Pulmonary function and functional capacity in COVID-19 survivors with persistent dyspnoea

Cortés-Télles, Arturo; López-Romero, S.; Figueroa‐Hurtado, Esperanza; Pou-Aguilar, Y.; Wong, Alyson W.; Milne, Kathryn M.; Ryerson, Christopher J.; Guenette, Jordan A.

doi:10.1016/j.resp.2021.103644

Cited by 139 publications

(127 citation statements)

References 16 publications

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“…Participants reporting use of medications for autoimmune disease reported a median [IQR] of 7 [5][6][7][8][9] symptoms at enrollment, while the median [IQR] number of symptoms for all other participants was 7 [4][5][6][7][8][9]. The median [IQR] severity score at enrollment for those reporting use of medications for autoimmune disease was 12 [7][8][9][10][11][12][13][14][15][16][17] decreased sense of smell or taste at enrollment; among those reporting use of medications for autoimmune disease, a higher proportion reported symptoms at all time points in follow-up, as well as symptoms of greater severity (Figure 1). Around day 30 (range=24-45 days) a higher proportion of participants reporting use of medications for autoimmune disease remained symptomatic compared to all other participants, with 67% vs 34% continuing to report fatigue, 40% vs 19% reporting nasal congestion, 33% vs 20% cough, and 33% vs 12% shortness of breath (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, the odds of experiencing persistent fatigue and shortness of breath at approximately 30 days were included as outcomes of special interest, as those symptoms are commonly reported as having a significant impact on the ability to perform daily living and work activities; [6][7][8][9] persistent shortness of breath may also indicate long-term damage to the lungs. 10 Potential confounders included in all models were demographics and risk factors for more severe COVID-19 disease: age in 10-year intervals, gender, race, ethnicity, body mass index (BMI) category, level of education, smoking status, use of medications for diabetes, hypertension, or lung disease. Models for 30-day symptom persistence were additionally adjusted for the number of symptoms reported at enrollment to account for differential reporting patterns (eg, those reporting more symptoms at enrollment might also report more symptoms in follow-up).…”

Section: Methodsmentioning

confidence: 99%

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Identification of a Vulnerable Group for Post-Acute Sequelae of SARS-CoV-2 (PASC): People with Autoimmune Diseases Recover More Slowly from COVID-19

Dreyer¹,

Petruski‐Ivleva²,

Albert³

et al. 2021

IJGM

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Purpose: Evidence is emerging that a significant percentage of COVID-19 cases experience symptom persistence beyond 30 days and go on to develop post-acute sequelae. Our objective was to compare the risk for COVID-19 symptom persistence by self-reported use of medications for autoimmune disease among participants of an on-line COVID-19 registry. Patients and Methods: A community-based online survey collected weekly data on COVID-19 symptom presentation. Participants who completed informed consent online, reported a positive COVID-19 test result within 14 days prior to enrollment and also reported demographics, underlying illnesses, and medication use were included. Symptom presence and severity were evaluated weekly after enrollment and compared between participants reporting use of medications for autoimmune conditions and all others. Logistic regression was used to evaluate the odds of more severe acute illness and symptom persistence approximately 30 days after enrollment. Results: A total of 1,518 COVID-19-positive participants were included. Participants reporting use of medications for autoimmune disease (n=70) were more likely to have experienced symptoms at all time points over a 30-day time period and were more likely to report more severe presentation of COVID-19 during acute illness (adjusted OR (95% CI)=1.32 (0.76-2.29)) compared to those reporting not taking medications for autoimmune disease. At about 30 days after enrollment, users of medications for autoimmune disease were more than twice as likely to report three or more symptoms (adjusted OR (95% CI)=2. 53 (1.21-5.29)). In particular, their risk of persistent shortness of breath and fatigue was elevated (adjusted OR (95% CI)=2.66 (1.15-6.18) and 4.73 (2.17-10.34), respectively). Conclusion: Individuals with underlying autoimmune conditions appear to be particularly vulnerable to post-acute sequelae from COVID-19; early intervention might be considered.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Identification of a Vulnerable Group for Post-Acute Sequelae of SARS-CoV-2 (PASC): People with Autoimmune Diseases Recover More Slowly from COVID-19

Dreyer¹,

Petruski‐Ivleva²,

Albert³

et al. 2021

IJGM

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“…As the lungs are a primary target for COVID-19, with varying degrees of impact, newly developed COPD after infection was documented in 10 (1.8%) patients, and 17 more (60.7%) required treatment intensification. The physiological mechanisms leading to persistent dyspnea in non-critically ill COVID-19 survivors have been recently analyzed [54], and a significant decrease in forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and diffusing capacity of the lung of carbon monoxide (DLCO) after 6 min' walking distance was noted among patients with persistent dyspnea when examined 30-60 days after the onset of COVID-19 symptoms. The respiratory outcomes in SARS and MERS-the two previous viral infection outbreaks similar to COVID-19-were systematically reviewed: after 12 months, 32.4% of sufferers who recovered presented impaired FEV1, and 29.8% had a decrease in FVC [55], which parallels the 22.6% functional impairment documented in COPD patients.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Patients with Coronavirus Disease 2019 at One Year after Hospital Discharge

Maestre-Muñiz

Arias

Mata-Vázquez

et al. 2021

JCM

136

126

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Background: The long-term effects of COVID-19 remain largely unclear. This study aims to investigate post-acute health consequences and mortality one year after hospital discharge. Methods: All surviving adult patients who were discharged after hospital admission due to acute COVID-19 in the first wave of the pandemic underwent a comprehensive interview. Functional assessment was performed in patients aged over 65. Clinical and hospital records were reviewed and mortality causes assessed. Results: A total of 587 patients with COVID-19 were discharged from hospital, including 266 after hospital admission and 321 from the emergency room. Mortality within the following year occurred in 34/266 (12.8%) and 10/321 (3.1%), respectively, due to causes directly or possibly related to COVID-19 in 20.5% and 25% of patients. Post-COVID-19 syndrome was assessed in 543 patients at one year from discharge. Any clinical complaint was reported by 90.1% of patients who needed hospitalization and 80.4% of those discharged from the emergency room (p = 0.002), with breathlessness (41.6%), tiredness (35.4%), ageusia (30.2%), and anosmia (26.3%) being the most common complaints. Ongoing symptoms attributed to COVID-19 were reported by 66.8% and 49.5% of patients, respectively (p < 0.001). Newly developed COPD, asthma, diabetes, heart failure, and arthritis—as well as worsening of preexisting comorbidities—were found. Conclusions: One-year mortality among survivors of acute COVID-19 was 7.5%. A significant proportion of COVID-19 patients experienced ongoing symptoms at 1 year from onset of the disease.

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“…Even after six months, lower DLCO and TLC were detected in patients with critical disease [19]. A Mexican study investigating the correlation between persistent dyspnoea and pulmonary function reported that patients with persistent dyspnoea had significantly lower FVC, FEV1 and DLCO values than those without [21].…”

Section: Discussionmentioning

confidence: 99%

More complaints than findings - Long-term pulmonary function in children and adolescents after COVID-19

Knoke

Schlegtendal

Maier

et al. 2021

Preprint

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Background: The frequency of persistent symptoms after coronavirus disease 2019 (COVID-19) in adults varies from 4.5% to 87%. Pulmonary function can also show long-term impairment in adults: 10% of hospitalised adults had reduced spirometry values, and 24% had decreased diffusion capacity. To date, only preliminary evidence is available on persistent respiratory sequelae in children and adolescents, therefore our objective was to examine the long-term effects of COVID-19 on pulmonary function in this age group. Methods: Multiple-breath washout, body plethysmography, and diffusion capacity testing were performed after an average of 2.6 months (range 0.4-6.0) following COVID-19 in 73 children and adolescents (age 5-18 years) with different disease severity. Cases were compared to 45 controls with and without infection within six months prior to assessment after exclusion of severe acute respiratory coronavirus-2 infection (SARS-CoV-2). Results: Of the 19 patients (27.1%) who complained about persistent or newly emerged symptoms since COVID-19, 8 (11.4%) reported respiratory symptoms. Comparing patients with COVID-19 to controls, no significant differences were detected in frequency of abnormal pulmonary function (COVID-19: 12, 16.4%; controls: 12, 27.7%; OR 0.54, 95% CI 0.22-1.34). Only two patients with persistent respiratory symptoms showed abnormal pulmonary function. Multivariate analysis revealed reduced forced vital capacity (p=0.045) in patients with severe infection regardless of SARS-CoV-2 infection. Discussion: Pulmonary function is rarely impaired in children and adolescents after COVID-19, except of those with severe infection. The discrepancy between persistent respiratory symptoms and normal pulmonary function suggests a different underlying pathology such as dysfunctional breathing.

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Pulmonary function and functional capacity in COVID-19 survivors with persistent dyspnoea

Cited by 139 publications

References 16 publications

Identification of a Vulnerable Group for Post-Acute Sequelae of SARS-CoV-2 (PASC): People with Autoimmune Diseases Recover More Slowly from COVID-19

Identification of a Vulnerable Group for Post-Acute Sequelae of SARS-CoV-2 (PASC): People with Autoimmune Diseases Recover More Slowly from COVID-19

Long-Term Outcomes of Patients with Coronavirus Disease 2019 at One Year after Hospital Discharge

More complaints than findings - Long-term pulmonary function in children and adolescents after COVID-19

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