seat in the management of post Covid lung fibrosis and is available only at handful of centres across the city.

Pulmonary rehabilitation (PR) has proved helpful in reducing symptom, physiological and psychosocial for chronic respiratory patients. It is a standard of care alongside other well-established treatments (such as pharmacotherapy, supplemental oxygen, or noninvasive ventilation) for patients with a chronic respiratory disease.

Patients with a chronic respiratory disease.

Case 1: Mr. Ajay (Name changed) a 69 years old gentleman, diagnosed with Covid-19 was medically managed for 16 days and discharged from the hospital with continuous oxygen support of 4 litres/minute. Since he was on supplementary Oxygen support and was dependent on his family members even for basic self-care activities like bathing and dressing up. He could not even bend forward to pick anything from floor and even walking within the room was a tedious task. He started looking for a post Covid rehab facility and got re-admitted for Comprehensive Pulmonary Rehabilitation programme at Sakra World Hospital.

He had issues in carrying out conversations due to breathlessness, making him dependent on supplemental oxygen. When he enrolled for the pulmonary rehabilitation, he expressed his concerns about not being able to spend quality time with his grandchildren & other family members. While undergoing comprehensive pulmonary rehabilitation, he was gradually weaned off from oxygen, his respiratory system improved and he showed significant improvement in his exercise tolerance.

His 6 minute walk test distance (6MWT – standardized measure for functional capacity) improved from 170 metres at 4L/minute supplemental oxygen to 230 metres without any oxygen support. He regained the ability to independently do all activities of daily living and did not require oxygen support at all.  He thoroughly enjoyed the yoga therapy sessions and was highly motivated to further continue rehab sessions on outpatient basis. He has shown great improvement in his overall quality of life and self-esteem and is committed to return to life to enjoy all that life offers.

Case 2: Mr. Sanjay (Name changed), a 68 year old gentleman from Mumbai learned about our programme and has enrolled for home based rehabilitation through video consultations. He was admitted in the ICU and was there for almost 18 days. He developed Pulmonary Fibrosis as a sequel to Covid infection and was on continuous oxygen support at 5-8L/minute. Any change in position even on the bed resulted in a drop in oxygen levels.

He had feeling of chest tightness and was unable to sleep normally and had to be on a reclined position throughout in order to breathe comfortably. He was unable to walk even to the washroom and was using a commode chair next to his bed. He was emotionally low and was scared of total dependency as the days passed.

Case 3: Mr. Karthik (Name changed) a 47 year old gentleman had generalized weakness, loss of muscle mass and was not able to resume his office work due to Oxygen dependency. He enrolled for a home based rehabilitation through video consultations along with once a week centre based (OPD) rehabilitation.

He was dependent on his family to climb stairs at his home to reach his bedroom as the Oxygen levels would drop, making him breathless. Training through the systematic protocols, he learned energy conservation techniques and gained better breathing control to cope up with his challenges. He is now independently climbing stairs and is determined to reclaim life.

Dr. Sachin Kumar, Senior Consultant
Pulmonology & Critical Care Medicine,
Sakra World Hospital, Bengaluru

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