Browsing by Author "Gurung, Naresh"
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Publication Outcome of Pulmonary Rehabilitation on Post-Covid Pneumonia Survivors with Residual Lung Fibrosis(Nepalese Respiratory Society, 2025) Suvedi, Rashmi; Gyawali, Manju; Shahi, Reema; Shrestha, Asmita; Thapa, Anisha; Adhikari, Shradha; Tarmakar, Suraj; Chaudhary, Deepak; Karthak, Ashish; Gurung, Naresh; Shrestha, Sanjeet KrishnaAbstract: Background: A significant proportion of COVID-19 survivors develop residual pulmonary fibrosis, leading to persistent dyspnea, reduced exercise capacity, and impaired quality of life. Pulmonary rehabilitation (PR) may help address these sequelae, but evidence remains limited, particularly in low-resource settings. Objective: To evaluate the effect of an 8-week pulmonary rehabilitation program on functional outcomes in post-COVID pneumonia patients with residual lung fibrosis at Nepal Mediciti Hospital. Methods: This prospective cohort study was done from June 2020 to June 2021 and included adult patients with confirmed residual pulmonary fibrosis on imaging after COVID-19 pneumonia. Participants underwent a structured PR program comprising supervised aerobic and resistance training, breathing exercises, and patient education. Functional status was assessed using the 6-Minute Walk Test (6MWT), Modified Medical Research Council (MMRC) dyspnea scale, and ergometer pre- and post-intervention. Results: Participants showed statistically significant improvements in all key outcomes. Mean MRC total score increased from 49.03 to 56.66 (mean difference 7.63, p < 0.001). Mean 6MWT distance improved substantially from 177.6 meters to 276.9 meters (mean difference 99.3 meters, p < 0.001). Significant reductions were observed in perceived fatigue and dyspnea, both at rest and after the 6MWT (p ≤ 0.003 for all Borg scale comparisons). The distribution of improvements varied among individuals, but most showed positive gains. Age showed a slight, non-significant negative correlation with the magnitude of 6MWT improvement. Conclusion: Pulmonary rehabilitation significantly improves functional capacity, dyspnea, and quality of life in patients with post-COVID residual lung fibrosis. These findings highlight the importance of integrating PR into post-COVID care pathways in resource-limited settings like Nepal.Publication Six-Minute Walk Test as a Discharge Criterion and Predictor of Three-Month Readmission in Pulmonary Medicine Patients(Nepalese Respiratory Society, 2025) Krishna Shrestha, Sanjeet; Poudel, Saroj; Lama, Rakesh; Giri, Rashmi; Karthak, Ashish; Gurung, Naresh; Singh, Summer J; Bhattarai, SanjeetAbstract; Background: The six-minute walk test (6MWT) is a commonly used tool for measuring functional capacity and predicting outcomes in respiratory disease patients. Objective: To determine the three-month readmission rate among patients who have completed and those who have not completed the 6MWT at hospital discharge. Methods: A prospective observational study was carried out at a tertiary care hospital between June and August 2024 with, 250 respiratory disease patients admitted through the Emergency Department or OPD to the respiratory ward. All patients received a 6MWT before discharge, per ATS guidelines, which measures six-minute walk distance (6MWD), oxygen supplementation, and Borg scale scores for dyspnea and fatigue. Readmission was monitored for three-month periods through OPD visits. Results: Out of 250 patients, the mean age was 65.2 ± 14.0 years, and 46.8% were male. 80.4% of patients passed the test, and 19.6% failed. Oxygen supplementation was required by 28.8%, with comparable pass rates in both groups. The three-month readmission rate was 12.4%, with significantly higher odds among those patients who failed (34.7%, OR=6.94) versus those who passed (7.0%). Patients walking less than 300 meters had a 4.52-fold higher readmission risk, an each 100-meter increase in 6MWT reduced odds by 20 (OR=0.8). Most patients reported minimal dyspnea (49.2%) and fatigue (44.4%). Conclusion: The 6MWT served as an important assessment for the functional capacity of patients with respiratory disease. Failure to complete the test (OR=6.94) or walking less than 300 meters (OR=4.52) considerably increased the risk of readmission. The test is, therefore, a useful predictor for determining readmission risk and discharge criteria. Further research is required to explore interventions that will enhance the functional capacity and prevent readmission.