Symptoms, Pulmonary Function, and Functional Capacity Four Months after COVID-19

Abdallah, Sara J.; Voduc, Nha; Corrales–Medina, Vicente F.; McGuinty, Michaeline; Pratt, Alexandre; Chopra, Anchal; Law, Angeline; Garuba, Habibat A.; Thavorn, Kednapa; Reid, Ryan E.R.; Lavoie, Kim L.; Crawley, Angela M.; Chirinos, Julio A.; Cowan, Juthaporn

doi:10.1513/annalsats.202012-1489rl

Cited by 63 publications

(65 citation statements)

References 22 publications

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“…Impaired diffusion lung capacity was the most common finding in 31% (95% CI 24-38, I 2 = 89%) of the patients assessed, followed by restrictive pattern in 12% (95% CI 8-17, I 2 = 82%), and obstructive pattern in 8% (95% CI 6-9, I 2 = 7%). DLCO was lower in hospitalized vs. non-hospitalized patients, however, abnormal values were observed in both groups [46]. Mean DLCO was significantly lower in moderate-to-critical disease patients compared to referred mild disease patients who had normal mean DLCO [34,45].…”

Section: Lung Functionmentioning

confidence: 78%

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Long-Term Impact of COVID-19: A Systematic Review of the Literature and Meta-Analysis

et al. 2021

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Background: The long-term impact of COVID-19 is still unknown. This study aimed to explore post COVID-19 effects on patients chest computed tomography (CT), lung function, respiratory symptoms, fatigue, functional capacity, health-related quality of life (HRQoL), and the ability to return to work beyond 3 months post infection. Methods: A systematic search was performed on PubMed, Web of Science, and Ovid MEDLINE on 22 May 2021, to identify studies that reported persistent effects of COVID-19 beyond 3 months follow-up. Data on the proportion of patients who had the outcome were collected and analyzed using a one-group meta-analysis. Results: Data were extracted from 24 articles that presented information on a total of 5323 adults, post-infection, between 3 to 6 months after symptom onset or hospital discharge. The pooled prevalence of CT abnormalities was 59% (95% CI 44–73, I2 = 96%), abnormal lung function was 39% (95% CI 24–55, I2 = 94%), fatigue was 38% (95% CI 27–49, I2 = 98%), dyspnea was 32% (95% CI 24–40, I2 = 98%), chest paint/tightness was 16% (95% CI 12–21, I2 = 94%), and cough was 13%, (95% CI 9–17, I2 = 94%). Decreased functional capacity and HRQoL were found in 36% (95% CI 22–49, I2 = 97%) and 52% (95% CI 33–71, I2 = 94%), respectively. On average, 8 out of 10 of the patients had returned to work or reported no work impairment. Conclusion: Post-COVID-19 patients may experience persistent respiratory symptoms, fatigue, decreased functional capacity and decreased quality of life up to 6 months after infection. Further studies are needed to establish the extent to which post-COVID-19 effects continue beyond 6 months, how they interact with each other, and to clarify their causes and their effective management.

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Section: Lung Functionmentioning

confidence: 78%

“…Thirteen articles explored the effect of COVID-19 on lung function at follow-up [27][28][29][30][31][32]36,37,40,41,43,45,46] (Supplementary Table S3 and Figure S2). Abnormal pulmonary function tests (PFT) were identified in 39% (95% CI 24-55, I 2 = 94%) of the patients (Table 2).…”

Section: Lung Functionmentioning

confidence: 99%

Long-Term Impact of COVID-19: A Systematic Review of the Literature and Meta-Analysis

et al. 2021

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“…To our knowledge, only a few studies with a small number of subjects have compared the frequency of prolonged symptoms in COVID-19 survivors with different disease severity 14,21 In contrast to mild disease, survivors of severe COVID-19 had signi cant pulmonary sequalae, with evidence of reduced FEV1, FVC and TLC, and abnormal chest imaging (CXR or CT) at 3 months of follow up. Our ndings are consistent with previous reports that focused on the evaluation of severe COVID-19 survivors 18,19,27,28 .…”

Section: Discussionmentioning

confidence: 99%

“…Hospitalized patients had lower total lung and diffusion capacity 21 . Another study that evaluated mainly outpatients, showed that symptomatic patients have signi cantly reduced lung function, most notably impaired gas transfer 22 .…”

Section: Introductionmentioning

confidence: 90%

“…This group accounts for the large majority of COVID-19 infected patients, most of whom are outpatients. Abdallah et al showed persistent fatigue and exertional breathlessness in 81.6% of nonhospitalized COVID-19 survivors, but without impairment of lung function or cardiopulmonary exercise test21 . Logue et al reported persistent symptoms in 65.3% of 150 outpatients with mild disease11 .…”

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confidence: 99%

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Residual Symptoms, Lung Function and Imaging Findings in Patients Recovering from SARS-CoV-2 Infection

Darawshy

Rmeileh

Kuint

et al. 2021

Preprint

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RationaleSymptoms following acute COVID-19 infection are common, but their relationship to initial COVID-19 severity is unclear. We hypothesize that residual symptoms are related to disease severity, and severe acute COVID-19 infection is more likely to cause residual pulmonary damage. This study aims to evaluate symptoms, lung function and abnormal imaging within 3 months following COVID-19 infection, and whether they are related to initial disease severity.Methods A cross-sectional study was carried out at a designated post-COVID clinic in Hadassah Medical Center, Jerusalem, Israel. Patients with PCR-confirmed SARS-CoV-2 infection were evaluated within 12 weeks following infection and included both admitted and non-admitted subjects. All participants underwent assessment of symptoms, quality of life (SGRQ), pulmonary function tests, and imaging. Results A total of 208 patients (age 49.3±16 years) were included in the study. Initial disease severity was mild in 86, moderate in 49 and severe in 73 patients. At the time of follow up, there were no differences in frequency of residual symptoms or in SGRQ score between groups. Patients with severe COVID-19 were more likely to have residual dyspnea (p=0.04), lower oxygen saturation (p<0.01), lower FVC and TLC (p<0.001, p=0.03 respectively), abnormal CXR (p<0.01) and abnormal CT scan (p<0.01) compared to other groups. Conclusion Frequency of symptoms and impairment of quality of life at 12 weeks follow up are common and are not related to severity of initial COVID-19 disease. In contrast, reduced lung function and abnormal pulmonary imaging are more common in patients with more severe acute COVID-19 infection.

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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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Symptoms, Pulmonary Function, and Functional Capacity Four Months after COVID-19

Cited by 63 publications

References 22 publications

Long-Term Impact of COVID-19: A Systematic Review of the Literature and Meta-Analysis

Long-Term Impact of COVID-19: A Systematic Review of the Literature and Meta-Analysis

Residual Symptoms, Lung Function and Imaging Findings in Patients Recovering from SARS-CoV-2 Infection

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

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