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Aim. To determine the prevalence and show the features of the development of newly diagnosed heart failure (HF) in patients with dyspnea after a coronavirus disease 2019 (COVID-19). Material and methods. This clinical prospective observational study was conducted during 2020-2022. The study consecutively included 368 outpatients with shortness of breath, who applied to the clinic. Depending on the presence of prior COVID-19, the patients were divided into 2 groups: the first group consisted of 205 patients with shortness of breath after COVID-19, the second group - 163 patients without prior COVID-19. All patients underwent a clinical examination within 3 days after presentation with an assessment of outpatient records and other medical documents for the differential diagnosis of dyspnea. The severity of dyspnea was determined using the Modified Medical Research Council Dyspnoea Scale (mMRC). The diagnosis of HF was verified in accordance with the 2020 Russian Society of Cardiology guidelines and in some cases reclassified in accordance with the 2021European Society of Cardiology guidelines. For further analysis, 2 subgroups of patients with HF were identified depending on the presence and absence of prior COVID-19. The subgroup analysis excluded patients with acute heart failure, acute illness, and conditions requiring hospitalization and/or intensive care. Results. Among 368 patients who presented to the clinic with dyspnea during 2020-2022, 205 patients (55,7%) had COVID-19. The average period of treatment after COVID-19 was 3,5 [1,5;22,4] months. Patients after COVID-19 applied earlier after the onset of dyspnea, which is associated with higher mMRC score. The prevalence of HF among patients with shortness of breath after COVID-19 was significantly higher than in patients without this pathology in history, and amounted to 19,0% vs 9,8% (p=0,021). Prior COVID-19 increased the relative risk (RR) of HF in patients with shortness of breath by 1,7 times. RR for HF in systolic blood pressure >140 mm Hg increased by 1,9 times, while in diastolic blood pressure >90 mm Hg - by 1,9 times, with the development of a hypertensive crisis - by 28%, with a heart rate >80 bpm at rest - by 1,4 times, with the development of type 2 diabetes - by 31%, in the presence of pulmonary fibrosis - by 2,3 times. Patients with shortness of breath after COVID-19 had more severe HF, both according to clinical tests and according to the blood concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP), mainly with the preserved ejection fraction (EF) with a higher prevalence of left atrial (LA) enlargement in combination with a decrease in right ventricular (RV) systolic function and its dilatation. In patients after COVID-19 in the presence of chronic kidney disease, the RR for HF increased by 4,5 times;in the presence of C-reactive protein >4 mg/l - by 1,6 times. Conclusion. Every fifth patient with shortness of breath 3,5 months after COVID-19 had more severe HF, both according to clinical tests and according to blood NT-proBNP concentration, mainly with preserved EF with a higher prevalence of LA increase in combination with a decrease in RV systolic function and its dilatation. The risk of HF is interrelated with the female sex and multiple comorbidities.Copyright © 2023, Silicea-Poligraf. All rights reserved.
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Post-COVID syndrome develops after COVID-19 (COronaVIrus Disease 2019) and leads to cumulative effects in the form of shortness of breath and impaired lung function. Notably, patients with airway inflammation and COVID-19 were found to have increased concentrations of hyaluronic acid (HA). Since bovhyaluronidase azoximer (Longidase) catalyzes the hydrolysis of HA, this drug has the potential to reduce HA levels and improve lung function in patients with post-COVID syndrome. The aim of the DISSOLVE trial, which was conducted early in the pandemic, was to investigate the efficacy and safety of bovhyaluronidase azoximer in patients with symptoms associated with post-COVID syndrome. Methods. An open, prospective, controlled, comparative, multicenter clinical trial (NCT04645368) included adult patients (n = 160) who had post-COVID syndrome. Patients in the treatment group (n = 81) received bovhyaluronidase azoximer, and individuals in the control group (n = 79) were followed up without intervention. The study included physical examination, evaluation of forced vital capacity (FVC), assessment of dyspnea with the Modified Medical Research Council Dyspnea Scale (mMRC), 6-minute walking test, and pulse oximetry. These indicators were measured on 3 visits, at days 1 (baseline), 75, and 180. In addition, the number of patients who experienced adverse events and serious adverse events were recorded. Results. Baseline patient characteristics in the treatment group and the control group were similar. In the treatment group, there was a statistically significant reduction in residual pulmonary abnormalities after visit 2 (day 75) and visit 3 (day 180). In addition, FVC, pulse oximetry values, and functional exercise tolerance increased statistically significantly at days 75 and 180 compared to baseline. The mMRC scores for dyspnea decreased statistically significantly in the treatment group over 75 days. The safety profile of the drug was reported to be favorable throughout the study. Conclusion. Treatment with bovhyaluronidase azoximer in patients with post-COVID syndrome showed improvement in FVC, pulse oximetry, functional exercise tolerance, and mMRC dyspnea.Copyright © Chuchalin A.G. et al., 2023.
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Context Anxiety is one of the mood changes that occur postcoronavirus disease-2019 (post-COVID-19) and interfere with patients' daily activity. After supposed clinical and radiological improvement to COVID-19, some still experience somatic complaints such as sensation of dyspnea. Aims Evaluating the relation between COVID-19 survivors and anxiety and to what extent this could affect their functional status. Settings and design Ain Shams University Hospital, survey study. Patients and methods The survey included 120 patients post-COVID-19 one month or more and free symptoms attending Ain Shams University Hospitals Chest Outpatient Clinic for follow-up, 45% of them were in the age group 35-55 years, 56.7% were females, 78.3% had high education, and 27.5% were smokers. All included study participants were subjected to computed tomography of chest, oxygen saturation, State Trait Anxiety Inventory (STAI) Arabic version, and Modified Medical Research Council (MMRC) Dyspnea Scale. chi 2 -test (or Fisher's exact test) was used to compare data between different groups. Logistic regression analysis was used to determine the correlation between the features of individuals and their degree of anxiety. Results The most annoying COVID-19 symptoms as reported by this study participants were body pains (32.5%). About 61.7% of participants had high-state anxiety and 51.7% had high-trait anxiety. The age group 20-34 years was significantly associated with higher frequency of moderate or high-state anxiety (P0.05), male sex was significantly associated with lower frequency of moderate or high-state anxiety compared with females (P0.05). Conclusions Age and sex were important association factors with the prevalence of anxiety in post-COVID-19 patients. Higher grades of dyspnea were associated with higher probability of development of moderate or severe post-COVID anxiety.Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
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Introduction/Aim: As health systems emerge through successive waves of COVID-19, focus shifts to the management of Post-COVID-19 conditions. The aim of this prospective observational study was to characterise and evaluate the respiratory sequelae affecting patients 6-months post-diagnosis of COVID-19. SIGNFICANT MODELLING PREDICTORS Outcome Predictors MMRC>= 1 Disease severity Moderate: OR 16.5 +/- 1.02 (SE) p = 0.006 Impaired DLCO (%predicted) Disease severity B=-1.51+/-0.67 (SE) p = 0.010 Impaired TLC (%predicted) D-Dimer B= -0.305 +/- 0.001 (SE), p = 0.05 TLC below LLN Diabetes B=-1.28 +/- 0.32 (SE), p = 0.044 Methods: Patients were evaluated for symptom burden and lung function at 6-months post-diagnosis of COVID-19 in an outpatient setting. Result(s): Fifty-eight (45 inpatients and 13 outpatients;median age 59 years, 28 females) patients attended 6-month clinic appointment. Whilst nearly half (28,48.3%) were asymptomatic at 6-months, 24 (41.3%) patients reported a modified medical research council dyspnoea scale (MMRC) >= 1 and 21 (36.2%) patient-reported fatigue (n= 21, 36.2%). Reduced TLC (n= 11/50, 22.0%) and DLCO (n = 12/51, 23.5%) were common at 6-months. Results of predictive modelling analyses are described in adjacent table. Conclusion(s): Patients presenting with increased disease severity are at risk of persistent dyspnoea and impaired diffusion capacity, 6-months following acute COVID-19 illness. Research guided management of this growing at risk cohort, while paramount, poses a formidable challenge to stretched healthcare systems.
ABSTRACT
Post-COVID syndrome develops after COVID-19 (COronaVIrus Disease 2019) and leads to cumulative effects in the form of shortness of breath and impaired lung function. Notably, patients with airway inflammation and COVID-19 were found to have increased concentrations of hyaluronic acid (HA). Since bovhyaluronidase azoximer (Longidase) catalyzes the hydrolysis of HA, this drug has the potential to reduce HA levels and improve lung function in patients with post-COVID syndrome. The aim of the DISSOLVE trial, which was conducted early in the pandemic, was to investigate the efficacy and safety of bovhyaluronidase azoximer in patients with symptoms associated with post-COVID syndrome. Methods. An open, prospective, controlled, comparative, multicenter clinical trial (NCT04645368) included adult patients (n = 160) who had post-COVID syndrome. Patients in the treatment group (n = 81) received bovhyaluronidase azoximer, and individuals in the control group (n = 79) were followed up without intervention. The study included physical examination, evaluation of forced vital capacity (FVC), assessment of dyspnea with the Modified Medical Research Council Dyspnea Scale (mMRC), 6-minute walking test, and pulse oximetry. These indicators were measured on 3 visits, at days 1 (baseline), 75, and 180. In addition, the number of patients who experienced adverse events and serious adverse events were recorded. Results. Baseline patient characteristics in the treatment group and the control group were similar. In the treatment group, there was a statistically significant reduction in residual pulmonary abnormalities after visit 2 (day 75) and visit 3 (day 180). In addition, FVC, pulse oximetry values, and functional exercise tolerance increased statistically significantly at days 75 and 180 compared to baseline. The mMRC scores for dyspnea decreased statistically significantly in the treatment group over 75 days. The safety profile of the drug was reported to be favorable throughout the study. Conclusion. Treatment with bovhyaluronidase azoximer in patients with post-COVID syndrome showed improvement in FVC, pulse oximetry, functional exercise tolerance, and mMRC dyspnea.Copyright © Chuchalin A.G. et al., 2023.
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Purpose:The devasting effects of the coronavirus disease 2019 (COVID-19) pandemic have warranted the rapid development of evidence surrounding the physical therapy (PT) management of the disease within inpatient settings. However, the medical community is still working to define the long-term effects of COVID-19, referred to as Postacute Sequalae of SARS-CoV-2 (PASC), and ways for physical therapists to manage them in outpatient settings. The primary objective of this review was to summarize the available evidence related to the PT management of PASC in outpatient settings. Method(s):A systematic search in PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane CENTRAL, Academic Search Complete, and MedLine yielded systematic and scoping reviews and randomized controlled trials, among others. Data extraction was performed independently by 2 reviewers with 8 studies included. Result(s):Only 3 publications were specific to the outpatient setting area, with 5 more studies that focused on outpatient practice as part of a multisetting study, or the postacute setting. Although the limited number and quality of publications creates challenges applying the interventions provided across a population, each were specific to PASC. Conclusion(s):This review supports the need for further research focused on the PT management of patients who are experiencing PASC in outpatient settings.Copyright © Cardiovascular and Pulmonary Section, APTA.
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Background: COVID-19 caused the temporary suspnsion of outpatient-based pulmonary rehabilitation (PR). Pulmonary telerehabilitation (PTR) became a way of providing exercise training and education for people with respiratory conditions. Aim(s): To determine if PTR was safe and effective for people with respiratory conditions. Method(s): Retrospective observational study. Participants who were referred to PR, had a range of respiratory conditions, had access to Wi-Fi and a home device for videoconferencing. Outcomes were: five time sit-to-stand test (5STS), one minute sit-to-stand test (1MinSTS);St George's Respiratory Questionnaire (SGRQ);COPD assessment test (CAT);Hospital Anxiety and Depression Scale (HADS);Modified Medical Research Council dyspnoea scale (mMRC), adverse events. PTR used a zoom platform, ran for 40 minutes, twice per week for eight weeks, with a maximum of 10 participants in each class. An experienced physiotherapist led the exercise and education sessions with support from physiotherapy students. Result(s): Seventy-five participants (66 females) commenced PTR [mean (SD): Age 67 (11) years, FEV1 63 (20) % pred] and 52 (70%) completed. Statistically significant improvement (mean change (SD) [95% CI]) for 5STS: -4 (7) [-6 to -1] seconds;1MinSTS: 5 (8) [2 to 9] repetitions;SGRQ total: -7 (12) [-11 to -3] points;mMRC: -0.3 (0.7) [-0.6 to -0.7] score;CAT: -2.4 (6) [-4 to -0.5] score with no adverse events were reported. Conclusion(s): Outpatient-based PR remains the gold standard, however PTR could be provided during COVID lockdowns or incorporated into PR programs as a flexible option for people who find it difficult to attend outpatientbased programs.
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Background and Aim: This study aimed to understand the impact of breathlessness on quality of life, productivity loss and healthcare use of Australian adults. Method(s): The National Breathlessness Survey was a nationwide cross-sectional web-based survey in Oct 2019, recruiting Australians aged >=18 years stratified by age-group, gender and state of residence. Severity of breathlessness using the modified Medical Research Council (mMRC) dyspnoea scale (0-5), quality of life (QoL) using EQ-VAS and EQ-5D-5L, and healthcare use (HCU) and productivity loss associated with having a "breathing problem" in the past 12 months were analysed. Quintile regression was conducted to analyse QoL and binary logistic regression for HCU and productivity loss outcomes. Effect sizes were adjusted for age, gender, Indigenous background, self-reported heart and lung disease, high PHQ-4 score, multimorbidity and smoking. Result(s): 10,072 adults completed the survey. The prevalence of clinically important breathlessness (mMRC>=2) was 9.54%. mMRC>=2 was associated with worse QoL, and greater healthcare use and productivity loss compared with mMRC=1 (Table). Despite COVID-19 impacts, similar prevalence (8.15%) and associations were seen in a repeat cross-sectional survey in December 2020 (n=10,024). Conclusion(s): Breathlessness carries a significant burden for patients, the healthcare system, and the economy.
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Aim. To assess long-term sequelae of COVID-19 in hospitalized patients at 3 to 7 months after discharge. Material and Methods. The whole of 700 patients hospitalized to the temporary COVID-19 treatment center hosted by the FSBI “National Medical Research Center of Cardiology” of the Ministry of Health of Russia from April to June 2020 were invited to participate in a follow-up study. At 3-7 months after the index hospitalization, patients or their proxies were contacted via telephone in order to obtain information on their vital status, cardiovascular and other conditions or their complications, and new hospitalizations. In addition, patients were invited to an outpatient visit under the "COVID-19-follow-up" program, encompassing physical examination and a comprehensive battery of laboratory and instrumental tests, including spirometry, chest computed tomography (CT) and the six minute walk test (6MWT). Further, dyspnea was assessed using the mMRC (Modified Medical Research Council) Dyspnea Scale. Results: We were able to contact 87.4% (612/700) of patients or their proxies. At follow-up, 4.4% (27) patients died, of which 96.3% (26) had cardiovascular diseases (CVD). A total of 213 patients aged 19 to 94 years old (mean age 56.8±12.5, median 57 years [49.0;64.0];men, 55.4%) agreed come for an outpatient visit and to participate in the “COVID-19-follow-up” program. Since discharge, 8% (17) of patients required new hospitalizations, and more than a half of these patients (58.8%;10/17) had CVD-related hospitalizations. A total of 8.4% (18) patients experienced worsening of hypertension, 9 (4.2%) patients had newly diagnosed hypertension, 2 (0.9%) – coronary artery disease patients experienced new/recurrent angina symptoms. 4 (1.9%) patients had newly diagnosed coronary artery disease, and one patient had an ischemic stroke. At the outpatient visit, 114 (53.5%) patients had some symptoms, most frequently, shortness of breath (33%), fatigue (27.4%), chest pain (11.3%), and abnormal heartbeats (8.5%). Based on the mMRC Scale, 59% of patients had dyspnea of varying severity. Most patients had a normal vital capacity (VC), which was moderately reduced in 3.3% and severely reduced in 0.5% of patients. Chest CT scans were obtained in 78 (36.6%) patients, whose worst lung damage scores during hospitalization were CT3 or CT4. One in ten patients (10.8%) with severe lung damage during acute infection had persisting ground glass opacities, 35.9% developed fibrotic changes, 79.6% of patients had linear or fine focal opacities. According to the 6MWT data, 12.3% of patients walked less than 70% of the predicted distance, 67% walked 71 to 99% of the predicted distance, and 20.7% of patients were able to walk 100% of their predicted distance. Conclusion. These data suggest long-term negative sequelae of COVID-19 in more than half of hospitalized patients.
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ACKGROUND: Patients discharged from hospital after COVID-19-associated pneumonia often experience persistent symptoms (e.g., dyspnea, cough, fatigue), which affect their quality of life. Treatments are needed to solve these residual effects of COVID-19 and to help patients in making a full recovery. METHODS: We performed a single center open-label study to assess the impact of the oral mucolytic agent erdosteine (300 mg twice daily) for 30 days on 38 patients discharged from hospital after COVID-19-associated pneumonia who had persistent dyspnea. After discharge, all patients stopped taking all treatment for COVID-19 received during their hospital stay but continued their usual treatment for chronic diseases and they were divided into two groups: the treatment group, which received erdosteine 300 mg twice daily for 30 days and the control group, with no treatment. Patients completed St George's Respiratory Questionnaire (SGRQ) and the modified Medical Research Council (mMRC) dyspnea scale at time of discharge (Day 0) and on Day 30. The treatment group (N.=26) was compared with a control group (N.=12). RESULTS: SGRQ and mMRCscores were comparable between the treatment and control groups at hospital discharge. Both scores improved significantly in the treatment group between day 0 and day 30, whereas were not significant changes in the control group. At Day 30, significantly more patients in the treatment group than the control group had achieved clinically important changes in HRQoL and symptoms. CONCLUSIONS: In patients hospitalized for COVID-19-associated pneumonia Erdosteine treatment following hospital discharge may help their recovery, improving dyspnea and HRQoL.
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Aim: To assess the respiratory outcomes twelve weeks after the management with non-invasive positive pressure ventilation (NIPPV) in patients recovered from severe corona virus disease 2019 (COVID-19). Methodology: The cross-sectional analytical study was conducted in the Department of Pulmonology, Sir Ganga Ram Hospital Lahore between October 2020 and March 2021. Total 124 patients visiting the hospital twelve weeks after recovery from COVID-19 were enrolled using convenience sampling. After excluding patients with a history of previous respiratory symptoms before the development of COVID-19, data from 87 patients who required oxygen >15 L/minute and NIPPV support were subjected to final analysis. Results: The proportion of middle-aged adults was 52.9%, males 64.4% and smokers 49.4%. Twelve weeks after treatment with NIPPV, O2 saturation <97.0% at rest was found in 97.7% patients, PR >100 at rest in 16.1% patients, severe dyspnea in 65.5% patients, O2 dependency >5 L/min in 2.3% patients, severe CXR abnormalities in 20.7% patients and lung fibrosis in 27.6% patients. The distribution of SpO2, PR, and dyspnea status twelve weeks after recovery from severe COVID-19 were not significantly different between NIPPV duration groups (p-value >0.05). However, the number of patients with O2 dependency, severe CXR abnormality, and lung fibrosis were significantly different between NIPPV duration groups (all p-values <0.05). Conclusion: Oxygen desaturation, severe dyspnea and severe CXR abnormalities twelve weeks after the treatment with NIPPV were common among patients recovered from COVID-19. Severe CXR abnormality, lung fibrosis, and O2 dependency were significantly associated with prolonged duration of NIPPV.
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Introduction/Aim: Pulmonary tele-rehabilitation (PTR) became a way of providing exercise training and education for people with respiratory conditions during the COVID- 19 pandemic. To determine if PTR was safe, improved exercise capacity, breathlessness and health-related quality of life. Methods: Retrospective observational study. Participants had COPD, bronchiectasis, interstitial lung disease, asthma or recent lung surgery. As well as access to WIFI and a home device for videoconferencing. Outcomes: five time sitto- stand (5STS), 1 min sit-to-stand (1MinSTS);St George's Respiratory Questionnaire (SGRQ);COPD assessment test (CAT);Hospital Anxiety and Depression Scale (HADS);Modified Medical Research Council (mMRC) dyspnoea scale, number of adverse events. PTR used a zoom platform, ran for 40 min twice per week for 8 weeks, with a maximum of 10 participants in each class. An experienced physiotherapist led the exercise sessions with support from physiotherapy students. Results: Seventy-five people (66 females) commenced PTR [mean (SD): Age 67 (11) years, FEV1 63 (20) % pred] and 52 (70%) completed. Statistically significant improvement (mean change (SD) [95% CI]) for 5STS: -4 (7) [-6 to -1] s;1MinSTS: 5 (8) [2-9] times;SGRQ total: -7 (12) [-11 to -3] points;mMRC: -0.3 (0.7) [-0.6 to -0.7] score;CAT: -2.4 (6) [-4 to -0.5] score. No adverse events were reported. Conclusions: PTR improved exercise capacity, healthrelated quality of life and dyspnoea with no adverse events reported. Outpatient-based PR remains the gold standard;however, PTR could be provided during COVID lockdowns and incorporated as a flexible option for people who find it difficult to attend outpatient-based PR.
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Keywords: Digital;Improvement;Respiratory Purpose: In March 2020, all clinics and group sessions were suspended due to the COVID-19 pandemic and most of our respiratory clients were shielding. During our initial contact with these clients, they reported being less active than they were pre-lockdown. Reduced physical activity is directly related to quality of life (QoL). So, it became important for our team to look into innovative ways to engage with our clients. The aim was to find an effective alternative way for clients to participate in our Pulmonary Rehabilitation (PR) while the restrictions were in place. Methods: This service evaluation used a mixed method approach to investigate the effectiveness of Virtual PR (VPR). Both quantitative and qualitative data were collected during the initial assessment (IA) and post assessment (PA) for comparison. Informal feedbacks were collected from clients and staff during the VPR group sessions. Quantitative data: 1. COPD Assessment Tool (CAT), measures the impact of condition on client's health. 2. Patient Health Questionnaire (PHQ-9) for depression. 3. Generalised Anxiety Disorder (GAD-7) for anxiety. 4. Exercise Tolerance test (ET) Qualitative data: 1. Medical Research Council dyspnoea scale (MRC) 2. Client satisfactory survey during PA. Results: Of the 52 digitally enabled clients that were offered VPR, 88% completed the programme. 4% dropped out and the remaining 8% were expelled due to medical reasons. 11% of those who completed were housebound either due to their condition or lack of transport. 93% of the clients attended ten or more of the allocated 12 sessions. At the end of VPR, 13% of clients reported an improvement in MRC, and 65% of the clients had attained minimally important difference in ET. During IA, 86% reported to have medium to high impact on CAT. 43% of those clients had dropped to a lower impact level during post assessment. Initially, 63% reported to have psychological symptoms in at least one or both of the questionnaires (PHQ-9, GAD-7). Of these 29 clients who reported symptoms, 62% showed improvement at the end. 95% have said that VPR has motivated them to be active, 41% would have preferred face to face (F2F) sessions for the social aspects of the group, but all participants agreed that VPR was a good alternative. 95% of clients rated 8 or above for the quality of the sessions. During informal interviews, clients said VPR has saved them travel time and reduced dependency on family for transport. Staff reported lack of exercise equipment had an impact on the progress when compared to F2F. Conclusion(s): VPR as a digital solution has a positive effect on both physiological and psychological symptoms, thus improving QoL. Also, proved to be cost, time and clinically effective way to rehabilitate housebound clients. VPR is a good alternative to F2F sessions, but further work needs to be done to enable clients in digital and data poverty to uptake VPR to ensure fair access. Impact: VPR has been imbedded into our pathway and will be offered based on clinical decision and clients’ choice. Referral form will be revised to reflect the optional digital pathway. Funding acknowledgements: So far, this project has been funded at team level for the virtual platform licence. Funding has been secured for digital devices and data through the organisation (NELFT NHS trust) for a project on, ‘VPR for clients in digital/data poverty’.