Clinical standards for the assessment, management and rehabilitation of post-TB lung disease
Giovanni Battista Migliori, Florian M. Marx, Nicolino Ambrosino, Elisabetta Zampogna, H. Simon Schaaf, Marieke M. van der Zalm, Brian Allwood, Anthony Byrne, Kevin Mortimer, Robert S. Wallis, Greg J. Fox, Chi Chiu Leung, Jeremiah Chakaya, Barbara Seaworth, Andrea Rachow, Ben J. Marais, Jennifer Furin, Onno W. Akkerman, Fatma Al Yaquobi, André F.S. Amaral, Borisov Se, José A. Caminero, Anna Cristina Calçada Carvalho, Dumitru Chesov, Luigi Ruffo Codecasa, R. C. Teixeira, Margareth Pretti Dalcolmo, Sumona Datta, Anh Tuan Dinh‐Xuan, Raquel Duarte, Carlton A. Evans, José-María García-García, Gunar Günther, Graeme Hoddinott, Sophie Huddart, Olena Ivanova, Rafael Laniado-Laborı́n, Selene Manga, K. Manika, Andrei Mariandyshev, Fernanda Carvalho de Queiroz Mello, Stellah Mpagama, Marcela Muñóz-Torrico, Payam Nahid, Ong C, Domingo Palmero, Alberto Piubello, Emanuele Pontali, D. R. Silva, Rupak Singla, Antonio Spanevello, Simon Tiberi, Z. F. Udwadia, Michele Vitacca, Rosella Centis, L. D´Ambrosio, Giovanni Sotgiu, Christoph Lange, Dina Visca
Abstract
BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR). METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement). RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR. CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.