Assessment of respiratory function and exercise tolerance at 4–6 months after COVID‐19 infection in patients with pneumonia of different severity

Abstract

Background The evaluation of COVID‐19 systemic consequences is a wide research field in which respiratory function assessment has a pivotal role. However, the available data in the literature are still sparse and need further strengthening. Aim To assess respiratory function 4–6 months after hospital discharge based on lung disease severity in patients who overcome COVID‐19 pneumonia. Methods Patients hospitalised either in the Internal Medicine Department (IMD) for moderate to severe disease or in the Intensive Care Unit (ICU) for critical disease underwent spirometry with maximal flow‐volume curve, lung volumes, lung diffusion capacity (DL CO ) and six‐minute walking test (6‐MWT). Results Eighty‐eight patients were analysed: 40 from the IMD and 48 from the ICU. In both cohorts, there was a greater prevalence of male patients. In the IMD cohort, 38% of patients showed at least one altered respiratory parameter, while 62% in the ICU cohort did so ( P < 0.05). Total lung capacity (TLC) and DL CO were the most frequently altered parameters: 15% and 33% from IMD versus 33% and 56% from ICU, respectively ( P < 0.05). In IMD patients, 5% had only restrictive deficit, 22% had only lung diffusion impairment and 10% had both. In ICU patients, 6% had only restrictive deficit, 29% had only lung diffusion impairment and 27% had both ( P < 0.05). ICU patients showed a higher frequency of abnormal 6‐MWT ( P < 0.05). Conclusion Lung function tests and 6‐MWT are highly informative tools for monitoring the negative consequences of COVID‐19 pneumonia, which were more frequent and more complex in patients discharged from ICU.

Pulmonary rehabilitation improves functional outcomes and quality of life in post-SARS-CoV-2 mild-to-moderate infection patients: a pilot study

“…All patients in the abovementioned facility underwent a complete respiratory rehabilitation cycle lasting at least 24 consecutive days (one 120-minute session each day, weekends excluded), led by professional physiotherapists specialized in pulmonary rehabilitation and performed in a dedicated gymnasium; both groups underwent the same rehabilitation program, including respiratory gymnastics, pulmonary rehabilitation devices and exercises enhancing the mobilization of pulmonary secretions. The following parameters were monitored at the beginning and end of the treatment: 6 Minute Walk Distance (6MWD) [12], Borg CR10 Scale (license agreement #18CJP63), modified Medical Research Council (mMRC) Dyspnoea Scale (used with the permission of the Medical Research Council), EuroQol EQ-5D-3L questionnaire (registration No. 53534), Barthel scale (used with permission) [13], arterial blood gas (ABG) analysis and pulse oxymetry (SpO2).…”

Response to “Evaluation of pulmonary function and exercise capacity after COVID-19 pneumonia.”

“…Measurements other than 6-MWT and pulmonary function should also be measured because they reveal exercise limitations that cannot be assessed by dyspnea or 6-MWT, as suggested by a similar study. 3 Another significant finding from another study states that below 6-MWT results occur due to diminished skeletal muscle strength and muscle atrophy. Thus, to ensure accurate findings, the extent of muscle development in patients should be equally monitored.…”

“…Thus, other dependent variables should be used to study the relationship between them and patients' exercise capacity. 3 …”

“…Thus, to ensure accurate findings, the extent of muscle development in patients should be equally monitored. 3 …”

“…An additional measure that could be used to make the study more comprehensive and inclusive would be to use inflammatory markers that influence individuals' exercise capacity, as shown by a corresponding increase in inflammatory markers with a reduced exercise capacity and vice versa. 3 , 4 The susceptibility of patients to acute respiratory syndrome coupled with dyspnea following their recovery from COVID-19 is an important factor in assessing pulmonary function, and the follow-up results should be documented as well. According to one of the findings of a similar study, people with significantly diminished lung function did not suffer from the usual clinical symptoms of dyspnea.…”