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Published in: BMC Pulmonary Medicine 1/2021

Open Access 01-12-2021 | Pulmonary-Function Tests | Research

Residual respiratory impairment after COVID-19 pneumonia

Authors: Francesco Lombardi, Angelo Calabrese, Bruno Iovene, Chiara Pierandrei, Marialessia Lerede, Francesco Varone, Luca Richeldi, Giacomo Sgalla, the Gemelli Against COVID-19 Post-Acute Care Study Group

Published in: BMC Pulmonary Medicine | Issue 1/2021

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Abstract

Introduction

The novel coronavirus SARS-Cov-2 can infect the respiratory tract causing a spectrum of disease varying from mild to fatal pneumonia, and known as COVID-19. Ongoing clinical research is assessing the potential for long-term respiratory sequelae in these patients. We assessed the respiratory function in a cohort of patients after recovering from SARS-Cov-2 infection, stratified according to PaO2/FiO2 (p/F) values.

Method

Approximately one month after hospital discharge, 86 COVID-19 patients underwent physical examination, arterial blood gas (ABG) analysis, pulmonary function tests (PFTs), and six-minute walk test (6MWT). Patients were also asked to quantify the severity of dyspnoea and cough before, during, and after hospitalization using a visual analogic scale (VAS). Seventy-six subjects with ABG during hospitalization were stratified in three groups according to their worst p/F values: above 300 (n = 38), between 200 and 300 (n = 30) and below 200 (n = 20).

Results

On PFTs, lung volumes were overall preserved yet, mean percent predicted residual volume was slightly reduced (74.8 ± 18.1%). Percent predicted diffusing capacity for carbon monoxide (DLCO) was also mildly reduced (77.2 ± 16.5%). Patients reported residual breathlessness at the time of the visit (VAS 19.8, p < 0.001). Patients with p/F below 200 during hospitalization had lower percent predicted forced vital capacity (p = 0.005), lower percent predicted total lung capacity (p = 0.012), lower DLCO (p < 0.001) and shorter 6MWT distance (p = 0.004) than patients with higher p/F.

Conclusion

Approximately one month after hospital discharge, patients with COVID-19 can have residual respiratory impairment, including lower exercise tolerance. The extent of this impairment seems to correlate with the severity of respiratory failure during hospitalization.
Literature
1.
go back to reference Zu ZY, Jiang M Di, Xu PP, Chen W, Ni QQ, Lu GM, et al. Coronavirus Disease 2019 (COVID-19): A Perspective from China. Radiology. 2020;2019:200490. Zu ZY, Jiang M Di, Xu PP, Chen W, Ni QQ, Lu GM, et al. Coronavirus Disease 2019 (COVID-19): A Perspective from China. Radiology. 2020;2019:200490.
2.
go back to reference WHO. COVID-19 Weekly Epidemiological Update 44. World Heal Organ. 2021;(June):1–3. WHO. COVID-19 Weekly Epidemiological Update 44. World Heal Organ. 2021;(June):1–3.
3.
go back to reference Pal M, Berhanu G, Desalegn C, Kandi V. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2): an update. Cureus. 2020; Pal M, Berhanu G, Desalegn C, Kandi V. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2): an update. Cureus. 2020;
4.
go back to reference Huang Y, Tan C, Wu J, Chen M, Wang Z, Luo L, et al. Impact of Coronavirus Disease 2019 on Pulmonary Function in Early Convalescence Phase. 2020;1–10. Huang Y, Tan C, Wu J, Chen M, Wang Z, Luo L, et al. Impact of Coronavirus Disease 2019 on Pulmonary Function in Early Convalescence Phase. 2020;1–10.
5.
go back to reference Santus P, Flor N, Saad M, Pini S, Franceschi E, Airoldi A, et al. Trends over time of lung function and radiological abnormalities in COVID-19 pneumonia: a prospective, observational, Cohort study. J Clin Med. 2021;10(5):1021.CrossRef Santus P, Flor N, Saad M, Pini S, Franceschi E, Airoldi A, et al. Trends over time of lung function and radiological abnormalities in COVID-19 pneumonia: a prospective, observational, Cohort study. J Clin Med. 2021;10(5):1021.CrossRef
6.
go back to reference Barisione G, Brusasco V. Lung diffusing capacity for nitric oxide and carbon monoxide following mild-to-severe COVID-19. Physiol Rep. 2021;9(4):1–10.CrossRef Barisione G, Brusasco V. Lung diffusing capacity for nitric oxide and carbon monoxide following mild-to-severe COVID-19. Physiol Rep. 2021;9(4):1–10.CrossRef
7.
go back to reference Mo X, Jian W, Su Z, Chen M, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020;55:2–5.CrossRef Mo X, Jian W, Su Z, Chen M, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020;55:2–5.CrossRef
8.
go back to reference Landi F, Gremese E, Bernabei R, Fantoni M, Gasbarrini A, Settanni CR, et al. Post-COVID-19 global health strategies: the need for an interdisciplinary approach. Aging Clin Exp Res. 2020;32:1613–20.CrossRef Landi F, Gremese E, Bernabei R, Fantoni M, Gasbarrini A, Settanni CR, et al. Post-COVID-19 global health strategies: the need for an interdisciplinary approach. Aging Clin Exp Res. 2020;32:1613–20.CrossRef
9.
go back to reference Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA J Am Med Assoc. 2012;307(23):2526–33. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA J Am Med Assoc. 2012;307(23):2526–33.
10.
go back to reference Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.CrossRef Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.CrossRef
11.
go back to reference MacIntyre N, Crapo RO, Viegi G, Johnson DC, van der Grinten CPM, Brusasco V, et al. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J. 2005;26:720–35.CrossRef MacIntyre N, Crapo RO, Viegi G, Johnson DC, van der Grinten CPM, Brusasco V, et al. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J. 2005;26:720–35.CrossRef
12.
go back to reference Gift AG, Narsavage G. Validity of the numeric rating scale as a measure of dyspnea. Am J Crit Care. 1998;7(3):200–4.CrossRef Gift AG, Narsavage G. Validity of the numeric rating scale as a measure of dyspnea. Am J Crit Care. 1998;7(3):200–4.CrossRef
13.
go back to reference Wong AW, Shah AS, Johnston JC, Carlsten C, Ryerson CJ. Patient-reported outcome measures after COVID-19: a prospective cohort study. Eur Respir J. 2020;56:2003276.CrossRef Wong AW, Shah AS, Johnston JC, Carlsten C, Ryerson CJ. Patient-reported outcome measures after COVID-19: a prospective cohort study. Eur Respir J. 2020;56:2003276.CrossRef
14.
go back to reference The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19—preliminary report. N Engl J Med. 2020. The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19—preliminary report. N Engl J Med. 2020.
15.
go back to reference Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46(6):1099–102.CrossRef Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46(6):1099–102.CrossRef
16.
go back to reference Xie L, Liu Y, Fan B, Xiao Y, Tian Q, Chen L, et al. Dynamic changes of serum SARS-Coronavirus IgG, pulmonary function and radiography in patients recovering from SARS after hospital discharge. Respir Res. 2005;6:1–7.CrossRef Xie L, Liu Y, Fan B, Xiao Y, Tian Q, Chen L, et al. Dynamic changes of serum SARS-Coronavirus IgG, pulmonary function and radiography in patients recovering from SARS after hospital discharge. Respir Res. 2005;6:1–7.CrossRef
17.
go back to reference Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348(8):683–93.CrossRef Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348(8):683–93.CrossRef
18.
go back to reference Tobin MJ, Jubran A, Laghi F. PaO2 /FIO2 ratio: the mismeasure of oxygenation in COVID-19. Eur Respir J. 2021;57(3):3–4.CrossRef Tobin MJ, Jubran A, Laghi F. PaO2 /FIO2 ratio: the mismeasure of oxygenation in COVID-19. Eur Respir J. 2021;57(3):3–4.CrossRef
Metadata
Title
Residual respiratory impairment after COVID-19 pneumonia
Authors
Francesco Lombardi
Angelo Calabrese
Bruno Iovene
Chiara Pierandrei
Marialessia Lerede
Francesco Varone
Luca Richeldi
Giacomo Sgalla
the Gemelli Against COVID-19 Post-Acute Care Study Group
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2021
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-021-01594-4

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