Managing the Impact of Chronic Respiratory Diseases (CRDs) through Pulmonary Rehabilitation (PuRe) in Pakistan: A Path to Better Respiratory Health

Background/Aim: In Pakistan, chronic respiratory diseases (CRDs) present significant public health challenges. In 2022, over 7.5 million adults, were affected. The multidisciplinary pulmonary rehabilitation program (PuRe) is evaluated for its effect on walking distance and health-related quality of life. Rationale and intervention: Physical rehabilitation is recommended for symptomatic and exacerbating patients with CRD. It was introduced at The Indus Hospital, a private, donation-based tertiary referral center in Karachi, Pakistan, in 2018. Strategy: An 8-week program for patients aged 14+ with modified Medical Research Council (mMRC) above 2 and diagnosis of CRD encompassed 18 sessions (physiotherapy, mental health counseling, nutritional support and inhaler technique education, Figure 1). Patients with advanced cardiac, orthopedic, neurological diseases and pregnancy were excluded. Data variables include age, gender, diagnosis, referral source, pre-post mMRC, six-minute walk distance, and quality of life (St. George Respiratory questionnaire (SGRQ)). Excel was used for data analysis. Figure 1: Interdisciplinary Approach in Pulmonary Rehabilitation (PuRe) Impact: PuRe enrolled 128 patients with 46.8% completion and 50% dropout rate. Completion was enhanced by the addition of free transport (76%). Participants were over 50 years (73%) with 64% males and 37% females completing. Most referrals were from pulmonology (80%) and family medicine (14%). Leading diagnoses: COPD (38.3%) and asthma (10%). Post-intervention, mMRC scores improved by two scales, quality of life enhanced by over 60% (SGRQ), and mean walking distance improved by 120 meters. Challenges and Conclusion: Whilst significant benefits were seen in patients completing the program, there were challenges in program implementation. Capacity building was required at all levels of stakeholders, including physiotherapists, nutritionists and counsellors. Staff shortages introduced gaps in care. Funding had to be sought for transport facilities to enable completion rates to improve. Despite these issues, there is potential for pulmonary rehabilitation in low-middle-income countries like Pakistan.