Bronchoscopy Balloon Dilatation and Pulmonary Rehabilitation To Prevent Recurrent Dyspnea In Post-Tuberculosis Lung Disease: A Case Report
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Published:
Dec 24, 2025
Keywords:
Balloon-dilation, Bronchoscopy, Post-tuberculosis lung disease, Pulmonary rehabilitation
Main Article Content
Abstract
Background: Post-tuberculosis lung disease (PTLD) frequently results in chronic airway complications, including cicatricial bronchial stenosis, which can cause recurrent dyspnea and impaired quality of life. Therapeutic bronchoscopy with balloon dilation and comprehensive pulmonary rehabilitation are emerging modalities for restoring airway patency and improving functional capacity.
Case Description: A 23-year-old female with treated pulmonary tuberculosis in 2020 presented with worsening dyspnea and productive cough. Bronchoscopy revealed near-total cicatricial stenosis of the right main bronchus. Sequential electrocautery via the Mercedes-Benz technique and balloon dilations with 8 mm and 9 mm balloons achieved airway patency, confirmed by passage of a 5.4 mm bronchoscope beyond the stenotic segment.
Discussion: Bronchoscopic balloon dilation has demonstrated safety and minimal invasiveness for tuberculosis-related bronchial stenosis, with low morbidity and manageable restenosis rates. Pulmonary rehabilitation, including Active Cycle Breathing Technique, diaphragmatic and deep-breathing exercises, mobilization, and energy conservation, aligns with WHO recommendations and significantly enhances lung function (FEV?, FVC, DLCO), exercise capacity, and quality of life. The combination of interventional and rehabilitative strategies offers a comprehensive approach, optimizing functional recovery and reducing dyspnea.
Conclusions: Combining bronchoscopic balloon dilation with structured pulmonary rehabilitation effectively reduces airway obstruction and improves respiratory function in PTLD. Early intervention and ongoing rehabilitation are essential to sustain long-term benefits and prevent functional decline.
Case Description: A 23-year-old female with treated pulmonary tuberculosis in 2020 presented with worsening dyspnea and productive cough. Bronchoscopy revealed near-total cicatricial stenosis of the right main bronchus. Sequential electrocautery via the Mercedes-Benz technique and balloon dilations with 8 mm and 9 mm balloons achieved airway patency, confirmed by passage of a 5.4 mm bronchoscope beyond the stenotic segment.
Discussion: Bronchoscopic balloon dilation has demonstrated safety and minimal invasiveness for tuberculosis-related bronchial stenosis, with low morbidity and manageable restenosis rates. Pulmonary rehabilitation, including Active Cycle Breathing Technique, diaphragmatic and deep-breathing exercises, mobilization, and energy conservation, aligns with WHO recommendations and significantly enhances lung function (FEV?, FVC, DLCO), exercise capacity, and quality of life. The combination of interventional and rehabilitative strategies offers a comprehensive approach, optimizing functional recovery and reducing dyspnea.
Conclusions: Combining bronchoscopic balloon dilation with structured pulmonary rehabilitation effectively reduces airway obstruction and improves respiratory function in PTLD. Early intervention and ongoing rehabilitation are essential to sustain long-term benefits and prevent functional decline.
Article Details
How to Cite
Widjanantie, S. C., Suta, P. D. D., Anggoro, S. C., Agustin, H., Susanto, A. D., & Burhan, E. (2025). Bronchoscopy Balloon Dilatation and Pulmonary Rehabilitation To Prevent Recurrent Dyspnea In Post-Tuberculosis Lung Disease: A Case Report. Indonesian Journal of Physical Medicine and Rehabilitation, 14(2), 252 - 256. https://doi.org/10.36803/indojpmr.v14i2.515
Section
Case Report
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References
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9. Wahyuni TD, Alatas MF, Widyasanto A, Siahaan SS, Muljadi R, Carolline C. Bronchoscopic Balloon Dilatation for Tuberculosis-related Bronchial Stenosis: A Rare Case. Respiratory Science. 2023 Feb 28;4(2):133–8.
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11. Mtei FJ, Meadows I, Msaji K, Thobias F, Liyoyo A, Kimaro A, et al. Pulmonary rehabilitation for post-TB lung disease led by TB survivors. Public Health Action. 2025 Jun 4;15(2):82–7.
12. Ichikawa Y, Kurokawa K, Furusho S, Nakatsumi Y, Yasui M, Katayama N. An effective case of bronchoscopic balloon dilatation for tuberculous bronchial stenosis. Respirol Case Rep. 2023 Aug 18;11(8).
2. Meghji J, Auld SC, Bisson GP, Khosa C, Masekela R, Navuluri N, et al. Post-tuberculosis lung disease: towards prevention, diagnosis, and care. Lancet Respir Med. 2025 May;13(5):460–72.
3. Yarbrough C, Miller M, Zulu M, Sharp D, Andom AT, Ndayizigiye M, et al. Post-tuberculosis lung disease: Addressing the policy gap. PLOS Global Public Health. 2024 Sep 5;4(9):e0003560.
4. Dewi IMW, Fauziyyah RNP, Wanda D, Kulsum ID, Lestari BW, Soeroto AY. Chronic Respiratory Symptoms among TB Survivors in a High-TB Burden Setting in Indonesia: a Preliminary Study. Jurnal Respirologi Indonesia. 2025 Jul 31;45(3).
5. Rozaliyani A, Setianingrum F, Isbaniah F, Agustin H, Handayani RRD, Syahrir R, et al. A Silent Threat in Post-Tuberculosis Patients: Chronic Pulmonary Aspergillosis Survey in Multiple Regions of Indonesia (I-CHROME Study). Journal of Fungi. 2025 Apr 22;11(5):329.
6. Kosasih KA, Amin Z, Amanda AP. Mortality Rate of Patients with Tuberculosis-Destroyed Lung Who Underwent Pulmonary Resection: Evidence Based Case Report. 2016.
7. Byrne A, Al-Hindawi Y, Plit M, Yeung L, Rigava S, King M, et al. The prevalence and pattern of post tuberculosis lung disease including pulmonary hypertension from an Australian TB service; a single-centre, retrospective cohort study. BMC Pulm Med. 2025 Feb 21;25(1):84.
8. Migliori GB, Marx FM, Ambrosino N, Zampogna E, Schaaf HS, van der Zalm MM, et al. Clinical standards for the assessment, management and rehabilitation of post-TB lung disease. The International Journal of Tuberculosis and Lung Disease. 2021 Oct 1;25(10):797–813.
9. Wahyuni TD, Alatas MF, Widyasanto A, Siahaan SS, Muljadi R, Carolline C. Bronchoscopic Balloon Dilatation for Tuberculosis-related Bronchial Stenosis: A Rare Case. Respiratory Science. 2023 Feb 28;4(2):133–8.
10. Kim H. Rigid Bronchoscopy for Post-tuberculosis Tracheobronchial Stenosis. Tuberc Respir Dis (Seoul). 2023 Oct 1;86(4):245–50.
11. Mtei FJ, Meadows I, Msaji K, Thobias F, Liyoyo A, Kimaro A, et al. Pulmonary rehabilitation for post-TB lung disease led by TB survivors. Public Health Action. 2025 Jun 4;15(2):82–7.
12. Ichikawa Y, Kurokawa K, Furusho S, Nakatsumi Y, Yasui M, Katayama N. An effective case of bronchoscopic balloon dilatation for tuberculous bronchial stenosis. Respirol Case Rep. 2023 Aug 18;11(8).