Annals of the American Thoracic Society · Mar 24, 2026

Clinical and cost effectiveness of pulmonary rehabilitation for people with post-tuberculosis lung disease in Kyrgyzstan: a single-blind randomized controlled trial

By Akylbekov A, Orme MW, Matheson JA et al.

RATIONALE: Tuberculosis (TB) is a major worldwide cause of disability, with TB survivors experiencing a significant and often underrecognized burden, and approximately half going on to develop post-tuberculosis lung disease (PTLD). Pulmonary rehabilitation may offer effective disease management, but there is a lack of evidence in PTLD populations. OBJECTIVES: We aimed to determine the clinical and cost effectiveness of pulmonary rehabilitation for adults living with PTLD in Kyrgyzstan. METHODS: A single-blind randomized controlled trial, conducted March 2021 to June 2022 in Bishkek, Kyrgyzstan, compared supervised pulmonary rehabilitation to usual care for adults living with PTLD. Participants were randomized (1:1) to receive either usual care (control) or culturally adapted pulmonary rehabilitation (intervention), comprising individually prescribed and tailored exercise and self-management education. The primary outcome was change in maximal exercise capacity, measured by the incremental shuttle walking test (ISWT), from baseline to the end of 6 weeks of pulmonary rehabilitation, analyzed by intention-to-treat analysis. Secondary outcomes included health-related quality of life (HRQoL) and cost-effectiveness analysis. RESULTS: One hundred fourteen participants (mean ± SD, 43.3 ± 15.2 years; 57% male) received either supervised pulmonary rehabilitation or usual care. Compared with the control group, changes in exercise capacity and HRQoL from baseline were significantly greater in the intervention group (ISWT: 123.0 m [95% CI, 81.2-164.8 m], P <.001; EQ-5D-5L Visual Analogue Scale: 20.2 [95% CI 15.5-24.9], P <.0001). The intervention group saw a significant increase in quality-adjusted life-years (QALYs) over the control group (0.2 [95% CI, 0.1-0.2]). We calculated a total program cost of US$5686.5 (US$95 per patient who received pulmonary rehabilitation), giving a program cost, after adjusting for purchasing power, of US$2143.2 per QALY (95% CI, $1621.9-$2663.9). CONCLUSIONS: In adults with PTLD in Kyrgyzstan, a culturally adapted pulmonary rehabilitation program significantly improved exercise capacity and HRQoL compared with usual care and was both clinically and cost effective.

doi.org/10.1093/annalsats/aaoag062 Open access PubMed 41871998 Interventions