Predictors of reduced incremental shuttle walk test performance in patients with long post-COVID-19.

OBJECTIVE: One of the common limitations after COVID-19 pneumonia is the decrease in exercise capacity. The identification of the factors affecting exercise capacity and the assessment of patients at risk are important for determining treatment strategy. This study was conducted to determine the predictors of decreased exercise capacity in long post-COVID-19 patients. METHODS: We investigated the association of exercise capacity as measured by the incremental shuttle walk test (ISWT) with age, sex, spirometric variables, respiratory and peripheral muscle strength, quality of life, fatigue, hospital anxiety depression scale, chest X-ray involvement, and hospitalization. The patients were divided into three groups: outpatients, inpatients, and ICU patients. Regression analysis was used to determine which parameters were significant predictors of exercise capacity. RESULTS: Of the 181 patients included in the study, 56 (31%) were female. The mean ISWT in percentage of predicted values (ISWT%pred) was 43.20% in the whole sample, whereas that was 52.89%, 43.71%, and 32.21% in the outpatient, inpatient, and ICU patient groups, respectively. Linear regression analysis showed that predictors of decreased ISWT%pred were sex (b = 8.089; p = 0.002), mMRC scale score (b = -7.004; p ≤ 0.001), FVC%pred (b = 0.151; p = 0.003), and handgrip strength (b = 0.261; p = 0.030). CONCLUSIONS: In long post-COVID-19 patients, sex, perception of dyspnea, restrictive pattern in respiratory function, and decrease in peripheral muscle strength are predictors of reduced exercise capacity that persists three months after COVID-19. In this context, we suggest that pulmonary rehabilitation might be an important therapy for patients after COVID-19.

Health related quality of life and its determinants in COVID-19 patients.

Introduction: One of COVID-19's limitations is the reduced quality of life (QoL) caused by variety of underlying reasons. Even though multiple papers in the literature reveal a worsening of QoL after COVID-19, there is currently inadequate evidence on which patients' QoL is impacted the most. Our study's aim was to determine which patients' quality of life was most compromised so that interventions for poor QoL should not be overlooked in the post-disease assessments of those in the risk group. Materials and Methods: Patients referred to our pulmonary rehabilitation center for Long COVID symptoms had their dyspnea perception, body composition, exercise capacity, muscle strengths, and psychological state evaluated. In addition, SF-36 was used to assess their QoL. After obtaining all medical data, the patients were separated into three groups based on whether they had the disease as an outpatient, inpatient in the hospital, or in the intensive care unit. The Anova and Kruskal Wallis tests were utilized in the statistical analysis of demographic data among patient groups. Pearson's test was used for normal distributions, whereas Spearman's test was used for non-normal distribution analyses. The factors affecting QoL were investigated using multivariate linear regression analysis. Results: The majority of 173 study participants had poor QoL. Low exercise capacity (p= 0.026), impaired psychosocial status (p= 0.034 for anxiety, p= 0.022 for depression), and increased fatigue (p= 0.001) were the factors affecting SF-36's physical component summary (PCS), whereas young age (p= 0.026), male sex (p= 0.037), impaired psychosocial status (p< 0.001 for anxiety, p= 0.002 for depression), and increased fatigue (p= 0.005) were the factors affecting the SF-36's mental component summary (MCS). Conclusion: Young age, male sex, reduced exercise capacity, poor psychosocial status, and increased fatigue are predictors for impaired QoL after COVID19. Therefore, non-medical treatment options that improve QoL should be considered in the follow-up of these patients.

Long-term efficiency of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease, bronchiectasis, and asthma: Does it differ?

BACKGROUND: The long-term effects of pulmonary rehabilitation (PR) and maintenance programs in obstructive pulmonary diseases have not been sufficiently investigated, particularly in diseases other than COPD. This retrospective study aimed to examine the long-term results of individualized comprehensive outpatient pulmonary rehabilitation in patients with obstructive pulmonary disease. METHODS: This study is a single-center, retrospective cohort study. Between 2010 and 2019, 269 patients with chronic airway obstruction were treated in our multidisciplinary PR center at a tertiary training and research hospital, and they were divided into three groups based on their diagnosis: COPD, bronchiectasis, and asthma. Patients' perceptions of dyspnea, exercise capacity, inspiratory and peripheral muscle strength, body composition, quality of life, and psychosocial status were compared at the beginning, end, and 12th and 24th months of PR. RESULTS: Improvements in dyspnea perception remained longer in asthmatics than in the other two groups. The increases in exercisecapacity in the bronchiectasis and asthma groups lasted two years. All groups maintained their respiratory muscle strength gains at the end of the second year. Improvements in hand grip strength in the COPD and bronchiectasis groups have been sustained for two years, but in the asthma group, enhancements were lost in the second year. Even after the second year, quality of life was still better than the baseline in all groups, despite a worsening in the first year. However, groups anxiety and depression improvements were not sustained after the first year. DISCUSSION: The long-term effectiveness of PR in patients with bronchiectasis and asthma was similar to that of COPD patients. Therefore,multidisciplinary, comprehensive PR programs should be integrated into the management of patients with bronchiectasis and asthma. We also recommend structured follow-up programs to maintain gains and to detect the need for rerehabilitation.

Relation of impulse oscillometry and spirometry with quantitative thorax computed tomography after COVID-19 pneumonia.

OBJECTIVE: This study aimed to investigate if there is any correlation between the quantitative computed tomography and the impulse oscillometry or spirometry results of post-COVID-19 patients. METHODS: The study comprised 47 post-COVID-19 patients who had spirometry, impulse oscillometry, and high-resolution computed tomography examinations at the same time. The study group consisted of 33 patients with quantitative computed tomography involvement, while the control group included 14 patients who did not have CT findings. The quantitative computed tomography technology was used to calculate percentages of density range volumes. The relationship between percentages of density range volumes for different quantitative computed tomography density ranges and impulse oscillometry-spirometry findings was statistically analyzed. RESULTS: In quantitative computed tomography, the percentage of relatively high-density lung parenchyma, including fibrotic areas, was 1.76±0.43 and 5.65±3.73 in the control and study groups, respectively. The percentages of primarily ground-glass parenchyma areas were found to be 7.60±2.86 and 29.25±16.50 in the control and study groups, respectively. In the correlation analysis, the forced vital capacity% predicted in the study group was correlated with DRV%[(-750)-(-500)] (volume of the lung parenchyma that has density between (-750)-(-500) Hounsfield units), but no correlation with DRV%[(-500)-0] was detected. Also, reactance area and resonant frequency were correlated with DRV%[(-750)-(-500)], while X5 was correlated with both DRV%[(-500)-0] and DRV%[(-750)-(-500)] density. Modified Medical Research Council score was correlated with predicted percentages of forced vital capacity and X5. CONCLUSION: After COVID-19, forced vital capacity, reactance area, resonant frequency, and X5 correlated with the percentages of density range volumes of ground-glass opacity areas in the quantitative computed tomography. X5 was the only parameter correlated with density ranges consistent with both ground-glass opacity and fibrosis. Furthermore, the percentages of forced vital capacity and X5 were shown to be associated with the perception of dyspnea.

Tele-pulmonary rehabilitation with face to face in COVID-19 pandemic: A hybrid modeling.

Introduction: Post-illness pulmonary rehabilitation indications of Coronavirus disease-2019 (COVID-19) may include fatigue, respiratory restriction, exercise limitation, muscle weakness, deterioration in body composition, quality of life, and psychological status. Since tele-pulmonary rehabilitation (tele-PR) is the prominent approach in the current situation and questions such as who, how, and when are still unclear, in this study we aimed to investigate the efficacy of tele-PR as a hybrid model with face-to-face in post-COVID-19 patients. Materials and Methods: Thirty one patients who had completed viral infection treatment with the diagnosis of COVID-19 but still had persistent symptoms were enrolled in an eight-week synchronized video-conference mediated telePR program in a hybrid format, with the initial and final assessments and the first two sessions conducted in person. Before and after the tele-PR, pulmonary functions, exercise capacity, respiratory and peripheral muscle strength, body composition, quality of life, and psychological states were evaluated. Result: After the tele-PR program; a statistically significant improvement was observed in dyspnea sensation evaluated with modified Medical Research Council (mMRC) and BORG levels, body mass index (BMI), incremental shuttle walk test (ISWT), endurance shuttle walk test (ESWT), handgrip test, deltoid, and quadriceps 1-repetition maximum (1RM) results, maximal inspiratory and expiratory pressure (MIP, MEP), peripheral muscle strengths, fatigue severity scale and Nottingham extended activities of daily living scale (NEADLS). Conclusions: In this study, it has been shown that the hybrid model of tele-PR enables a comprehensive evaluation as well as the effective and safe applicability of a multidisciplinary and remotely directed program even in high workloads for post-COVID-19 patients.

Relationship between exercise capacity and impulse oscillometry parameters after COVID-19 infections.

BACKGROUND: After COVID-19 infection, persistent exercise intolerance, changes in lung function have been shown. Our aim is to investigate the correlation between impulse oscillometry (IOS) parameters and exercise capacity by using incremental and endurance shuttle walk tests (ISWT, ESWT) and investigate the factors and parameters which might have an effect on both IOS parameters and exercise capacity tests. METHOD: The patients who had a history of COVID-19 were enrolled into cross-sectional study according to inclusion criteria. The IOS parameters, ISWT, ESWT, smoking status, time since COVID-19 diagnosis, length of hospital stay, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), body mass index (BMI), fat-free mass index (FFMI), dyspnea, hospital anxiety-depression and fatigue severity scores were recorded. RESULTS: The study comprised 72 patients, 71% of whom were male, with a mean age of 54 ± 10 years. After COVID-19 diagnosis, the median duration was 3 (min: 1, max: 5) months and 51 (71%) of the patients were hospitalized. The FEV1 and FVC values were in normal range. The area of reactance (AX), resonance frequency (Fres), reactance at 20 Hz (X20) and the difference between resonance at 20 and 5 Hz (R5-20) correlated with both ISWT and ESWT. The FEV1 correlated with all IOS parameters (p < 0.05). Reactance correlated with FFMI (p = 024, r = 0.267), different according to hospitalization (p = 0.02). CONCLUSION: In COVID-19 survivors, there could be correlations between IOS parameters and exercise capacity; and between these parameters and FEV and FVC. Furthermore, small airway disease with normal spirometric functions could be related to decreased exercise capacity in COVID-19 survivors regardless of concomitant diseases, BMI, smoking status and time since COVID-19 diagnosis.

Factors affecting the success of pulmonary rehabilitation in asthma.

OBJECTIVE: The majority of patients with asthma limit their physical activity due to the fear of exercise dyspnea. Regular exercise, on the other hand, is currently suggested as one of the non-pharmaceutical treatment alternatives for patients with asthma since it improves their quality of life and symptom control. This study aimed to investigate the indicators of success in patients with asthma receiving pulmonary rehabilitation (PR). METHODS: A total of 131 patients with the diagnosis of asthma were included in the study. All patients attended an 8-week comprehensive, multidisciplinary, outpatient and individualized PR program. RESULTS: The factors related to the gains in dyspnea perception, exercise capacity, peripheral muscle strength, respiratory muscle strength and quality of life were evaluated. In the multivariate linear regression analysis, the gain in dyspnea perception is related to baseline dyspnea. The gain in exercise capacity is related to baseline exercise capacity and the amount of smoking. The gain in peripheral muscle strength is related to gender. The gain in respiratory muscle strength is related to age, and finally the gain in quality of life is related to baseline dyspnea and anxiety levels. CONCLUSIONS: Especially men, young people, heavy smokers, and those with low initial exercise capacity, high perception of dyspnea, and high anxiety are more likely to benefit from PR.

Predictors of reduced incremental shuttle walk test performance in patients with long post-COVID-19 / Preditores de desempenho reduzido no teste de caminhada incremental em pacientes com pós-COVID-19 longa

ABSTRACT Objective: One of the common limitations after COVID-19 pneumonia is the decrease in exercise capacity. The identification of the factors affecting exercise capacity and the assessment of patients at risk are important for determining treatment strategy. This study was conducted to determine the predictors of decreased exercise capacity in long post-COVID-19 patients. Methods: We investigated the association of exercise capacity as measured by the incremental shuttle walk test (ISWT) with age, sex, spirometric variables, respiratory and peripheral muscle strength, quality of life, fatigue, hospital anxiety depression scale, chest X-ray involvement, and hospitalization. The patients were divided into three groups: outpatients, inpatients, and ICU patients. Regression analysis was used to determine which parameters were significant predictors of exercise capacity. Results: Of the 181 patients included in the study, 56 (31%) were female. The mean ISWT in percentage of predicted values (ISWT%pred) was 43.20% in the whole sample, whereas that was 52.89%, 43.71%, and 32.21% in the outpatient, inpatient, and ICU patient groups, respectively. Linear regression analysis showed that predictors of decreased ISWT%pred were sex (b = 8.089; p = 0.002), mMRC scale score (b = −7.004; p ≤ 0.001), FVC%pred (b = 0.151; p = 0.003), and handgrip strength (b = 0.261; p = 0.030). Conclusions: In long post-COVID-19 patients, sex, perception of dyspnea, restrictive pattern in respiratory function, and decrease in peripheral muscle strength are predictors of reduced exercise capacity that persists three months after COVID-19. In this context, we suggest that pulmonary rehabilitation might be an important therapy for patients after COVID-19.

RESUMO Objetivo: Uma das limitações comuns após a pneumonia por COVID-19 é a diminuição da capacidade de exercício. A identificação dos fatores que afetam a capacidade de exercício e a avaliação dos pacientes em risco são importantes para determinar a estratégia de tratamento. Este estudo foi conduzido para determinar os preditores de diminuição da capacidade de exercício em pacientes pós-COVID-19 longa. Métodos: Foi investigada a associação da capacidade de exercício medida pelo incremental shuttle walk test (ISWT, teste de caminhada incremental) com idade, sexo, variáveis espirométricas, força muscular respiratória e periférica, qualidade de vida, fadiga, escala hospitalar de ansiedade e depressão, envolvimento na radiografia de tórax e status de atendimento. Os pacientes foram divididos em três grupos: pacientes ambulatoriais, pacientes internados e pacientes em UTI. A análise de regressão foi utilizada para determinar quais parâmetros eram preditores significativos da capacidade de exercício. Resultados: Dos 181 pacientes incluídos no estudo, 56 (31%) eram do sexo feminino. O ISWT médio em porcentagem dos valores previstos (ISWT%prev) foi de 43,20% em toda a amostra, enquanto foi de 52,89%, 43,71% e 32,21% nos grupos de pacientes ambulatoriais, internados e em UTI, respectivamente. A análise de regressão linear mostrou que os preditores de diminuição do ISWT%prev foram sexo (b = 8,089; p = 0,002), pontuação na escala mMRC (b = −7,004; p ≤ 0,001), CVF%prev (b = 0,151; p = 0,003), e força de preensão manual (b = 0,261; p = 0,030). Conclusões: Em pacientes pós-COVID-19 longa, sexo, percepção de dispneia, padrão restritivo da função respiratória e diminuição da força muscular periférica são preditores de redução da capacidade de exercício que persiste três meses após COVID-19. Nesse contexto, sugerimos que a reabilitação pulmonar pode ser uma terapia importante para pacientes pós-COVID-19.

Relation of impulse oscillometry and spirometry with quantitative thorax computed tomography after COVID-19 pneumonia

SUMMARY OBJECTIVE: This study aimed to investigate if there is any correlation between the quantitative computed tomography and the impulse oscillometry or spirometry results of post-COVID-19 patients. METHODS: The study comprised 47 post-COVID-19 patients who had spirometry, impulse oscillometry, and high-resolution computed tomography examinations at the same time. The study group consisted of 33 patients with quantitative computed tomography involvement, while the control group included 14 patients who did not have CT findings. The quantitative computed tomography technology was used to calculate percentages of density range volumes. The relationship between percentages of density range volumes for different quantitative computed tomography density ranges and impulse oscillometry-spirometry findings was statistically analyzed. RESULTS: In quantitative computed tomography, the percentage of relatively high-density lung parenchyma, including fibrotic areas, was 1.76±0.43 and 5.65±3.73 in the control and study groups, respectively. The percentages of primarily ground-glass parenchyma areas were found to be 7.60±2.86 and 29.25±16.50 in the control and study groups, respectively. In the correlation analysis, the forced vital capacity% predicted in the study group was correlated with DRV%[(-750)-(-500)] (volume of the lung parenchyma that has density between (-750)-(-500) Hounsfield units), but no correlation with DRV%[(-500)-0] was detected. Also, reactance area and resonant frequency were correlated with DRV%[(-750)-(-500)], while X5 was correlated with both DRV%[(-500)-0] and DRV%[(-750)-(-500)] density. Modified Medical Research Council score was correlated with predicted percentages of forced vital capacity and X5. CONCLUSION: After COVID-19, forced vital capacity, reactance area, resonant frequency, and X5 correlated with the percentages of density range volumes of ground-glass opacity areas in the quantitative computed tomography. X5 was the only parameter correlated with density ranges consistent with both ground-glass opacity and fibrosis. Furthermore, the percentages of forced vital capacity and X5 were shown to be associated with the perception of dyspnea.

The effect of comprehensive multidisciplinary pulmonary rehabilitation on 5-year survival in COPD: does maintaining a home exercise program improve survival?

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is one of the most common causes of death worldwide. Therefore, optimizing medical therapy in the comprehensive management of the disease, as well as including pulmonary rehabilitation (PR) in the treatment, is essential. The goal of our study was to determine the impact of PR on the survival of COPD patients. METHODS: Between 2007-2015, 509 COPD patients who completed the PR constituted the PR group, while 167 patients who applied but could not complete it after the initial evaluations formed the control group. In the PR group, dyspnea perception, exercise capacity, muscle strength, body composition, quality of life, psychosocial status, and i-BODE scores were assessed at the beginning and end of the program, whereas in the control group, these assessments could only be conducted at the beginning. Also, after PR, our PR participants have prescribed a home exercise program, and they were recalled to the hospital at the 3rd, 6th, 12th, 18th, and 24th months for follow-up visits. RESULTS: A statistically significant improvement was found in almost all the data (except FEV1/FVC, BORG after exercise, and FFMI) after PR. There was a statistically significant difference in 5-year survival in favor of the PR group (p = 0.006), and in PR patients who accompanied the home exercise program vs. those who did not (p = 0.000). Also the gains in MRC (p = 0.003; OR: 2.20; CI: 1.319- 3.682), MEP (p = 0.041; OR: 1.02; CI: 1.001-1.035), and i-BODE (p = 0.006; OR: 0.914; CI: 0.857-0.974) increased the survival. DISCUSSION: Apart from incorporating PR into treatment in the comprehensive management of COPD, we demonstrated that maintaining a home exercise program for at least two years following PR increased 5-year survival significantly.

Maintenance of pulmonary rehabilitation benefits in patients with COPD: is a structured 5-year follow-up program helpful?

Background/aim: Pulmonary rehabilitation (PR) has proven useful in patients with chronic obstructive pulmonary disease (COPD), but the benefits decrease over time. We evaluated the effects of a structured follow-up program after PR on patient pulmonary function, dyspnea, body composition, exercise capacity, quality of life, psychological status, i-BODE index, hospitalization status, 5-year survival rate. We explored whether this follow-up program could serve as a maintenance program. Materials and methods: COPD patients who completed PR attended follow-up visits over 5 years. We administered incremental (ISWT), endurance shuttle walk tests (ESWT), measured body (BMI), fat-free mass indices (FFMI), recorded modified Medical Research Council (mMRC), St. George's respiratory questionnaire (SGRQ), anxiety-depression scores. We also noted the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC), the forced midexpiratory flow (FEF25-75), hospitalization, survival rates before, after PR, and in years 1, 2, 3, 5. This was a retrospective observational study. Results: Thirty-three COPD patients with a mean age of 58 ± 8 years were enrolled. Twenty-seven (82%) were male. The mean FEV1 was 47 ± 16% of the predicted. After PR, the mMRC scale, SGRQ, anxiety, depression scores; i-BODE index; ISWT, ESWT results improved (all p < 0.001), with the improvements persisting through the first year. Patient body composition, pulmonary function did not differ from the baseline over the 5 years (except for a decrease in the FEF25-75 value in year 5; p = 0.003). The hospitalization rate, i-BODE index did not change significantly over the 5 years, the improvements in the ISWT, ESWT outcomes were preserved for 3 years (p = 0.013/0.005, respectively). The quality-of-life, anxiety scores deteriorated in year 1 (both p < 0.001) and year 3 (p = 0.005/0.010, respectively). The dyspnea, depression scores increased progressively over the 5 years. Conclusion: Structured follow-up programs with visits at 6-month intervals may effectively maintain improvements in COPD. Long-term randomized controlled studies are needed to verify these results.