In this study we are going to cover PHC centre (Khuldabad & Daulatabad) at Chh Sambhajinagar comes under MGM Hospital.  Following approval from the ethical committee, the total population of the village will be identified, with a focus on selecting the target population aged between 40 and 70 years. Once the target population has been determined, the screening process for COPD will be initiated. Subjects will be screened based on predefined inclusion and exclusion criteria. All individuals within the target age group who visit the Primary Health Centre (PHC) with health-related concerns will be evaluated according to these criteria. The screening process will be conducted under the supervision of a Medical Officer from the Department of Preventive and Social Medicine, utilizing spirometry software, which is recognized as a reliable and validated tool for assessing lung function. Individuals who are suspected of having COPD based on the initial screening will be referred to a pulmonologist for confirmation of the diagnosis. Written informed consent will be obtained from all patients diagnosed with COPD, prior to their participation in further evaluation and the pulmonary rehabilitation program. 

Pre Intervention Readings:-

1. Lung Function Test will be done by Spirometry Software. In this procedure, the patients will be instructed to sit in an upright position. Flow Turbine will be given to patients with mouth piece. We instruct the patients to inhale deeply and exhale force fully three times. Best values of Lung function test as FEV1 (Force Expiratory Volume 1), FVC (Force Vital Capacity) & TLC (Total Lung Capacity) will be noted. 

2. 1. For oxygen saturation finger Pulse Oxymeter will be used on first or middle finger and value of oxygen saturation SPO2 will be recorded.

3. 1. For respiratory muscle strength we will use Mouth pressure meter. Maximal Inspiratory Pressure (MIP) & Maximal Expiratory Pressure (MEP) Measures the strength of the inspiratory & expiratory muscles respectively. Mouth pressure measurement is a simple and non-invasive technique used to evaluate respiratory muscle strength, particularly the strength of the inspiratory

and expiratory muscles. During evaluation the patient should be seated comfortably in an upright

position & should seal their lips tightly around the mouthpiece, ensuring there is no air leakage. For MIP patient has take a deep breath in and then exhale fully. After exhalation, ask them to inhale forcefully (inhalation should be as deep and forceful as possible). The mouth pressure meter device will record the maximum inspiratory pressure generated during the forceful inhalation. Same for MEP patients ask to take a deep breath in and then exhale forcefully through the mouthpiece. The expiration should be as fast and forceful as possible. The mouth pressure meter will record the maximum expiratory pressure generated during the forceful exhalation. This test is also typically repeated three times, with the highest value being recorded.

4. 6 minute walk test will be used to evaluate exercise capacity (cardiorespiratory endurance). It measures the distance a patient can walk in 6 minutes, which reflects their overall functional capacity and endurance. During this test patient is instructed to wear comfortable clothing and shoes. On a flat surface of at least 30 meters, patient’s instructed to walk at their own pace, and can encouraged to walk as far as possible without running. We evaluate the baseline vitals including heart rate, blood pressure, oxygen saturation and record usual symptoms like dyspnea or fatigue. During the test, the patient walks for 6 minutes, and allowed for resting if needed, but should resume walking once will be able. Monitor vital signs, especially oxygen saturation, and provide supplemental oxygen if saturation falls below 88% or 90%. Afterward, assess recovery and repeat vital signs. The total distance walked in meters is the primary measure of exercise capacity

5. 1. St George’s Respiratory Questionnaire (SGRQ) will be used for evaluation of Quality-of-Life. The St George’s Respiratory Questionnaire (SGRQ) is a widely used tool to assess the health-related quality of life (HRQoL) in patients with COPD. SGRQ consists of 50 items divided into three domains, including Symptoms, Activity & Impact. The SGRQ score is calculated for each domain, and an overall total score is derived. The scores range from 0 to 100, where 0 indicates no impairment and 100 represents the maximum possible impairment.

• All the patients will be divided into subgroups based on aged ie: 40-50, 51-60, 61-70 years for further aged wise analysis.

• Patient education will be given by the researcher. Recorded sessions by Psychologist along with Diet charts prescribed by Dietician will also be provided once a month.

• Patients diagnosed with COPD will be referred to a pulmonologist for medical management.

• After the pre-intervention readings have been recorded, pulmonary rehabilitation will be initiated, which will include an exercise protocol and breathing training conducted at the PHC Centre. The pulmonary rehabilitation protocol has been designed in accordance with the guidelines provided by the British Thoracic Society and the Australia and New Zealand Pulmonary Rehabilitation Clinical Practice Guidelines with PIR Issued by WHO for pulmonary rehabilitation, we will provide exercises that include all the basic pulmonary rehabilitation exercises. During the evaluation of outcomes, patient feedback will be collected to assess the feasibility of the pulmonary rehabilitation program . All the exercises will be performed for 12 weeks 2 days per week at PHC under supervision and 4 days at home followed by at 6 month and 12-month follow-up.