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2.
Chest ; 160(1): 175-186, 2021 07.
Article in English | MEDLINE | ID: covidwho-1525725

ABSTRACT

BACKGROUND: SARS-CoV-2 aerosolization during noninvasive positive-pressure ventilation may endanger health care professionals. Various circuit setups have been described to reduce virus aerosolization. However, these setups may alter ventilator performance. RESEARCH QUESTION: What are the consequences of the various suggested circuit setups on ventilator efficacy during CPAP and noninvasive ventilation (NIV)? STUDY DESIGN AND METHODS: Eight circuit setups were evaluated on a bench test model that consisted of a three-dimensional printed head and an artificial lung. Setups included a dual-limb circuit with an oronasal mask, a dual-limb circuit with a helmet interface, a single-limb circuit with a passive exhalation valve, three single-limb circuits with custom-made additional leaks, and two single-limb circuits with active exhalation valves. All setups were evaluated during NIV and CPAP. The following variables were recorded: the inspiratory flow preceding triggering of the ventilator, the inspiratory effort required to trigger the ventilator, the triggering delay, the maximal inspiratory pressure delivered by the ventilator, the tidal volume generated to the artificial lung, the total work of breathing, and the pressure-time product needed to trigger the ventilator. RESULTS: With NIV, the type of circuit setup had a significant impact on inspiratory flow preceding triggering of the ventilator (P < .0001), the inspiratory effort required to trigger the ventilator (P < .0001), the triggering delay (P < .0001), the maximal inspiratory pressure (P < .0001), the tidal volume (P = .0008), the work of breathing (P < .0001), and the pressure-time product needed to trigger the ventilator (P < .0001). Similar differences and consequences were seen with CPAP as well as with the addition of bacterial filters. Best performance was achieved with a dual-limb circuit with an oronasal mask. Worst performance was achieved with a dual-limb circuit with a helmet interface. INTERPRETATION: Ventilator performance is significantly impacted by the circuit setup. A dual-limb circuit with oronasal mask should be used preferentially.


Subject(s)
COVID-19 , Continuous Positive Airway Pressure , Disease Transmission, Infectious/prevention & control , Noninvasive Ventilation , Air Filters , Benchmarking/methods , COVID-19/therapy , COVID-19/transmission , Continuous Positive Airway Pressure/adverse effects , Continuous Positive Airway Pressure/instrumentation , Continuous Positive Airway Pressure/methods , Critical Pathways/standards , Critical Pathways/trends , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Noninvasive Ventilation/adverse effects , Noninvasive Ventilation/instrumentation , Noninvasive Ventilation/methods , Research Design , Respiratory Function Tests/methods , SARS-CoV-2 , Treatment Outcome , Ventilators, Mechanical
3.
BMC Pulm Med ; 21(1): 136, 2021 Apr 26.
Article in English | MEDLINE | ID: covidwho-1511742

ABSTRACT

BACKGROUND: All over the world, SARS-CoV-2 pneumonia is causing a significant short-term morbidity and mortality, but the medium-term impact on lung function and quality of life of affected patients are still unknown. METHODS: In this prospective observational study, 39 patients with SARS-CoV-2 pneumonia were recruited from a single COVID-19 hospital in Southern Switzerland. At three months patients underwent radiological and functional follow-up through CT scan, lung function tests, and 6 min walking test. Furthermore, quality of life was assessed through self-reported questionnaires. RESULTS: Among 39 patients with SARS-CoV-2 pneumonia, 32 (82% of all participants) presented abnormalities in CT scan and 25 (64.1%) had lung function tests impairment at three months. Moreover, 31 patients (79.5%) reported a perception of poor health due to respiratory symptoms and all 39 patients showed an overall decreased quality of life. CONCLUSIONS: Medium-term follow up at three months of patients diagnosed with SARS-CoV-2 pneumonia shows the persistence of abnormalities in CT scans, a significant functional impairment assessed by lung function tests and a decreased quality of life in affected patients. Further studies evaluating the long-term impact are warranted to guarantee an appropriate follow-up to patients recovering from SARS-CoV-2 pneumonia.


Subject(s)
COVID-19/physiopathology , Lung/physiopathology , Quality of Life , Aged , COVID-19/diagnostic imaging , Convalescence , Female , Forced Expiratory Volume , Health Status , Humans , Length of Stay , Lung/diagnostic imaging , Male , Middle Aged , Prospective Studies , Pulmonary Diffusing Capacity , Recovery of Function , Respiratory Function Tests , SARS-CoV-2 , Switzerland , Tomography, X-Ray Computed , Vital Capacity , Walk Test
4.
Ital J Pediatr ; 47(1): 221, 2021 Nov 06.
Article in English | MEDLINE | ID: covidwho-1505719

ABSTRACT

BACKGROUND: With the gradual resumption of sports activities after the lock-down period for coronavirus pandemic, a new problem is emerging: Allow all athletes to be able to return to compete after SARS-CoV-2 infection in total safety. Several protocols have been proposed for healed athletes but all of them have been formulated for the adult population. The aim of the present study is to evaluate the adequacy of Italian practical recommendations for return-to-paly, in order to exclude cardiorespiratory complications due to COVID-19 in children and adolescents. METHODS: Between April 2020 and January 2021 the Italian Sports Medical Federation formulated cardiorespiratory protocols to be applied to athletes recovered from SARS-CoV-2 infection. The protocols take into account the severity of the infection. Protocols include lung function tests, cardiopulmonary exercise test, echocardiographic evaluation, blood chemistry tests. RESULTS: From September 2020 to February 2021, 45 children and adolescents (aged from 9 to 18 years; male = 26) with previous SARS-CoV-2 infection were evaluated according to the protocols in force for adult. 55.5% of the subjects (N = 25) reported an asymptomatic infection; 44.5% reported a mild symptomatic infection. Results of lung function test have exceeded the limit of 80% of the theoretical value in all patients. The cardiorespiratory capacity of all patients was within normal limits (average value of maximal oxigen uptake 41 ml/kg/min). No arrhythmic events or reduction in the ejection fraction were highlighted. CONCLUSION: The data obtained showed that, in the pediatric population, mild coronavirus infection does not cause cardiorespiratory complications in the short and medium term. Return to play after Coronavirus infection seems to be safe but it will be necessary to continue with the data analysis in order to modulate and optimize the protocols especially in the pediatric field.


Subject(s)
COVID-19/complications , Return to Sport , Adolescent , Age Factors , COVID-19/physiopathology , COVID-19/therapy , Cardiorespiratory Fitness , Child , Clinical Protocols , Female , Humans , Italy , Male , Recovery of Function , Respiratory Function Tests , Time Factors
5.
Sci Rep ; 11(1): 20144, 2021 10 11.
Article in English | MEDLINE | ID: covidwho-1462037

ABSTRACT

Pulmonary function testing (PFT) allows for quantitative analysis of lung function. However, as a result of the coronavirus disease 2019 (COVID-19) pandemic, a majority of international medical societies have postponed PFTs in an effort to mitigate disease transmission, complicating the continuity of care in high-risk patients diagnosed with COVID-19 or preexisting lung pathologies. Here, we describe the development of a non-contact wearable pulmonary sensor for pulmonary waveform analysis, pulmonary volume quantification, and crude thoracic imaging using the eddy current (EC) phenomenon. Statistical regression analysis is performed to confirm the predictive validity of the sensor, and all data are continuously and digitally stored with a sampling rate of 6,660 samples/second. Wearable pulmonary function sensors may facilitate rapid point-of-care monitoring for high-risk individuals, especially during the COVID-19 pandemic, and easily interface with patient hospital records or telehealth services.


Subject(s)
COVID-19/diagnosis , Monitoring, Physiologic/instrumentation , Point-of-Care Systems , Respiratory Function Tests/instrumentation , Wearable Electronic Devices , COVID-19/epidemiology , COVID-19/transmission , COVID-19/virology , Feasibility Studies , Healthy Volunteers , Humans , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Monitoring, Physiologic/methods , Pandemics/prevention & control , Respiratory Function Tests/methods , Respiratory Physiological Phenomena
6.
Eur Respir J ; 58(3)2021 09.
Article in English | MEDLINE | ID: covidwho-1458032

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread worldwide, having a dramatic impact on healthcare systems. The aim of this study is to evaluate mid-term clinical impact of COVID-19 on respiratory function. METHODS: 379 patients were evaluated 4 months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Patients were divided in two groups based on the presence of pneumonia during COVID-19. Clinical conditions, quality of life, symptomatology, 6-min walk test, pulmonary function test with spirometry and diffusing capacity of the lung for carbon monoxide were analysed. Data were compared to clinical evolution during COVID-19 (development of acute respiratory distress syndrome, need of invasive mechanical ventilation, partial oxygen saturation (S pO2 )/inspiratory oxygen fraction (F IO2 ) ratio and pneumonia severity index (PSI)). RESULTS: After a median 135 days, 260 (68.6%) out of 379 patients referred at least one symptom. Patients who developed pneumonia during COVID-19 showed lower S pO2 at rest (p<0.001), S pO2 during 6-min walk test (p<0.001), total lung capacity (p<0.001), airway occlusion pressure after 0.1 s (P 0.1) (p=0.02), P 0.1/maximal inspiratory pressure ratio (p=0.005) and higher Borg category-ratio scale (p=0.006) and modified Medical Research Council breathlessness scale (p=0.003), compared to patients without pneumonia. S pO2 /F IO2 ratio and PSI during SARS-CoV-2 pneumonia were directly associated with mid-term alteration of S pO2 at rest (p<0.001) and during 6-min walk test (p<0.001), residual volume (p<0.001), total lung capacity (p<0.001 and p=0.003, respectively) and forced vital capacity (p=0.004 and p=0.03, respectively). CONCLUSION: Lung damage during COVID-19 correlates to the reduction of pulmonary function 4 months after acute infection.


Subject(s)
COVID-19 , Quality of Life , Humans , Lung , Respiratory Function Tests , SARS-CoV-2
7.
Respir Res ; 22(1): 255, 2021 Sep 27.
Article in English | MEDLINE | ID: covidwho-1440932

ABSTRACT

INTRODUCTION: There is relatively little published on the effects of COVID-19 on respiratory physiology, particularly breathing patterns. We sought to determine if there were lasting detrimental effect following hospital discharge and if these related to the severity of COVID-19. METHODS: We reviewed lung function and breathing patterns in COVID-19 survivors > 3 months after discharge, comparing patients who had been admitted to the intensive therapy unit (ITU) (n = 47) to those who just received ward treatments (n = 45). Lung function included spirometry and gas transfer and breathing patterns were measured with structured light plethysmography. Continuous data were compared with an independent t-test or Mann Whitney-U test (depending on distribution) and nominal data were compared using a Fisher's exact test (for 2 categories in 2 groups) or a chi-squared test (for > 2 categories in 2 groups). A p-value of < 0.05 was taken to be statistically significant. RESULTS: We found evidence of pulmonary restriction (reduced vital capacity and/or alveolar volume) in 65.4% of all patients. 36.1% of all patients has a reduced transfer factor (TLCO) but the majority of these (78.1%) had a preserved/increased transfer coefficient (KCO), suggesting an extrapulmonary cause. There were no major differences between ITU and ward lung function, although KCO alone was higher in the ITU patients (p = 0.03). This could be explained partly by obesity, respiratory muscle fatigue, localised microvascular changes, or haemosiderosis from lung damage. Abnormal breathing patterns were observed in 18.8% of subjects, although no consistent pattern of breathing pattern abnormalities was evident. CONCLUSIONS: An "extrapulmonary restrictive" like pattern appears to be a common phenomenon in previously admitted COVID-19 survivors. Whilst the cause of this is not clear, the effects seem to be similar on patients whether or not they received mechanical ventilation or had ward based respiratory support/supplemental oxygen.


Subject(s)
COVID-19/physiopathology , Hospitalization/trends , Lung/physiology , Respiratory Mechanics/physiology , Spirometry/trends , Survivors , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/therapy , Female , Humans , Lung Diseases/diagnosis , Lung Diseases/physiopathology , Lung Diseases/therapy , Male , Middle Aged , Patient Discharge/trends , Respiratory Function Tests/methods , Respiratory Function Tests/trends , Spirometry/methods , Young Adult
8.
Lancet Respir Med ; 9(7): 747-754, 2021 07.
Article in English | MEDLINE | ID: covidwho-1433967

ABSTRACT

BACKGROUND: The consequences of COVID-19 in those who recover from acute infection requiring hospitalisation have yet to be clearly defined. We aimed to describe the temporal trends in respiratory outcomes over 12 months in patients hospitalised for severe COVID-19 and to investigate the associated risk factors. METHODS: In this prospective, longitudinal, cohort study, patients admitted to hospital for severe COVID-19 who did not require mechanical ventilation were prospectively followed up at 3 months, 6 months, 9 months, and 12 months after discharge from Renmin Hospital of Wuhan University, Wuhan, China. Patients with a history of hypertension; diabetes; cardiovascular disease; cancer; and chronic lung disease, including asthma or chronic obstructive pulmonary disease; or a history of smoking documented at time of hospital admission were excluded at time of electronic case-note review. Patients who required intubation and mechanical ventilation were excluded given the potential for the consequences of mechanical ventilation itself to influence the factors under investigation. During the follow-up visits, patients were interviewed and underwent physical examination, routine blood test, pulmonary function tests (ie, diffusing capacity of the lungs for carbon monoxide [DLCO]; forced expiratory flow between 25% and 75% of forced vital capacity [FVC]; functional residual capacity; FVC; FEV1; residual volume; total lung capacity; and vital capacity), chest high-resolution CT (HRCT), and 6-min walk distance test, as well as assessment using a modified Medical Research Council dyspnoea scale (mMRC). FINDINGS: Between Feb 1, and March 31, 2020, of 135 eligible patients, 83 (61%) patients participated in this study. The median age of participants was 60 years (IQR 52-66). Temporal improvement in pulmonary physiology and exercise capacity was observed in most patients; however, persistent physiological and radiographic abnormalities remained in some patients with COVID-19 at 12 months after discharge. We found a significant reduction in DLCO over the study period, with a median of 77% of predicted (IQR 67-87) at 3 months, 76% of predicted (68-90) at 6 months, and 88% of predicted (78-101) at 12 months after discharge. At 12 months after discharge, radiological changes persisted in 20 (24%) patients. Multivariate logistic regression showed increasing odds of impaired DLCO associated with female sex (odds ratio 8·61 [95% CI 2·83-26·2; p=0·0002) and radiological abnormalities were associated with peak HRCT pneumonia scores during hospitalisation (1·36 [1·13-1·62]; p=0·0009). INTERPRETATION: In most patients who recovered from severe COVID-19, dyspnoea scores and exercise capacity improved over time; however, in a subgroup of patients at 12 months we found evidence of persistent physiological and radiographic change. A unified pathway for the respiratory follow-up of patients with COVID-19 is required. FUNDING: National Natural Science Foundation of China, UK Medical Research Council, and National Institute for Health Research Southampton Biomedical Research Centre. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.


Subject(s)
COVID-19/physiopathology , COVID-19/therapy , Hospitalization , Aged , Cohort Studies , Female , Humans , Longitudinal Studies , Male , Middle Aged , Prospective Studies , Respiratory Function Tests , Time Factors
9.
Radiologe ; 61(10): 888-895, 2021 Oct.
Article in German | MEDLINE | ID: covidwho-1413121

ABSTRACT

BACKGROUND: Following coronavirus disease 2019 (COVID-19), a proportion of patients report prolonged or worsening symptoms and impairments. These symptoms are increasingly referred to as "long COVID" syndrome. They may be associated with radiological changes on computed tomography (CT) and pulmonary function impairment. OBJECTIVES: To discuss the role of long-term assessment of COVID-19 patients to determine which patients may benefit from follow-up. MATERIALS AND METHODS: This article presents the current results of clinical, radiological, and pulmonary function follow-up tests after COVID-19 pneumonia. RESULTS: Chronic fatigue and dyspnea are the most common persistent symptoms after COVID-19. Patients also present impaired exercise capacity. On CT, ground-glass opacities and parenchymal bands are the most common residual changes after COVID-19 pneumonia, histologically corresponding to organizing pneumonia. A proportion of patients who had severe COVID-19 pneumonia may show fibrotic-like changes during follow-up. Patients with severe acute infection may present with a restrictive syndrome with lower diffusing capacity for carbon monoxide (DLCO) and total lung capacity (TLC) values. Overall, significant and continuous improvement in all symptoms as well as radiomorphological and functional changes were observed over time. CONCLUSIONS: Patients with persistent symptoms after COVID-19 should be evaluated and treated in specialized post-COVID-19 clinics in a multidisciplinary manner.


Subject(s)
COVID-19 , Pneumonia , Humans , Lung/diagnostic imaging , Respiratory Function Tests , SARS-CoV-2
10.
Medicine (Baltimore) ; 100(31): e26866, 2021 Aug 06.
Article in English | MEDLINE | ID: covidwho-1410308

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak began in late 2019 and spread rapidly throughout China and then the rest of the world. COVID-19 is a serious respiratory disease and many patients' exhibit varying levels of persistent parenchymal lung damage. However, there is currently a lack of effective rehabilitation treatments for COVID-19 patients with lung damage. Several clinical trials have shown that Liuzijue Qigong (LQG) can enhance the strength of respiratory muscles and overall quality of life. In this study, a meta-analysis approach was used to assess the effects of LQG on the lung function of COVID-19 patients during disease recovery. METHODS: Eight databases will be explored for relevant investigations including China National Knowledge Infrastructure, Wanfang, VIP, China Biology Medicine, EMBASE, PubMed, Web of Science, and the Cochrane Library. All databases will be explored for articles published from inception through July 2021. Data will be extracted independently by 2 researchers according to the eligibility criteria. Finally, RevMan 5.3.0 will be implemented for statistical analyses. RESULTS: The results of this study will show the effects of LQG on the lung function of COVID-19 patients during disease recovery and will be submitted to a peer-reviewed journal for publication. CONCLUSIONS: This study will provide reliable evidence based on the effects of LQG on the lung function of COVID-19 patients during disease recovery. TRIAL REGISTRATION NUMBER: CRD42021268102.


Subject(s)
COVID-19/therapy , Clinical Protocols , Lung/abnormalities , Qigong/standards , COVID-19/psychology , Humans , Lung/physiopathology , Meta-Analysis as Topic , Qigong/methods , Respiratory Function Tests/methods , Systematic Reviews as Topic , Treatment Outcome
11.
J Cardiovasc Med (Hagerstown) ; 22(11): 828-831, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1406806

ABSTRACT

AIMS: Controversial data have been published regarding the prognostic role of cardiac troponins in patients who need hospitalization because of coronavirus disease 2019 (COVID-19). The aim of the study was to assess the role of high-sensitivity troponin plasma levels and of respiratory function at admission on all-cause deaths in unselected patients hospitalized because of COVID-19. METHODS: We pooled individual patient data from observational studies that assessed all-cause mortality of unselected patients hospitalized for COVID-19. The individual data of 722 patients were included. The ratio of partial pressure arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) and high-sensitivity troponins was reported at admission in all patients. This meta-analysis was registered on PROSPERO (CRD42020213209). RESULTS: After a median follow-up of 14 days, 180 deaths were observed. At multivariable regression analysis, age [hazard ratio (HR) 1.083, 95% confidence interval (CI) 1.061-1.105, P < 0.0001], male sex (HR 2.049, 95% CI 1.319-3.184, P = 0.0014), moderate-severe renal dysfunction (estimated glomerular filtration rate  < 30 mL/min/m2) (HR 2.108, 95% CI 1.237-3.594, P = 0.0061) and lower PaO2/FiO2 (HR 0.901, 95% CI 0.829-0.978, P = 0.0133) were the independent predictors of death. A linear increase in the HR was associated with decreasing values of PaO2/FiO2 below the normality threshold. On the contrary, the HR curve for troponin plasma levels was near-flat with large CI for values above the normality thresholds. CONCLUSION: In unselected patients hospitalized for COVID-19, mortality is mainly driven by male gender, older age and respiratory failure. Elevated plasma levels of high-sensitivity troponins are not an independent predictor of worse survival when respiratory function is accounted for.


Subject(s)
COVID-19 , Oxygen/analysis , Respiratory Function Tests/methods , Troponin/blood , Age Factors , Biomarkers/analysis , Biomarkers/blood , Blood Gas Analysis/methods , Breath Tests/methods , COVID-19/blood , COVID-19/diagnosis , COVID-19/mortality , Humans , Prognosis , Risk Assessment/methods , SARS-CoV-2 , Sex Factors
12.
Respir Med ; 188: 106602, 2021 11.
Article in English | MEDLINE | ID: covidwho-1401830

ABSTRACT

INTRODUCTION: Survivors of COVID-19 infection may develop post-covid pulmonary fibrosis (PCF) and suffer from long term multi-system complications. The magnitude and risk factors associated with these are unknown. OBJECTIVES: We investigated the prevalence and risk factors associated with PCF and other complications in patients discharged after COVID-19 infection. METHODS: Patients had phone assessment 6 weeks post hospital discharge after COVID-19 infection using a set protocol. Those with significant respiratory symptoms were investigated with a CTPA, Pulmonary Function Tests and echocardiogram. Prevalence of myalgia, fatigue, psychological symptoms and PCF was obtained. Risk factors associated with these were investigated. RESULTS: A large number of patients had persistent fatigue (45.1%), breathlessness (36.5%), myalgia (20.5%) and psychological symptoms (19.5%). PCF was seen in 9.5% of the patients and was associated with persistent breathlessness at 6 weeks and inpatient ventilation [adjusted OR 5.02(1.76-14.27) and 4.45(1.27-15.58)] respectively. It was more common in men and in patients with peak CRP >171.5 mg/L, peak WBC count ≥12 × 10 9/L, severe inpatient COVID-19 CXR changes and CT changes. Ventilation was also a risk factor for persisting fatigue and myalgia, the latter was also more common in those with severe cytokine storm and severe COVID-19 inpatient CXR changes. CONCLUSIONS: All the patients discharged after COVID-19 should be assessed using a set protocol by a multidisciplinary team. Patients who had severe COVID-19 infection particularly those who were intubated and who have persistent breathlessness are at risk of developing PCF. They should have a CT Chest and have respiratory follow-up.


Subject(s)
COVID-19/complications , Lung/physiopathology , Pandemics , Patient Discharge/trends , Pulmonary Fibrosis/etiology , SARS-CoV-2 , Adult , COVID-19/epidemiology , Humans , Male , Middle Aged , Prevalence , Pulmonary Fibrosis/diagnosis , Pulmonary Fibrosis/physiopathology , Respiratory Function Tests , Risk Factors , United Kingdom/epidemiology
13.
Respir Care ; 66(11): 1691-1698, 2021 11.
Article in English | MEDLINE | ID: covidwho-1399497

ABSTRACT

BACKGROUND: Because impulse oscillometry (IOS) can detect changes in the small airways and is safer to perform during the COVID-19 pandemic than other pulmonary function tests, it may have value in investigating pulmonary sequelae in COVID-19 survivors. This study evaluated the performance of IOS in detecting lung abnormalities in COVID-19 survivors and investigated the associations of the findings with those of lung ultrasound (LUS) and spirometry. METHODS: In this cross-sectional study, 117 subjects underwent IOS at a frequency range of 4-20 Hz 2 months after COVID-19 diagnosis. They also underwent spirometry and LUS, and their aeration scores were calculated. RESULTS: On IOS, the resonance frequency was > 12 Hz, and the area under the reactance curve was > 3.60 cm H2O/L/s in 70 (59.8%) and 55 (47.0%) subjects, respectively. A heterogeneity of resistance between R4 and R20 (R4-R20) > 20% was observed in 60 (51.3%) participants. Based on their abnormalities in resistive and reactive parameters, 76 (65.0%) participants had abnormal IOS. Spirometry abnormalities were detected in 40 (34.2%) cases. LUS was abnormal in 51 (43.6%) participants, and the median aeration score was 0 (0-8) points. Abnormal IOS was associated with abnormal LUS (P < .001) and abnormal spirometry (P = .002). Abnormal spirometry had a significant but weaker association with abnormal LUS (P = .031). In participants who reported hospitalization, abnormal IOS was associated with both abnormal LUS (P = .001) and abnormal spirometry (P = .006). In participants who did not report hospitalization, abnormal IOS was associated with abnormal LUS (P < .001) but not abnormal spirometry (P = .063). CONCLUSIONS: In COVID-19 survivors, IOS detected changes even when spirometry was normal. In these individuals, IOS parameters were more strongly associated with abnormalities on LUS than with abnormalities on spirometry.


Subject(s)
COVID-19 , COVID-19 Testing , Cross-Sectional Studies , Humans , Lung/diagnostic imaging , Oscillometry , Pandemics , Respiratory Function Tests , SARS-CoV-2 , Spirometry , Survivors
14.
PLoS One ; 16(9): e0257040, 2021.
Article in English | MEDLINE | ID: covidwho-1394554

ABSTRACT

OBJECTIVES: To study abnormality of spirometry, six-minute walk distance, and chest radiograph among patients recovered from Coronavirus Disease 2019 (COVID-19). METHODS AND STUDY DESIGN: A prospective cohort study was conducted in 87 COVID-19 confirmed cases who recovered and discharged from a medical school hospital in Thailand. At the follow-up visit on day 60 after onset of symptoms, patients underwent an evaluation by spirometry (FVC, FEV1, FEV1/FVC, FEF25-75, and PEF), a six-minute-walk test (6MWT), and a chest radiograph. RESULTS: There were 35 men and 52 women, with a mean age of 39.6±11.8 years and the mean body mass index (BMI) was 23.8±4.3 kg/m2. Of all, 45 cases had mild symptoms; 35 had non-severe pneumonia, and 7 had severe pneumonia. Abnormality in spirometry was observed in 15 cases (17.2%), with 8% of restrictive defect and 9.2% of obstructive defect. Among the patients with an abnormal spirometry, the majority of the cases were in the severe pneumonia group (71.4%), compared with 15.6% in the non-severe pneumonia group, and 10.2% in the mild symptom group (p = 0.001). The mean six-minute-walk distance (6MWD) in the mild symptom and non-severe pneumonia groups was 538±56.8 and 527.5±53.5 meters, respectively. Although the severe pneumonia group tended to have a shorter mean 6-min walking distance, but this was not statistically significant (p = 0.118). Twelve patients (13.8%) had abnormal chest radiographs that showed residual fibrosis. This abnormality was more common in the severe pneumonia group (85.7%) and in others (7.5%) (p<0.001). CONCLUSIONS: Abnormal spirometry was noted in 17.2% of COVID-19 survivors with both restrictive and obstructive defects. Severe COVID-19 pneumonia patients had higher prevalence rates of abnormal spirometry and residual fibrosis on the chest radiographs when compared to patients in the mild symptom and non-severe pneumonia groups.


Subject(s)
COVID-19/physiopathology , Respiratory Function Tests/methods , Survivors/statistics & numerical data , Walk Test/methods , Adult , COVID-19/diagnosis , COVID-19/virology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pneumonia/diagnosis , Pneumonia/physiopathology , Prospective Studies , SARS-CoV-2/physiology , Spirometry/methods , Thailand
15.
BMJ Open Respir Res ; 8(1)2021 09.
Article in English | MEDLINE | ID: covidwho-1394124

ABSTRACT

Many patients struggle with ongoing symptoms in different domains (physical, mental, cognitive) after hospitalisation for COVID-19, calling out for a multidisciplinary approach. An outpatient multidisciplinary rehabilitation programme, according to a respiratory rehabilitation strategy, was set up for adult patients who were able to attend group sessions during 12 weeks. Results of 22 adult patients with COVID-19, of which 15 had required intensive care, were analysed and some general impressions and challenges of rehabilitation in COVID-19 were reported. Impressive results on physical recovery were determined after 6 weeks and 3 months, with significant improvement of lung function, muscle force and exercise capacity variables. A positive evolution of mental and cognitive burden was present, although less pronounced than the physical recovery. These mental and cognitive consequences seem, next to musculoskeletal and medical complications, the most challenging aspect of rehabilitating patients with COVID-19. These real-world data show feasibility and efficiency of a multidisciplinary respiratory rehabilitation programme after moderate to severe COVID-19 disease.


Subject(s)
COVID-19 , Respiratory Therapy , Adult , COVID-19/rehabilitation , Critical Care , Female , Humans , Male , Middle Aged , Respiratory Function Tests , Treatment Outcome
16.
BMJ Open Respir Res ; 8(1)2021 06.
Article in English | MEDLINE | ID: covidwho-1388519

ABSTRACT

INTRODUCTION: Almost half of all school-age children with bronchopulmonary dysplasia (BPD) have asthma-like symptoms and more suffer from lung function deficits. While air pollution and indoor respiratory irritants are known to affect high-risk populations of children, few studies have objectively evaluated environmental contributions to long-term respiratory morbidity in this population. This study aimed to examine the role of indoor environmental exposures on respiratory morbidity in children with BPD. METHODS AND ANALYSIS: The Air quality, Environment and Respiratory Ouctomes in BPD (AERO-BPD) study is a prospective, single-centre observational study that will enrol a unique cohort of 240 children with BPD and carefully characterise participants and their indoor home environmental exposures. Measures of indoor air quality constituents will assess the relationship of nitrogen dioxide (NO2), particulate matter (PM2.5), nitric oxide (NO), temperature and humidity, as well as dust concentrations of allergens, with concurrently measured respiratory symptoms and lung function.Adaptations to the research protocol due to the SARS-CoV-2 pandemic included remote home environment and participant assessments. ETHICS AND DISSEMINATION: Study protocol was approved by the Boston Children's Hospital Committee on Clinical Investigation. Dissemination will be in the form of peer-reviewed publications and participant information products. TRIAL REGISTRATION NUMBER: NCT04107701.


Subject(s)
Air Pollution/adverse effects , Bronchopulmonary Dysplasia/epidemiology , Environmental Exposure/adverse effects , Particulate Matter/adverse effects , Air Pollution, Indoor/analysis , Allergens , Asthma/epidemiology , Asthma/physiopathology , Bronchopulmonary Dysplasia/diagnosis , Bronchopulmonary Dysplasia/physiopathology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Child , Cohort Studies , Environmental Exposure/statistics & numerical data , Female , Humans , Humidity , Male , Nitric Oxide/analysis , Nitrogen Dioxide/analysis , Prospective Studies , Respiratory Function Tests/methods , SARS-CoV-2/genetics , Temperature
17.
Respir Care ; 66(10): 1610-1617, 2021 10.
Article in English | MEDLINE | ID: covidwho-1381426

ABSTRACT

BACKGROUND: Persistent impairment of pulmonary function and exercise capacity has been known to last for months or even years in the survivors who recovered from other coronavirus pneumonia. Some reports showed that subjects with coronavirus disease 2019 pneumonia after being discharged could have several sequelae, but there are few studies on gas exchange and exercise capacity complications in these subjects. AIMS: To describe residual gas exchange abnormalities during recovery from coronavirus disease 2019 pneumonia. METHODS: In an observational study, ∼90 d after onset of disease, we scheduled almost 200 subjects for an out-patient visit with pulmonary function testing and computed tomography of the lungs. Lung mechanics by using body plethysmography, gas exchange with diffusing lung capacity for carbon monoxide determined by the single-breath technique (DLCOsb) and diffusing lung capacity for nitric oxide determined by the single-breath technique (DLNOsb), and exercise ability by using the 6-min walk test (6MWT) were measured in the subjects. The results were compared between those who required invasive mechanical ventilation and those who did not. RESULTS: A total of 171 subjects were included, the majority (96%) had signs of residual pneumonia (such as an excess of high attenuation areas) on computed tomography of the lungs. The DLCOSB results were below the lower limit of the normal range in 29.2% of the subjects; during the 6MWT, 67% experienced oxygen desaturation ([Formula: see text]) > 4%; and, in 81 (47%), the dropped below 88%. Subjects who required invasive mechanical ventilation (49.7%) were more likely to have lower lung volumes, more gas exchange abnormality, less exercise capacity and more radiologic abnormality. CONCLUSIONS: Subjects who recovered from severe COVID-19 pneumonia continued to have abnormal lung function and abnormal radiologic findings.


Subject(s)
COVID-19 , Humans , Lung/diagnostic imaging , Pulmonary Diffusing Capacity , Pulmonary Gas Exchange , Respiratory Function Tests , SARS-CoV-2 , Walk Test
18.
Respiration ; 100(11): 1078-1087, 2021.
Article in English | MEDLINE | ID: covidwho-1374004

ABSTRACT

BACKGROUND: Long-term pulmonary sequelae following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia are not yet confirmed; however, preliminary observations suggest a possible relevant clinical, functional, and radiological impairment. OBJECTIVES: The aim of this study was to identify and characterize pulmonary sequelae caused by SARS-CoV-2 pneumonia at 6-month follow-up. METHODS: In this multicentre, prospective, observational cohort study, patients hospitalized for SARS-CoV-2 pneumonia and without prior diagnosis of structural lung diseases were stratified by maximum ventilatory support ("oxygen only," "continuous positive airway pressure," and "invasive mechanical ventilation") and followed up at 6 months from discharge. Pulmonary function tests and diffusion capacity for carbon monoxide (DLCO), 6-min walking test, chest X-ray, physical examination, and modified Medical Research Council (mMRC) dyspnoea score were collected. RESULTS: Between March and June 2020, 312 patients were enrolled (83, 27% women; median interquartile range age 61.1 [53.4, 69.3] years). The parameters that showed the highest rate of impairment were DLCO and chest X-ray, in 46% and 25% of patients, respectively. However, only a minority of patients reported dyspnoea (31%), defined as mMRC ≥1, or showed restrictive ventilatory defects (9%). In the logistic regression model, having asthma as a comorbidity was associated with DLCO impairment at follow-up, while prophylactic heparin administration during hospitalization appeared as a protective factor. The need for invasive ventilatory support during hospitalization was associated with chest imaging abnormalities. CONCLUSIONS: DLCO and radiological assessment appear to be the most sensitive tools to monitor patients with the coronavirus disease 2019 (COVID-19) during follow-up. Future studies with longer follow-up are warranted to better understand pulmonary sequelae.


Subject(s)
COVID-19/complications , Lung Diseases/epidemiology , Lung Diseases/virology , Respiration, Artificial , Aged , COVID-19/diagnosis , COVID-19/therapy , Female , Follow-Up Studies , Hospitalization , Humans , Logistic Models , Lung Diseases/therapy , Male , Middle Aged , Prevalence , Prospective Studies , Respiratory Function Tests , Time Factors
19.
Respir Res ; 22(1): 237, 2021 Aug 26.
Article in English | MEDLINE | ID: covidwho-1371969

ABSTRACT

Follow-up studies of COVID-19 patients have found lung function impairment up to six months after initial infection, but small airway function has not previously been studied. Patients (n = 20) hospitalised for a severe SARS-CoV-2 infection underwent spirometry, impulse oscillometry, and multiple measurements of alveolar nitric oxide three to six months after acute infection. None of the patients had small airway obstruction, nor increased nitric oxide concentration in the alveolar level. None of the patients had a reduced FEV1/FVC or significant bronchodilator responses in IOS or spirometry. In conclusion, we found no evidence of inflammation or dysfunction in the small airways.


Subject(s)
COVID-19/complications , COVID-19/physiopathology , Respiratory Tract Diseases/physiopathology , Adult , Aged , Female , Finland , Follow-Up Studies , Forced Expiratory Volume , Humans , Length of Stay , Male , Middle Aged , Nitric Oxide/metabolism , Pulmonary Alveoli/metabolism , Respiratory Function Tests , Respiratory Tract Diseases/etiology , Spirometry , Survivors , Vital Capacity
20.
J Med Virol ; 93(9): 5574-5581, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1363701

ABSTRACT

OBJECTIVE: It was aimed to evaluate long-term radiological changes in severe coronavirus disease 2019 (COVID-19) patients, to investigate pulmonary function, exercise capacities, and health-related quality of life results. METHODS: Sixty-five patients with severe COVID-19 pneumonia were evaluated in the sixth month after discharge from the hospital. Spirometry, 6 min walking test (6MWT), and short form of health-related quality of life scale (SF-36) were applied in the sixth month. Chest computed tomography (CT) was performed and the findings were grouped according to lung involvement. RESULTS: Forty-nine male and 16 female patients were included in the study. Forced expiratory volume in 1 s (FEV1)% values of 18 patients (30.5%), forced vital capacity (FVC)% values of 27 patients (45.8%), and 6MWT of 13 patients (23.2%) were found lower than expected in the sixth month. On the SF-36 scale, physical function, energy-vitality, social functionality, pain, and general health parameters were found lower than normal. Minimal interstitial changes in chest CT were seen in 26 patients. Nine patients had lung area involvement between 10% and 50% of the surface, there was a correlation between FEV1% and FVC% values in this group. There was severe pulmonary fibrosis in four patients. There was a correlation between pulmonary function and physical function and general perception of health from SF-36 scale subparameters. CONCLUSION: Functional and radiological abnormalities were detected in a significant number of patients in the sixth month after severe COVID-19 pneumonia. A systematic monitoring plan must be established to assess and properly manage the long-term problems that may arise.


Subject(s)
COVID-19/physiopathology , Lung/physiopathology , Quality of Life , Adult , Aged , COVID-19/diagnosis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Discharge , Respiratory Function Tests , SARS-CoV-2/isolation & purification , Spirometry , Survivors , Time Factors , Tomography, X-Ray Computed , Turkey , Walk Test
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