DISCUSSION:

This study showed the results of effect of Incentive Spirometry with Pulmonary Rehabilitation
protocol versus Inspiratory Muscle Training with Pulmonary Rehabilitation protocol on Health
related Quality of Life of patients with Pulmonary Tuberculosis. The result of the study
demonstrated that the both the groups; one with Incentive Spirometry with Pulmonary
Rehabilitation protocol and another group with Inspiratory Muscle Training with Pulmonary
Rehabilitation protocol experienced significant improvement in Health related Quality of Life in
patients with Pulmonary Tuberculosis following 12 weeks of intervention. The Inspiratory
Muscle Training with Pulmonary Rehabilitation group experienced greater outcomes in Health
related Quality of Life (EQ-5D) in comparison to those received Incentive Spirometry with
Pulmonary Rehabilitation.

This study included a total number of 20 subjects (n=20) between the age group of 18-60 years,
both genders male and female. Informed consent was obtained from the participants in prior and
were randomly allocated into two groups of Group-A and Group-B. Each group consisting of 10
subjects and were included for the study satisfying the inclusion and exclusion criteria. In Group-
A, 6 (54.4%) were males and 4 (46.4%) of them were females. In the Group-B, 7 (72.7%) were
males and 3 (27.3 %) were females. There was no much variation in between the groups. It
evidenced that the baseline characteristics of gender was homogenous in nature in both the
groups. The background variables included were age, gender.

Pre-Post test data were recorded for both the groups; Health related Quality of Life was
measured through EQ-5D. The subjects of Group-A were allowed to perform Incentive
Spirometry with Pulmonary Rehabilitation protocol, as three 60-minute sessions every week for
12 weeks. The subjects of Group-B were allowed to perform Inspiratory Muscle Training with
Pulmonary Rehabilitation, as three 60-minute sessions every week for 12 weeks.

In Group-A the mean EQ-5D was 39.7000± 6.86456 with average improvement
58.3000±5.12185. The significance level is 0.002. We could say there is a significant difference
within the group.

COPD is a common comorbidity in patients with TB, second only to diabetes (7,8,9,10). Hwang
J. et al have studied the frequency of anthracofibrosis in foreign born Pulmonary TB patients in
Canada. According to them patients from the Indian subcontinent were more likely to have
anthracofibrosis compared to patients from other Asian countries. Most of the patients present
with cough, sputum and dyspnea. Indeed, dyspnea during daily activities and physical exercise is
common in COPD. Basoglu OK et al. (2005) found IS improved arterial blood gases and health-
related quality of life in patients with COPD exacerbations. Tiwary et al. (38) reported a
remarkable improvement in subjective feeling of well-being and breathlessness with the use of
incentive spirometry in COPD patients. The subjective findings reflect an improvement in
quality of life as reported in this study.

In Group-B the mean EQ-5D was 44.3000±6.41266 with average improvement 60.000±4.57044.
The significance level is 0.003. We could say that there is a significant difference within the
group.The goals of pulmonary rehabilitation programmes are mainly to improve the quality of
life of the patients, rather than functional parameters. It has been shown that pulmonary
rehabilitation, with and without additional inspiratory muscle training, can improve quality of
life in patients with COPD.(39-41) An improvement in inspiratory muscle strength and
endurance might reduce symptoms and improve functional capacity in patients with severe
COPD, even if airway obstruction does not improve. Inspiratory muscle training is recommended
for COPD patients,(42) and in a meta-analysis,(43) inspiratory muscle training alone
significantly improved inspiratory muscle strength and endurance, whereas the sensation of
dyspnoea decreased significantly in patients with COPD.

Jaya Negi et al (2019) conducted a study to compare the effectiveness of Incentive Spirometer
and Inspiratory Muscle Trainer in Patients with Chronic Obstructive Pulmonary Disease. In this
study, efforts were made to compare the effects of Incentive Spirometer and Inspiratory muscles
trainer devices as a treatment for improving ventilatory muscle strength in patients with mild to
severe dyspneain COPD. The study was done on randomized 30 COPD patients with mild to
moderate dyspnea diagnosed byphysician. The patients were randomly divided into 2 groups
consisting of 15 subjects each. Group A was treatedwith Inspiratory muscles trainer and Group B
with Incentive spirometer for a duration of 4 weeks. The resultsdemonstrated that the patients
treated with both the intervention were highly significant in improving ventilator muscle strength
and hence decreasing the exertional dyspnea. However statistically there was significant
differencebetween the two groups.

In our study the mean comparison between the groups in week 12 showed a significant
difference between the groups with significant level 0.004 (p<0.005). The mean EQ-5D after 12
weeks in Group-A is 58.3000±5.12185 and that in Group-B is 60.000±4.57044 and the result
also revealed that the patients treated with both the intervention were highly significant in
improving Health-Related Quality of Life (EQ-5D) as both the interventions improved ventilator
muscle strength in the study conducted by Jaya Negi et al. However there is significant
difference between the two groups.