Hyperventilation as one of the mechanisms of persistent dyspnoea in SARS-CoV-2 survivors

Motiejūnaitė, Justina; Balagny, Pauline; Arnoult, Florence; Mangin, Laurence; Bancal, Catherine; Vidal‐Petiot, Emmanuelle; Flamant, Martin; Jondeau, Guillaume; Cohen‐Solal, Alain; d’Ortho, Marie-Pia; Frija‐Masson, Justine

doi:10.1183/13993003.01578-2021

Cited by 81 publications

(111 citation statements)

References 14 publications

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“…However, ambulatory access to diagnosis was highly limited in the early beginning of the current pandemic and recent guidelines support including in Covid-19 cohorts patients in which diagnosis was based on clinical symptoms [ 25 ]. Characteristics of our population are nevertheless consistent with data recently reported by Trinkmann et al and Sonnweber et al in patients presenting with long-lasting Covid-19 symptoms [ 6 , 13 , [26] , [27] , [28] ].…”

Section: Discussionsupporting

confidence: 92%

“…Another component which may explain persistence of symptoms in our population, and especially dyspnoea-related functional limitation, is the presence of hyperventilation syndrome as previously suggested by Motiejunaite et al [ 6 , 14 , 27 , 28 ]. In our study, 41% of patients with PFS presented with both positive Nijmegen score and positive provocation test.…”

Section: Discussionmentioning

confidence: 53%

“…Out of the whole cohort, 29(74%) patients had PFS ( Table 1 ). They were younger (43±14 vs. 60±10yr, p=0.002), had a non-significantly lower rate of initial hospital admission (28% vs. 60%, p=0.123), a later rehabilitation referral (107[56-240] vs. 32[ [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ] days, p<.001) and a longer rehabilitation duration (94[63-142] vs. 24[ [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ] days, p<.001) than those without PFS. PFS were associated with more severe rest and exertional dyspnoea (respectively, Börg scale at rest: 2±2 vs. 0±0; p=0.002, mMRC: 2±1 vs. 1±1, p=0.051).…”

Section: Resultsmentioning

confidence: 99%

“…(%) 6(15%) 5(17%) 1(10%) 1 Initial hospitalisation > 48h; no. (%) 14(36%) 8(28%) 6(60%) 0.123 Time before rehabilitation (d); (median[IQR]) 73[34-178] 107[56-240] 32[ [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ] <.001 Rehabilitation duration (d); (median[IQR]) 66[26-110] 94[63-142] 24[ [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ] <.001 PCR+ diagnos...…”

Section: Methodsmentioning

confidence: 99%

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Respiratory rehabilitation for Covid-19 related persistent dyspnoea: A one-year experience

Bouteleux¹,

Henrot

Ernst³

et al. 2021

Respiratory Medicine

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Background Growing consideration is emerging regarding the burden of persisting sequelae after SARS-CoV-2 infection. Out-patients exhibiting long Covid may benefit from ambulatory rehabilitation which is, to date, poorly documented. Methods A longitudinal follow-up over a one-year period was conducted in two ambulatory rehabilitation structures in order to describe the characteristics of real-life patients referred with Covid-19 sequelae and their evolution over the course of rehabilitation. Results 39 consecutive patients were included from April 1 st 2020 to April 1 st 2021. Patients were middle-aged (48±15yr), without comorbidities, and mostly mild to moderate SARS-CoV-2 infection (25(64%) not requiring hospitalisation). Rehabilitation referral was considered with a median delay of 73[34-178] days after disease onset. Most prevalent symptoms were dyspnoea (n=35(90%)) and fatigue (n=30(77%)). Hyperventilation syndrome was highly frequent (n=12(34%)). 29(74%) patients presented with prolonged functional sequelae, which was associated with younger age (43±14 vs . 50±10yr; p=0.002), greater prevalence of hyperventilation syndrome (n=12(41%) vs . 0(0%); p=0.255) and poorer quality of life (VQ-11; 31±10 vs . 23±9; p=0.030). Over the course of rehabilitation, exertional dyspnoea, 6-minutes walking distance, 3-minutes sit-to-stand test, hyperventilation syndrome prevalence and quality of life significantly improved. Conclusion Hyperventilation is frequent in long Covid and may explain persistent dyspnoea as well as altered quality of life. Our data support screening of hyperventilation syndrome and functional impairment in mild Covid-19 out-patients as both of these components may improve with ambulatory rehabilitation.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 53%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Respiratory rehabilitation for Covid-19 related persistent dyspnoea: A one-year experience

Bouteleux¹,

Henrot

Ernst³

et al. 2021

Respiratory Medicine

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“…Nos poucos estudos com teste de exercício cardiopulmonar (TECP) em COVID19 publicados até o momento (Tabela 1), foi sugerido que a intolerância ao exercício seria decorrente do descondicionamento (Tabela 1), foi sugerido que a intolerância ao exercício seria decorrente do descondicionamento físico. (4)(5)(6) Mas o que é descondicionamento? No dicionário médico é definido por "perda de aptidão física devido à incapacidade de manter um nível ideal de atividade física ou treinamento.…”

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Mechanisms of exercise intolerance after COVID-19: new perspectives beyond physical deconditioning

Ferreira

Oliveira

2021

J Bras Pneumol.

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Use of Cardiopulmonary Exercise Testing to Evaluate Long COVID-19 Symptoms in Adults

et al. 2022

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ImportanceReduced exercise capacity is commonly reported among individuals with COVID-19 symptoms more than 3 months after SARS-CoV-2 infection (long COVID-19 [LC]). Cardiopulmonary exercise testing (CPET) is the criterion standard to measure exercise capacity and identify patterns of exertional intolerance.ObjectivesTo estimate the difference in exercise capacity among individuals with and without LC symptoms and characterize physiological patterns of limitations to elucidate possible mechanisms of LC.Data SourcesA search of PubMed, EMBASE, Web of Science, preprint servers, conference abstracts, and cited references was performed on December 20, 2021, and again on May 24, 2022. A preprint search of medrxiv.org, biorxiv.org, and researchsquare.com was performed on June 9, 2022.Study SelectionStudies of adults with SARS-CoV-2 infection more than 3 months earlier that included CPET-measured peak oxygen consumption (V̇o2) were screened independently by 2 blinded reviewers; 72 (2%) were selected for full-text review, and 35 (1%) met the inclusion criteria. An additional 3 studies were identified from preprint servers.Data Extraction and SynthesisData extraction was performed by 2 independent reviewers according to the PRISMA reporting guideline. Data were pooled using random-effects models.Main Outcomes and MeasuresDifference in peak V̇o2 (in mL/kg/min) among individuals with and without persistent COVID-19 symptoms more than 3 months after SARS-CoV-2 infection.ResultsA total of 38 studies were identified that performed CPET on 2160 individuals 3 to 18 months after SARS-CoV-2 infection, including 1228 with symptoms consistent with LC. Most studies were case series of individuals with LC or cross-sectional assessments within posthospitalization cohorts. Based on a meta-analysis of 9 studies including 464 individuals with LC symptoms and 359 without symptoms, the mean peak V̇o2 was −4.9 (95% CI, −6.4 to −3.4) mL/kg/min among those with symptoms with a low degree of certainty. Deconditioning and peripheral limitations (abnormal oxygen extraction) were common, but dysfunctional breathing and chronotropic incompetence were also described. The existing literature was limited by small sample sizes, selection bias, confounding, and varying symptom definitions and CPET interpretations, resulting in high risk of bias and heterogeneity.Conclusions and RelevanceThe findings of this systematic review and meta-analysis study suggest that exercise capacity was reduced more than 3 months after SARS-CoV-2 infection among individuals with symptoms consistent with LC compared with individuals without LC symptoms, with low confidence. Potential mechanisms for exertional intolerance other than deconditioning include altered autonomic function (eg, chronotropic incompetence, dysfunctional breathing), endothelial dysfunction, and muscular or mitochondrial pathology.

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Hyperventilation as one of the mechanisms of persistent dyspnoea in SARS-CoV-2 survivors

Cited by 81 publications

References 14 publications

Respiratory rehabilitation for Covid-19 related persistent dyspnoea: A one-year experience

Respiratory rehabilitation for Covid-19 related persistent dyspnoea: A one-year experience

Mechanisms of exercise intolerance after COVID-19: new perspectives beyond physical deconditioning

Use of Cardiopulmonary Exercise Testing to Evaluate Long COVID-19 Symptoms in Adults

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