Cardiopulmonary rehabilitation programme improves physical health and quality of life in post-COVID syndrome.

BACKGROUND: Many patients with previous COVID-19 infection suffer from prolonged symptoms after their recovery: cough, dyspnea, chest pain, shortness of breath, fatigue, anxiety or depression, regardless of milder or severe coronavirus infection. Review of the literature demonstrates underrepresented complex cardiopulmonary rehabilitation of patients with post-COVID syndrome. The aim of our quasi-experimental study was to evaluate the effectiveness of complex cardiopulmonary rehabilitation and to assess the quality of life, functional parameters before and after a 14-day specific cardiopulmonary rehabilitation and two months later. METHODS: Sixty-eight patients participated in rehabilitation at Semmelweis University's Department of Pulmonology. Respiratory function: forced expiratory volume in 1 second (FEV1%pred), 6-minute walk test (6MWT), chest kinematics (CK), quality of life [EuroQol-5D (EQ-5D), Post-COVID-19 Functional Status (PCFS)] and Modified Medical Research Council (mMRC) dyspnea scale were measured at the beginning and end of the programme and two months after the rehabilitation. RESULTS: The 14-day rehabilitation programme resulted in significant improvement of 6MWT {492 [interquartile range (IQR), 435-547] vs. 523 (IQR, 477-580) m; P=0.031}, mMRC [1 (IQR, 0.25-1) vs. 0 (IQR, 0-1); P=0.003], EQ-VAS score [75 (IQR, 65-80) vs. 85 (IQR, 75-90); P=0.015], and PCFS [1 (IQR, 1-2) vs. 0.5 (IQR, 0-1); P=0.032]. Respiratory function and chest kinematics also improved, FEV1(%pred) [86 (IQR, 73-103) vs. 91 (IQR, 80-99); P=0.360], chest kinematics [3.5 (IQR, 2.75-4.25) vs. 4 (IQR, 1-5.25) cm; P=0.296], and breath-holding test (BHT) [33 (IQR, 23-44) vs. 41 (IQR, 28-58) s; P=0.041]. CONCLUSIONS: Complex cardiopulmonary rehabilitation improved workload, quality of life, respiratory function, complaints and clinical status of patients with post-COVID syndrome. Personalized complex pulmonary rehabilitation can be beneficial and recommended for patients suffer from post-COVID syndrome, who have good potential for recovery and are able to participate in the two weeks complex pulmonary rehabilitation.

First booster dose uptake of COVID-19 vaccine and disease-related factors in chronic obstructive pulmonary disease-a cross-sectional survey in Hungary.

BACKGROUND: In chronic obstructive pulmonary disease (COPD), uptake of the coronavirus disease 2019 (COVID-19) booster vaccine is important, as they are more likely to develop serious complications. Our aim was to investigate the uptake rate of first booster vaccination against COVID-19 among COPD patients and to identify other related factors of vaccine uptake. METHODS: We conducted a multicenter survey of COPD patients in Hungary by region: eastern, western and central ones from 15 November 2021. Respiratory function test results, anthropometric data and vaccination status were recorded for 1,510 randomly selected patients over 35 years of age. Multiple logistic regression analysis was used to determine factors associated with uptake of COVID-19 first booster dose vaccines. RESULTS: The average age was 67 [61-72] years, for men it was: 67 [62-73] and 66 [60-72] years for women, with a sample of 47.95% men and 52.05% women. The uptake rate of the COVID-19 first booster vaccine during the study period was 62.45%. Comparing patients who received the 3rd vaccine with those who did not receive the 3rd vaccine, the difference was significant in quality of life: COPD Assessment Test (CAT): 16 [11-21] vs. 14 [10-19], P<0.001, modified Medical Research Council (mMRC) dyspnea scale: 2 [2-2] vs. 2 [1-2], P=0.01 and in the number of moderate exacerbations: 1 [0-1] vs. 0 [0-1], P=0.04. In addition, who did not take the third vaccination significantly more people were hospitalized for acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (16 vs. 0, P<0.001) and almost the same proportion (n=14) required pulmonary outpatient rehabilitation for post-COVID symptoms. The factors that were most associated with higher COVID-19 vaccine first booster dose uptake were older age [odds ratio (OR): 1.06; 95% confidence interval (CI): 1.04-1.08], male gender (OR: 0.74; 95% CI: 0.57-0.96), absence of previous COVID-19 infection (OR: 0.34; 95% CI: 0.23-0.51). CONCLUSIONS: The uptake rate of the COVID-19 booster vaccine among COPD patients in Hungary is lower than the target, and is associated with disease-related factors, and age, sex, previous COVID infection. The global COVID-19 vaccination target is 70% and 100% for elderly, vulnerable patients. Highlighting the importance of taking booster vaccine(s) should be a priority for health workers.

Fatigue, sleepiness and sleep quality are SARS-CoV-2 variant independent in patients with long COVID symptoms.

Acute infections with SARS-CoV-2 variants of concerns (VOCs) differ in clinical presentation. Discrepancies in their long-term sequelae, commonly referred to as long COVID, however, remain to be explored. We retrospectively analyzed data of 287 patients presented at the post-COVID care of the Pulmonology Department, Semmelweis University, Budapest, Hungary, and infected with SARS-CoV-2 during a period of 3 major epidemic waves in Hungary (February-July 2021, VOC: B.1.1.7, Alpha, N = 135; August-December 2021, VOC: B.1.617.2, Delta, N = 89; and January-June 2022, VOC: B.1.1.529, Omicron; N = 63), > 4 weeks after acute COVID-19. Overall, the ratio of long COVID symptomatic (LC) and asymptomatic (NS) patients was 2:1. Self-reported questionnaires on fatigue (Fatigue Severity Scale, FSS), sleepiness (Epworth Sleepiness Scale, ESS) and sleep quality (Pittsburgh Sleep Quality Index, PSQI) showed higher scores for LC (4.79 ± 0.12, 7.45 ± 0.33 and 7.46 ± 0.27, respectively) than NS patients (2.85 ± 0.16, 5.23 ± 0.32 and 4.26 ± 0.29, respectively; p < 0.05 for all vs. LC). By comparing data of the three waves, mean FSS and PSQI scores of LC patients, but not ESS scores, exceeded the normal range in all, with no significant inter-wave differences. Considering FSS ≥ 4 and PSQI > 5 cutoff values, LC patients commonly exhibited problematic fatigue (≥ 70%) and poor sleep quality (> 60%) in all three waves. Comparative analysis of PSQI component scores of LC patients identified no significant differences between the three waves. Our findings highlight the importance of concerted efforts to manage both fatigue and sleep disturbances in long COVID patient care. This multifaceted approach should be followed in all cases infected with either VOCs of SARS-CoV-2.

COVID-19 vaccination coverage in patients with chronic obstructive pulmonary disease - A cross-sectional study in Hungary.

INTRODUCTION: Coronavirus infection is a particular risk for patients with chronic obstructive pulmonary disease (COPD), because they are much more likely to become severely ill due to oxygen supply problems. Primary prevention, including COVID-19 vaccination is of paramount importance in this disease group. The aim of our study was to assess COVID-19 vaccination coverage in COPD patients during the first vaccination campaign of the COVID-19 pandemic. METHODS: A cross-sectional observational study (CHANCE) has been conducted in COPD patients in the eastern, western and central regions of Hungary from 15th November 2021. The anthropometric, respiratory function test results and vaccination status of 1,511 randomly selected patients were recorded who were aged 35 years and older. RESULTS: The median age was 67 (61-72) years, for men: 67 (62-73) and for women: 66 (60-72) years, with 47.98 % men and 52.02 % women in our sample. The prevalence of vaccination coverage for the first COVID-19 vaccine dose was 88.62 %, whereas 86.57 % of the patients received the second vaccine dose. When unvaccinated (n = 172) and double vaccinated (n = 1308) patients were compared, the difference was significant both in quality of life (CAT: 17 (12-23) vs 14 (10-19); p < 0.001) and severity of dyspnea (mMRC: 2 (2-2) vs 2 (1-2); p = 0.048). The COVID-19 infection rate between double vaccinated and unvaccinated patients was 1.61 % vs 22.67 %; p < 0.001 six months after vaccination. The difference between unvaccinated and vaccinated patients was significant (8.14 % vs 0.08 %; p < 0.001) among those with acute COVID-19 infection hospitalized. In terms of post-COVID symptoms, single or double vaccinated patients had significantly fewer outpatient hospital admissions than unvaccinated patients (7.56 vs 0 %; p < 0.001). CONCLUSION: The COVID-19 vaccination coverage was satisfactory in our sample. The uptake of COVID-19 vaccines by patients with COPD is of utmost importance because they are much more likely to develop severe complications.

COVID-19 infection in patients with chronic obstructive pulmonary disease: From pathophysiology to therapy. Mini-review.

INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) are a vulnerable group in terms of the outcome of coronavirus infection in relation to their disease or its treatment, with a higher risk of developing serious complications compared to the healthy population. AIM: The aim of our summary study is to review the background and health outcomes of chronic obstructive pulmonary disease and COVID-19 infection in the presence of both diseases. METHODS: Review of national and international medical databases (PubMed, MEDLINE, and MOB) with keywords COPD, COVID-19, disease risk, cause, prevention, complications, and prognosis. RESULTS: Meta-analyses show that COPD is one of the most common underlying conditions in patients hospitalized for COVID-19. Such patients are five times more likely to develop a serious complication due to oxygen supply problems therefore they are more likely to be admitted to intensive care units, where they may require mechanical ventilation. In the case of underlying COPD, the usual care plan for COVID-19 infection should be followed, as well as all public health recommendations to minimize the risk of developing and transmitting COVID-19. CONCLUSION: Coronavirus infection is especially dangerous for COPD patients, who are much more likely to become seriously ill, so increased surveillance, prevention, early detection, adequate treatment and rehabilitation of the disease group are of paramount importance.

Outpatient rehabilitation programs for COVID-19 patients / Ambuláns rehabilitációs programok COVID-19-betegek számára.

Összefoglaló. A COVID-19-fertozésen átesett betegek közül többen elhúzódó panaszokról számolnak be a felépülést követoen, sokaknál tartósan fennáll a köhögés, a nehézlégzés, a mellkasi fájdalom, a légszomj attól függetlenül, hogy enyhe vagy súlyosabb tüneteket okozott a koronavírus. A betegek erotlennek érzik magukat, eros fáradtságérzetre panaszkodnak, míg mások gyomor-bél rendszeri panaszokra, fejfájásra, depresszióra, a szaglás- és ízérzékelés elvesztésére. Számtalan kutatás leírja, hogy a fertozés még akár hónapokkal késobb is hatással lehet a tüdo muködésére, és korábban egészséges tüdon is látható a koronavírus-fertozés a gyógyulás után három hónappal készült kontroll-mellkas-CT-leleten. Éppen ezért szükség van a fertozés lezajlását követoen tüdogyógyászati kivizsgálásra, ha a betegnek elhúzódó panaszai vannak, vagy ha a betegség tüdogyulladást okozott. Szükség van a jelenleg muködo fekvobeteg-légzoszervi rehabilitáció mellett a kezelés ambuláns kiterjesztésére is, melynek célja újabb kórházi ápolás nélkül a teljes gyógyulás elérése a betegeknél. A COVID-19-fertozésen átesett betegeknél a komplex rehabilitáció hatására javul a terhelhetoség, az életminoség, javulnak a légzésfunkciós értékek, csökkennek a panaszok, javul a betegek fizikai és pszichikai állapota. Összefoglaló kutatásunk célja áttekinteni, hogy milyen COVID-19 ambuláns rehabilitációs programok indultak el a koronavírus-fertozésen átesett betegek esetében nemzetközi és hazai színtereken. Orv Hetil. 22021; 162(42): 1671-1677. Summary. Several patients with COVID-19 infection report prolonged complaints after recovery and many of them suffer from persistent cough, dyspnea, chest pain and shortness of breath regardless of whether the coronavirus caused mild or more severe symptoms. They complain of severe fatigue and weakness while others grizzle about gastrointestinal complaints, headache, depression, loss of sense of smell and taste. Numerous studies describe that the infection can affect lung function even in months and coronavirus infection can be detectable in previously healthy lungs by taking a control chest CT scan three months after recovery. Therefore, chest follow-up is required after the infection if the patient has prolonged complaints or if the disease has caused pneumonia. In addition to the currently operating inpatient respiratory rehabilitation, there is also a need for an outpatient extension of treatment to achieve complete recovery in patients without further hospitalization. For those patients who have had the COVID-19 infection complex rehabilitation can improve their workload, quality of life, improves their respiratory function values, reduces their complaints and also improves their physical and mental condition. The aim of our summary research is to review what COVID-19 outpatient rehabilitation programs have been initiated for patients who went through coronavirus infection on international and domestic scenes. Orv Hetil. 2021; 162(42): 1671-1677.