Pulmonary tuberculosis

1. PULMONARY
TUBERCULOSIS
SUBMITTED TO : DR. JAMAL ALI MOIZ
SUBMITTED BY : SUALEHA KHANAM
ROLL NO. : 17BPT037
BPT 4th YR
SUBJECT : PT IN CARDIOPULMONARY CONDITION
(BPT402)
DATE OF PRESENTATION : 04/01/2021
JAMIA MILLIA ISLAMIA
CENTRE FOR PHYSIOTHERAPY AND REHABILITATION SCIENCES

2. INTRODUCTION:
Pulmonary tuberculosis (TB) is a contagious bacterial infection that
involves the lungs. It may also spread to other organs causing
extrapulmonary TB.
It is chracterized by :
• Coughing lasting >3 weeks are not respond to usual antibiotic
• Production of purulent , sometimes blood stained sputum
• Evening rise of temperature
• Night sweats
• Weight loss

3. EPIDEMIOLOGY :
ETIOLOGY : caused by mycobacterium tuberculosis.
Droplets Nuclie ( Coughing , sneezing , laughing )
Exposure to TB
MODE OF TRANSMISSION : Inhalation ,ingestion ,inoculation and
transplacental route .
INCIDECE AND PREVALENCE : Most common chronic disease
worldwide .Affected 1/3 population.
More common in poor countries of Asia and Africa.

4. PHASES:
• PRIMARY TUBERCULOSIS ( Dormant or Latent) – Although a
person’s body can be infected with mycobacterium
tuberculosis, they may not be showing clinical signs and
symptoms.
• SECONDARY TUBERCULOSIS (Active ) – This will develop
after the immune system of a person is lowered.secondary
tuberculosis differs in clinical presentation from the primary
progressive disease. In secondary disease, the tissue reaction
and hypersensitivity is more severe, and patients usually form
cavities in the upper portion of the lungs.

5. PATHOPHYSIOLOGY
• Due to etiological factors
• Bacteria goes to alveoli deposits and multiply
• Stimulate body immune response
• Macrophages destroy many bacteria and normal tissues
• Dead bacilli and live masses surrounded by macrophages (
Ghons tubercle )
• Necrotic degeneration occur ( production of cavity filled with
cheese like mass of tubercle bacilli ,dead WBCs and dead
tissues ). It leads to,
• Pulmonary tuberculosis

7. SIGN AND SYMPTOMS
• Fever
• Fatigue
• Malaise
• Anorexia
• Rales could be heard in the lobes of involvement in the lungs
• Bronchial Breath Sounds
• Dull chest pain, tightness, or discomfort
• Dyspnea
• Haemoptysis (late-stage symptom)

9. RISK FACTORS
• HIV - AIDS : due to compromised immunosuppressive
system
• Rheumatoid Arthritis - due to immunosuppressive
treatments
• Diabetes Mellitus
• End-stage Renal Disease
• Alcoholism
• Malnutrition
PREVENTION :
• Early diagnosis and treatment
• Use protective respiratory devices
• BCG vaccination

10. ASSESSMENT AND DIAGNOSTIC FINDINGS
• HISTORY COLLECTION
• PHYSICAL EXAMINATION : Abnormal breath sounds specially
over the upper lobes .Rales or bronchial breath signs
indicating lung consolidation
• Clubbing of the finger or toes
• Swollen or tender lymph nodes in neck or other areas.
• Montoux tuberculin skin test with purified derivatives proteins
• X- ray : Cavity formation , Non calcified nodules infiltrates
• Sputum smear ( Acid fast bacillus )

11. A person with advanced
tuberculosis: Infection in both lungs
is marked by white arrow-heads, and
the formation of a cavity is marked
by black arrows.
Ghons tubercle

12. TREATMENT
PHARMACOLOGICAL:
• Always treat with multiple drugs
• Treatment course depend on the categories of the patient.
Usually 6 months to 9 months
• Four drugs ( Isoniazid ,rifampicin ,ethambutol and
pyrszinamid ) for 2 months .And two drugs ( Isoniazid and
rifampicin ) for 4 to 7 months .
• DOTS ( direct observed treatment shourtcourse ) is given
.PHYSICAL MEASURES: Isolate patients with possible TB
in a private room with negative pressure.Continue isolation
until sputum smears are negative for 3 consecutive
determinations (usually after approximately 2-4 weeks of
treatment)

13. PULMONARY REHABILITATION
PR is a multidisciplinary programme, addressed to patients
with respiratory impairment this therapy is individualized and
involves physical training, psychological counselling, nutritional
support, along with compliance with TB drug treatment.
Nutrition support:
Proper nutrition is an important element in all stages of TB
infection
Nutritional supplementation may have a positive role in these
patients recovery. Adding high calorie supplements for patients
with TB in first phase of treatment has to be shown to have
benefits on lean mass, body weight and physical function after 6
weeks

14. Psychological support : relaxation techniques , stress
management .
Therapeutic education :Quitting smoking , avoiding
environment with toxins ,irritants or allergens that may worsen
the symptoms.
PR programs improves symptoms , exercise capacity and social
integration .it involves,
• Breathing exercises
• Upper and lower limb strengthening exercises and
conditioning exercise
• Relaxation exercise
• Respiratory muscle strengthening exercises
• Level walking

15. PR IN ACTIVE PHASE OF PULMONARY TUBERCULOSIS :
Exercise training :
• Initially typically bed rest and avoidance of exercise is
recommended in patient with severe hemoptysis
• After few days , starting with passive exercise (arm , shoulder,elbow
,knee )active - assisted and active exercise
• Exercise at slow pacewill be preferred first follwed by increasing the
degree of precision and postural control .
• The exercise must target the both upper limb and lower limb and
walk test may be used
• In order to mobilize the diaphragm expansion and recovering the lung
reserve volumes, abdominal – diaphragmatic breathing, thoracic
mobilization against a resistance can be used. After 1 month, the rib
expansion exercise can be start .

16. PR IN POST TUBERCULOSIS SEQUELAE
Airway clearance techniques:
• Postural drainage : it must be done before a meal, once or several
times a but not more than 20–30 min, during which time several
positions will be used, 5–10 min each. At the end of each position
period, the drained region will be tap for 1 min.
• Another techniques used to diminish the sputum load are as follow
as : autogenic drainage ,forced expiration, vibration with special
devices and manual procedures such as clapping and
percussions.

17. COUGH EDUCATION :Cough education is important for patient with
TB and consist of : body positioning during coughing, control of
breathing in coughing (slowly nose inspiration, short apnoea and
strong air expiration in 2–3 sessions). The goal is to achieve
mobilization and secretions removal from the bronchial tree.
Exercise Training : PR programme, including physical aerobic
training,therapeutic education and activities of daily living. The
sessions took place three times per week for 8 weeks
exercisetraining was aerobic, performed on a treadmill for lower
limb, with training intensity starting from 60% and reaching 90% of
the maximum oxygen consumption.it leads to improvement in
exercise tolerance ,QOL,deminution of chest pain and hemoptysis.

18. PR IN MDR (Multiple drug resistant) TUBERCULOSIS
The PR programme in their case should be started as soon as
their condition becomes stable and include exercise training
(aerobic and endurance), nutrition support and psychological
counselling. A very important part is represented by the education
that aims to improve the long-term adherence to treatment and
the participation in daily life activities and social reintegration. The
palliative care should also be included in very severe patient with
MDR-TB.

19. SUMMARY
• Pulmonary TB is a bacterial infection of the lungs that can
cause a range of symptoms, including chest pain,
breathlessness, and severe coughing. Pulmonary TB can
be life-threatening if a person does not receive treatment.
• Most individuals who become infected with TB bacteria do
not feel sick or experience any symptoms. Latent TB is not
contagious but it can eventually develop into active TB.
• People with active TB usually begin to feel better after a
few weeks of treatment.
• Pulmonary rehabilitation useful tool in patient with active
phase and post TB sequeal.

20. REFRENCES:
• Maguire GP, Anstey NM, Ardian M, Waramori G, Tjitra et al.
Pulmonary tuberculosis, International Journal of Tuberculosis
and Lung Disease.
• Jones R, Kirenga BJ, Katagira W, Singh SJ, Pooler J,
Okwera A, et al. A pre-post intervention study of pulmonary
rehabilitation for adults with post-tuberculosis lung disease in
Uganda.
• WHO health organisation report on the global tuberculosis
epidemic Genera WHO :2008.