Pulmonary Function and Long-Term Respiratory Symptoms in Children and Adolescents After COVID-19

Abstract

BackgroundPersistent respiratory symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adults are frequent, and there can be long-term impairment of pulmonary function. To date, only preliminary evidence is available on persistent respiratory sequelae of SARS-CoV-2 in children and adolescents. Our objective was to examine the long-term effects of symptomatic and asymptomatic SARS-CoV-2 infections on pulmonary function in this age group in a single-center, controlled, prospective study.MethodsParticipants with serological or polymerase chain reaction-based evidence of SARS-CoV-2 infection were recruited from a population-based study of seroconversion rates. Multiple-breath washout (MBW), body plethysmography, and diffusion capacity testing were performed for children and adolescents. Participants were interviewed about their symptoms during the acute phase of infection and long-lasting symptoms. Cases were compared with SARS-CoV-2 seronegative controls from the same population-based study with and without history of respiratory infection within 6 months prior to assessment. Primary endpoints were differences in pulmonary function, including diffusion capacity and MBW, between participants with and without evidence of SARS-CoV-2 infection. Secondary endpoints included correlation between lung function and long-lasting symptoms as well as disease severity.FindingsIn total, 73 seropositive children and adolescents (5–18 years) were recruited after an average of 2.6 months (range 0.4–6.0) following SARS-CoV-2 infection. Among 19 patients (27.1%) who complained of persistent or newly emerged symptoms since SARS-CoV-2, 8 (11.4%) reported respiratory symptoms. No significant differences were detected in frequency of abnormal pulmonary function when comparing cases with 45 controls, including 14 (31.1%) with a history of previous infection (SARS-CoV-2: 12, 16.4%; controls: 12, 27.7%; odds ratio 0.54, 95% confidence interval 0.22–1.34). Only two patients with persistent respiratory symptoms showed abnormal pulmonary function. Multivariate analysis revealed reduced forced vital capacity (p = 0.012) in patients with severe SARS-CoV-2 infection.InterpretationPulmonary function is rarely impaired in children and adolescents after SARS-CoV-2 infection, except from those with severe infection, and did not differ between SARS-CoV-2 and other previous infections, suggesting that SARS-CoV-2 is not more likely to cause pulmonary sequelae than other infections. The discrepancy between persisting respiratory symptoms and normal pulmonary function suggests a different underlying pathology such as dysfunctional breathing.

Long-COVID in Children and Adolescents: A Systematic Review and Meta-analyses

“…The controls were chosen in a very different way among studies, which might have introduced significant heterogeneity. The following were the different definitions of controls, minors with: 1) other infections (e.g., common cold, pharyngotonsillitis, gastrointestinal, urinary tract infections, pneumonia of bacteria or unknown origin) 17 ; 2) no antibodies testing 24 mixed with other infections 17 ; 3) a negative antibody test 29 , 4) a negative rtPCR test among symptomatic minors 35 ; and 5) minors who did not have a positive test recorded in the database 15 (Supplementary Figure 2). The adjustments among studies also varied.…”

Long-COVID in children and adolescents: a systematic review and meta-analyses

“…The following were the different definitions of controls, children and adolescents with: (1) other infections (e.g., common cold, pharyngotonsillitis, gastrointestinal, urinary tract infections, pneumonia of bacteria or unknown origin) 17 ; (2) no antibodies testing 24 mixed with other infections 17 ; (3) a negative antibody test 29 , (4) a negative rtPCR test among symptomatic children 35 ; and (5) children who did not have a positive test recorded in the database 15 (Supplementary Fig. 2).…”

“…Several studies adjusted their OR by age, sex, ethnicity, socioeconomic status, and comorbidities 35 . However, age and sex 15 only adjusted for sex, only for age 17 , did not adjust, or by OR without adjusting previous conditions 24 .…”

Einheitliche Basisversorgung von Kindern und Jugendlichen mit Long COVID

“…Als Ursache für die subjektiv empfundene Dyspnoe ist eine autonome Dysregulation denkbar. Auch Trainingseffekte und funktionelle Atemstörungen können eine Rolle spielen [ 18 ]. Letztere können durch spezielle Atemtherapie behandelt werden.…”