Beyond Medication: Pulmonary rehabilitation in an older adult with non-cystic fibrosis bronchiectasis and allergic bronchopulmonary aspergillosis – a case report

Bronchiectasis results from a vicious cycle of pulmonary infection, airway inflammation and impaired mucociliary clearance, leading to abnormal and permanent dilatation of bronchi. Allergic bronchopulmonary aspergillosis (ABPA) is a common infection seen in adults with non-cystic fibrosis bronchiectasis. We present the short and long-term effects of Pulmonary rehabilitation (PR) and exercise training in a 69-year-old female with bronchiectasis. The patient's refusal to take any medication led to referral for physiotherapy, being a non-pharmacological treatment, as a last resort. PR was based on an individualised protocol, as determined by the physiotherapeutic assessment. Treatment included patient and family education, various breathing exercises, nutritional counselling, endurance, strength and functional activity training over a period of 6 months to 1 year. Significant improvement in functional capacity after 4 months of training, 1 min sit-to-stand (STS) count improved from 17/min to 30/min, Leichester quality of life (LCQ) total scores improved from 9.9/21 to 15.95/21. Single breath count (SBC) improved from 6 to 14. Improvements in the amount of sputum (5 tablespoons per bout, 8-10 times a day to 1-2 tablespoons per day), colour and consistency from P3 to M2 (Miller and Jones classification), with reduced frequency of coughing bouts. 1 year follow up showed further improvement in LCQ scores to 24.87, 1 min STS to 36 per minute and SBC to 24. Pulmonary rehabilitation plays a vital role in older patients diagnosed with bronchiectasis in improving physical, mental and social impairments, thereby contributing to improved quality of life.