Abstract
Patients with pulmonary tuberculosis (PTB) often experience persistent mucus retention, bronchiectasis, and systemic inflammation even after microbiological cure, resulting in impaired quality of life and exercise capacity. This randomized controlled trial compared the efficacy of the Lung Flute (acoustic vibration device) and Acapella (oscillatory positive expiratory pressure device) with standard care in microbiologically cured PTB patients with residual respiratory symptoms. Sixty patients with daily sputum production were randomized (1:1:1) into Lung Flute, Acapella, or control groups and followed for 8 weeks. Primary outcomes were changes in six-minute walk distance (6MWD) and St. George’s Respiratory Questionnaire (SGRQ) total score. Secondary outcomes included sputum volume, modified Medical Research Council (mMRC) dyspnea scale score, maximal inspiratory pressure (MIP), C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), and exacerbation/readmission rates. Both devices significantly outperformed standard care. The Lung Flute group showed the greatest improvements: 6MWD +72.4 ± 31.2 m, SGRQ -12.3 ± 5.1 points, daily sputum volume +18.2 ± 7.1 mL, ESR -28.4 ± 11.2 mm/h, CRP -42 ± 18%, and IL-6 -48 ± 22% (all p<0.01 vs. control; most p<0.05 vs. Acapella). Reductions in inflammatory markers strongly correlated with clinical improvements, particularly in the Lung Flute group (r = -0.68 for ?ESR vs. ?6MWD, p<0.001). Six-month readmission rates were 0.3, 0.5, and 0.9 per patient-year for the Lung Flute, Acapella, and control groups, respectively (log-rank p=0.05). No adverse events were reported. The Lung Flute is superior to Acapella and standard care in reducing systemic inflammation and improving functional outcomes in PTB patients with residual mucus hypersecretion.
Keywords: 6MWD, Acapella, Airway clearance, Lung flute, Post-tuberculosis lung disease, Pulmonary tuberculosis, SGRQ, Systemic inflammation.
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