Effects of Active Cycle of Breathing Techniques on Pulmonary Function, Sputum Clearance, Chest Expansion, and Exercise Capacity in Tuberculosis Patients

Abstract

Background: Tuberculosis (TB) remains a significant global health challenge, particularly in low-resource settings, where residual pulmonary dysfunction and impaired exercise capacity persist despite pharmacological advances, highlighting the need for effective adjunctive therapies such as Active Cycle of Breathing Techniques (ACBTs), which remain underexplored in TB rehabilitation. Objective: To evaluate the effects of ACBTs on pulmonary function, sputum clearance, chest expansion, and exercise capacity among patients with pulmonary tuberculosis undergoing standard anti-TB therapy. Methods: A randomized controlled trial was conducted involving 40 hospitalized acute-stage pulmonary TB patients (n = 40; aged 25–46 years) at The University of Lahore Teaching Hospital. Participants were randomized into a control group (standard treatment) or an experimental group (standard treatment plus ACBTs). Inclusion criteria included stable vital signs and ≥2 weeks of anti-TB therapy; exclusions included MDR-TB, hemoptysis, severe comorbidities, and extrapulmonary TB. Assessments included digital spirometry (FVC, FEV1, FEV1/FVC, PEF), cirtometry, the 6-Minute Walk Test, and the Breathlessness, Cough and Sputum Scale (BCSS). Ethical approval was obtained by the Declaration of Helsinki (IRB No. UOL/REH/2024/0432). Data was analyzed using SPSS v25; parametric and nonparametric tests were applied with significance at p ≤ 0.05. Results: The experimental group showed significantly greater improvements in FEV1 (1.83 ± 0.19 L vs. 1.71 ± 0.20 L, p = 0.04), FEV1/FVC ratio (61.85 ± 3.10% vs. 59.55 ± 2.80%, p = 0.01), PEF (278.75 ± 14.32 L/min vs. 263.50 ± 13.77 L/min, p < 0.001), and BCSS score reduction (5.50 ± 1.76 vs. 8.25 ± 1.55, p < 0.001), alongside greater chest expansion and lower exertion levels. Conclusion: Integration of ACBTs with standard anti-TB treatment significantly enhances pulmonary function, chest mobility, airway clearance, and symptom burden, supporting their clinical incorporation into tuberculosis rehabilitation protocols to improve functional outcomes and patient quality of life.