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- DOI 10.18231/j.ijrimcr.2024.057
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CrossMark
- Citation
To study the pulmonary function changes in post-COVID-19 discharged patients and their correlation with disease severity
- Author Details:
-
Junaid Hussain *
Introduction
The COVID-19 pandemic has exploded since cases were first reported in China in December 2019.
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in December 2019 in China, quickly spread to countries across five continents, and was declared a pandemic by the World Health Organization (WHO) on March 11, 2020.[1]
The symptoms of COVID-19 range from mild flu-like symptoms to respiratory system failure. The epidemiology of the infection indicates that the majority of patients develop milder forms of the disease, while 14% of those infected have a severe form, and a smaller percentage (5%) become critically ill.[2] Among patients who have required hospitalization, 14.2% required care in the intensive care unit and 12.2% received mechanical ventilation, and the mortality in this group was approximately 24.5%.[3] Pulmonary manifestations are the most common due to the route of entry of the virus, which uses angiotensin-converting enzyme 2 receptors present in type 2 pneumocytes, leading to a subsequent inflammatory response.[4]
The demographic profile and risk factors for COVID-19 show a wide spectrum around the world, and the factors responsible for the occurrence of different clinical forms and variability of symptoms are not yet understood. Moreover, health issues that persist for more than four weeks after COVID-19 infection, known as post-COVID conditions, are still not well understood and present a major challenge to health systems worldwide given the high number of individuals affected by the disease and who recover after varying periods of hospitalization.[5]
To date, few studies have evaluated the clinical evolution and the occurrence of structural and functional post-COVID conditions in the lungs of individuals who survive the severe form of the disease, mainly because it is a new and recent disease. Initial studies described possible long-term complications of COVID-19, including cardiovascular, pulmonary, metabolic, and neuropsychiatric sequelae based on data from the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) epidemics.[6] Recent publications have described the persistence of symptoms, especially fatigue and dyspnea, approximately two months after the onset of symptoms, associated with a decrease in patients’ quality of life, as well as an altered respiratory function after discharge.[7], [8], [9], [10]
Its transmission occur primarily through respiratory secretions, and, to a lesser extent, contact with contaminated surfaces. Most transmission occur through droplets; covering coughs and sneezes and maintaining a distance of six feet from others can reduce the risk of transmission.
Clinical presentation
The estimated incubation period for COVID-19 is up to 14 days from the time of exposure, with a median I.P. of 4 to 5 days. The spectrum of illness ranges from asymptomatic infection to severe pneumonia with ARDS and death. Disease was categorized into:
Mild: No pneumonia, mild illness defined by a variety of signs and symptoms(e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea on exertion or abnormal imaging, respiratory rate < 24, SpO2 > 94%, no evidence of hypoxemia.
Moderate: Having symptoms and radiographic evidence of pneumonia with no requirements of supplemental oxygen, SpO2 > 94%
Severe: Having pneumonia including one of the following RR > 30 breath/min, severe respiratory distress, SpO2 < 94 % measured by a pulse oximeter, PaO2/FiO2 < 300, or lung infiltrates > 50%.
Critical cases: Respiratory failure requiring mechanical ventilation, septic shock, and other organ failure requiring ICU admission.
A recent report portrayed that discharged patients with COVID-19 pneumonia still have residual abnormalities in chest CT scans, with ground glass opacity as the most common pattern. Persistent impairments of pulmonary function and exercise capacity have been known to last for months OR even years in the recovered survivors.
It’s worth noting that evidence about pulmonary function tests among COVID-19 patients is currently showing that 6 week respiratory rehabilitation can improve respiratory function, quality of life and anxiety of older patients. Until now, there is only a few reports in regard to pulmonary function in discharged COVID-19 survivors.
When a patient with the coronavirus is declared negative, the symptoms of COVID-19 infection do not immediately disappear; the symptoms can even continue for months.
More than 50% of people who have been infected with COVID-19 will feel persistent symptoms after COVID-19, such as chronic fatigue, shortness of breath, chest pain, and decreased sensitivity to smell.
Persistent symptoms due to inflammation and post-acute COVID-19 organ damage that can continue for months are referred to as post-COVID-19 syndrome or long COVID-19.
Approximately 50 to 70% of patients hospitalized express some symptoms of COVID-19 for up to 3 months after completing treatment and being discharged from the hospital (Moreno-Perez et al., 2021).[11]
These persistent symptoms that are well do not disappear immediately but can be relieved by various exercises. Various researchers have conducted research on actions that can be taken during the rehabilitation period to reduce the symptoms so long. WHO states that there are many actions that can be taken in the post-COVID rehabilitation process, including breathing exercises and physical exercises after discharge from the hospital (WHO Europe, 2020).
Therefore, we aimed to assess respiratory functions in three intervals, in a gap of three months after clinical recovery and discharge from the hospital. This study aims to describe the characteristics of pulmonary function changes in these subjects.
Post-acute coronavirus (COVID-19) syndrome
Coronavirus disease 2019 (COVID-19), the viral illness caused by the novel coronavirus SARS-CoV-2, has resulted in significant morbidity and mortality across the world since the first cases were identified in Wuhan, China, in December 2019. Although the majority of the patients who contract COVID-19 are asymptomatic or have mild to moderate disease, approximately 5% to 8% of infected patients develop hypoxia, bilateral lung infiltrates, decreased lung compliance requiring non-invasive ventilation (NIV) or mechanical ventilatory support.[12] The management of COVID-19 infection is mainly supportive. Although many therapeutics such as antiviral drugs (remdesevir), monoclonal antibodies (e.g., bamlanivimab/etesevimab, casirivimab/imdevimab), anti-inflammatory drugs (e.g., dexamethasone), immunomodulatory agents (e.g., baricitinib, tocilizumab) is available under emergency use authorization (EUA) for the management of COVID-19, the utility of these treatments varies based on the timing and severity of illness and/or certain risk factors.[13]
Post-acute COVID-19 is a syndrome characterized by the persistence of clinical symptoms beyond four weeks from the onset of acute symptoms. The Centers for Disease Control (CDC) has formulated "post-COVID conditions" to describe health issues that persist more than four weeks after being infected with COVID-19. These include
Long COVID (which consists of a wide range of symptoms that can last weeks to months) or persistent post-COVID syndrome (PPCS).
Multiorgan effects of COVID-19.
Effects of COVID-19 treatment/hospitalization.
Pulmonary manifestations
Dyspnea, cough, oxygen dependence, difficulty weaning from mechanical ventilation or NIV, fibrotic lung changes, decreased diffusion capacity, and reduced endurance are the common pulmonary sequelae seen in patients with post-acute COVID-19 syndrome.
Dyspnea is the predominant pulmonary symptom (40% to 50% prevalence at 100 days) in post-acute COVID-19. At a 6-month follow-up, the average 6-minute walking distance was significantly lower than the standard reference because of shortness of breath. About 6% of patients continue to require supplemental oxygen at 60-day follow-up.
Aim and Objectives
Aim
This study aims to assess pulmonary function changes in post-COVID-19 discharged patients using the EasyOne® Air utilizing TrueFlow™ Technology at one month and three-month intervals after clinical recovery. The research also intends to correlate these changes with the severity of the disease, providing valuable insights into the long-term impact of COVID-19 on lung health.
Objectives
To study the influence of coronavirus disease 2019 on pulmonary function changes in post-COVID-19 discharged patients
To assess respiratory function in two intervals at the time of one month and three months after clinical recovery and discharge from the hospital
To study its relation with the severity of the disease
To study the progression of respiratory function changes associated with COVID-19 and whether changes persist or improve
Materials and Methods
Study design
A single, hospital-based, observational study.
Study site
Department of Respiratory Medicine, Indraprastha Apollo hospitals, New Delhi, both indoor and OPD patients.
Inclusion criteria
Patients with ICMR laboratory confirmed RT-PCR/ Geneexpert positive noncritical COVID-19 cases.
All participants were categorized as mild illness(mild clinical symptoms without pneumonia manifestations in imaging), moderate (having symptoms and pneumonia manifestations in imaging, with no requirement for supplemental oxygen), and severe (having radiographic evidence of pneumonia, meeting any of the following: respiratory rate > 30/min; oxygen saturation < 93% at a resting rate; severe respiratory distress; > 50% lesions progression within 24 to 48 hrs in lung imaging).
Patient guardians gave informed written consent for the same.
Exclusion criteria
Critical cases.
Patient unable to perform breath holding or diffusion capacity testing.
Patients/guardians refusing consent.
Patients with a previous history of chronic lung diseases like asthma/COPD or restrictive lung diseases like lung fibrosis.
Sample size calculation
The sample size of the observational study was the number of patients they received who presented to their hospital, Indraprastha Apollo Hospital, from August 25, 2020, to June 25, 2021.
Statistical analysis
This observational, cross-sectional study was conducted at the Department of Respiratory Medicine Indraprastha Apollo Hospitals, New Delhi, on ICMR laboratory-confirmed non-critical COVID-19 cases. Participants were categorized into mild, moderate, and severe clinical types based on clinical and radiographic evidence. Pulmonary function tests work performed using the EasyOne® Air with TrueFlow™ Technology at one-month and three-month intervals after clinical recovery. Statistical analysis involved Microsoft Excel and SPSS version 27.0, with descriptive statistics and chi-square tests for categorical variables. A p-value of 0.05 was considered statistically significant.
Result and Analysis
In our study, 16 (20.0%) patients were Mild Clinical Types, 50 (62.5%) patients were Moderate Clinical Types and 14 (17.5%) patients were Severe Clinical Types.
Distribution of mean FEV1 (% of predicted)-x: Clinical types
In Mild Clinical Types, the mean FEV1(% of predicted)-x (mean ± s.d.) of patients was 62.7500 ± 6.1482.
In Moderate Clinical Types, the mean FEV1(% of predicted)-x (mean ± s.d.) of patients was 71.1600 ± 8.1800.
In Severe Clinical Types, the mean FEV1(% of predicted)-x (mean ± s.d.) of patients was 57.0000 ± 10.3775.
The difference of mean FEV1(% of predicted)-x with three clinical types was statistically significant (p<0.0001).
Distribution of mean FEV1 (% of predicted)-y: Clinical types
In Mild Clinical Types, the mean FEV1(% of predicted)-y (mean ± s.d.) of patients was 85.2500 ± 26.6421.
In Moderate Clinical Types, the mean FEV1(% of predicted)-y (mean ± s.d.) of patients was 75.5400 ± 3.0184.
In Severe Clinical Types, the mean FEV1(% of predicted)-y (mean ± s.d.) of patients was 65.0000 ± 11.4152.
The difference of mean FEV1 (% of predicted)-y with three clinical types was statistically significant (p=0.0003).
Distribution of mean FVC (% of predicted)-x: Clinical types
In Mild Clinical Types, the mean FVC (% of predicted)-x (mean ± s.d.) of patients was 58.2500 ± 2.0494.
In Moderate Clinical Types, the mean FVC(% of predicted)-x (mean ± s.d.) of patients was 67.4200 ± 9.6110.
In SevereClinical Types, the mean FVC(% of predicted)-x (mean ± s.d.) of patients was 47.0000 ± 6.2265.
The difference of mean FVC (% of predicted)-x with three clinical types was statistically significant (p<0.0001).
Distribution of mean FVC(% of predicted)-y: Clinical types
In Mild Clinical Types, the mean FVC (% of predicted)-y (mean ± s.d.) of patients was 80.7500 ± 22.5433.
In Moderate Clinical Types, the mean FVC (% of predicted)-y (mean ± s.d.) of patients was 74.2400 ± 7.3694.
In Severe Clinical Types, the mean FVC(% of predicted)-y (mean± s.d.) of patients was 56.5000 ± 11.9341.
The difference of mean FVC (% of predicted)-y with three clinical types was statistically significant (p<0.0001).
Distribution of mean FEV1/FVC-x: Clinical types
In Mild Clinical Types, the mean FEV1/FVC-x (mean ± s.d.) of patients was 83.9313 ± 4.7648.
In Moderate Clinical Types, the mean FEV1/FVC-x (mean ± s.d.) of patients was 102.4200 ± 10.9621.
In Severe Clinical Types, the mean FEV1/FVC-x (mean ± s.d.) of patients was 104.3500 ± 12.0898.
The difference of mean FEV1/FVC-x with three clinical types was statistically significant (p<0.0001).
Distribution of mean FEV1/FVC-y : Clinical types
In Mild Clinical Types, the mean FEV1/FVC-y (mean ± s.d.) of patients was 79.5875 ± .7173.
In Moderate Clinical Types, the mean FEV1/FVC-y (mean ± s.d.) of patients was 102.9600 ± 11.6092.
In Severe Clinical Types, the mean FEV1/FVC-y (mean ± s.d.) of patients was 96.0000 ± 14.5285.
The difference of mean FEV1/FVC-y with three clinical types was statistically significant (p<0.0001).
Distribution of mean DLCO-x: Clinical types
In Mild Clinical Types, the mean DLCO-x (mean ± s.d.) of patients was 53.2500 ± 2.0494.
In Moderate Clinical Types, the mean DLCO-x (mean ± s.d.) of patients was 56.4000 ± 10.2877.
In Severe Clinical Types, the mean DLCO-x (mean ± s.d.) of patients was 26.0000 ± 4.1510.
The difference of mean DLCO-x with three clinical types was statistically significant (p<0.000).
Distribution of mean DLCO-y: Clinical types
In Mild Clinical Types, the mean DLCO-y (mean ± s.d.) of patients was 56.3750 ± 3.0741.
In Moderate Clinical Types, the mean DLCO-y (mean ± s.d.) of patients was 61.0400 ± 11.7716.
In Severe Clinical Types, the mean DLCO-y (mean ± s.d.) of patients was 33.5000 ± 2.5944.
The difference of mean DLCO-y with three clinical types was statistically significant (p<0.0001).
The difference of mean DLCO/Va-y with three clinical types was statistically significant (p<0.0001).
Distribution of mean TLC-x: Clinical types
In Mild Clinical Types, the mean TLC-x (mean ± s.d.) of patients was 70.7500 ± 14.3457.
In Moderate Clinical Types, the mean TLC-x (mean ± s.d.) of patients was 70.6400 ± 14.2195.
In Severe Clinical Types, the mean TLC-x (mean ± s.d.) of patients was 38.0000 ± 9.3397.
The difference of mean TLC-x with three clinical types was statistically significant (p<0.0001).
Distribution of mean TLC-y: Clinical types
In Mild Clinical Types, the mean TLC-y (mean ± s.d.) of patients was 77.1875 ± 30.2285.
In Moderate Clinical Types, the mean TLC-y (mean ± s.d.) of patients was 75.2800 ± 14.7787.
In Severe Clinical Types, the mean TLC-y (mean ± s.d.) of patients was 49.5000 ± 11.9341.
The difference of mean TLC-y with three clinical types was statistically significant (p<0.0001).
|
|
Number |
Mean |
SD |
Minimum |
Maximum |
Median |
|
BMI(kg/m2) |
80 |
24.4750 |
3.9399 |
20.4000 |
32.2000 |
22.1000 |
|
DLCO-x |
80 |
50.4500 |
14.1143 |
22.0000 |
71.0000 |
53.0000 |
|
DLCO/Va-x |
80 |
88.4500 |
19.7169 |
46.0000 |
112.0000 |
88.0000 |
|
TLC-x |
80 |
64.9500 |
18.2991 |
29.0000 |
85.0000 |
69.0000 |
|
RV/TLC-x |
80 |
100.8875 |
33.8758 |
57.0000 |
157.0000 |
98.0000 |
|
FEV1(% ofpredicted)-x |
80 |
67.0000 |
9.9365 |
47.0000 |
85.0000 |
68.0000 |
|
FVC(% of predicted)-x |
80 |
62.0125 |
11.2154 |
41.0000 |
79.0000 |
64.0000 |
|
FEV1/FVC-x |
80 |
99.0600 |
12.7026 |
78.7000 |
116.0000 |
93.0000 |
|
DLCO-y |
80 |
55.2875 |
13.9340 |
31.0000 |
74.0000 |
59.0000 |
|
DLCO/Va- y |
80 |
91.9000 |
22.8377 |
41.0000 |
118.0000 |
91.0000 |
|
TLC-y |
80 |
71.1500 |
20.8242 |
38.0000 |
103.0000 |
74.0000 |
|
RV/TLC-y |
80 |
92.1250 |
23.7995 |
51.0000 |
134.0000 |
84.0000 |
|
FEV1(%of of predicted)-y |
80 |
75.6375 |
14.1647 |
54.0000 |
108.0000 |
75.0000 |
|
FVC(% of predicted)-y |
80 |
72.4375 |
14.6519 |
45.0000 |
100.0000 |
72.0000 |
|
FEV1/FVC-y |
80 |
97.0675 |
14.2298 |
78.8000 |
117.0000 |
90.0000 |
In above table showed that the mean BMI (kg/m2) (mean ± s.d.) of patients was 24.4750 ± 3.9399.
In above table showed that the mean DLCO-x (mean ± s.d.) of patients was 50.4500 ± 14.1143.
In above table showed that the mean DLCO/Va-x (mean ± s.d.) of patients was 88.4500 ± 19.7169.
In above table showed that the mean TLC-x (mean ± s.d.) of patients was 64.9500 ± 18.2991.
In above table showed that the mean RV/TLC-x (mean ± s.d.) of patients was 100.8875 ± 33.8758.
In above table showed that the mean FEV1 (% of predicted)-x (mean ± s.d.) of patients was 67.0000 ± 9.9365.
In above table showed that the mean FVC (% of predicted)-x (mean ± s.d.) of patients was 62.0125 ± 11.2154.
In above table showed that the mean FEV1/FVC-x (mean ± s.d.) of patients was 99.0600 ± 12.7026.
In above table showed that the mean DLCO-y (mean ± s.d.) of patients was 55.2875 ± 13.9340.
In above table showed that the mean DLCO/Va- y (mean ± s.d.) of patients was 91.9000 ± 22.8377.
In above table showed that the mean TLC-y (mean ± s.d.) of patients was 71.1500 ± 20.8242.
In above table showed that the mean RV/TLC-y (mean ± s.d.) of patients was 92.1250 ± 23.7995.
In above table showed that the mean FEV1 (% of predicted)-y (mean ± s.d.) of patients was 75.6375 ± 14.1647.
In above table showed that the mean FVC (% of predicted)-y (mean ± s.d.) of patients was 72.4375 ± 14.6519.
In above table showed that the mean FEV1/FVC-y (mean ± s.d.) of patients was 97.0675 ± 14.2298.
Association between PFT interpretation-x: Clinical types
In Mild Clinical Types, 9 (56.3%) patients had restrictive lung disorder with mild diffusion restriction and 7 (43.8%) patients had restrictive lung disorder with moderate diffusion restriction.
In Moderate Clinical Types, 16 (32.0%) patients had restrictive lung disorder with mild diffusion restriction and 34(68.0%) patients had restrictive lung disorder with moderate diffusion restriction.
In Severe Clinical Types, 7 (50.0%) patients had restrictive lung disorder with moderate diffusion restriction and 7 (50.0%) patients had restrictive lung disorder with severe diffusion restriction.
Association of PFT interpretation -x vs Clinical Types was statistically significant (p<0.0001).
Chi-square value: 42.0548; p-value:<0.0001.
Association between PFT interpretation-y: Clinical types
In Mild Clinical Types, 9 (56.3%) patients had Mild diffusion restriction at PFT interpretation-y and 7 (43.8%) patients had Restrictive lung disorder with moderate diffusion restriction at PFT Interpretation- y.
In Moderate Clinical Types, 34 (68.0%) patients had restrictive lung disorder with mild diffusion restriction at PFT Interpretation-y and 16 (32.0%) patients had restrictive lung disorder with moderate diffusion restriction at PFT interpretation-y.
In Severe Clinical Types, 7 (50.0%) patients had Restrictive lung disorder with moderate diffusion restriction at PFT interpretation-y and 7 (50.0%) patients had restrictive lung disorder with severe diffusion restriction at PFT interpretation-y.
Association of PFT interpretation-y vs. Clinical Types was statistically significant (p<0.0001).
Chi-square value: 90.5533; p-value:<0.0001.
Association between outcome: Clinical types
In Mild Clinical Types, 9 (56.3%) patients had improved in outcome and 7(43.8%) patients had no significant change in outcome.
In Moderate Clinical Types, 34 (68.0%) patients had improved in outcome and 16 (32.0%) patients had no significant change in outcome.
In Severe Clinical Types, 14 (100.0%) patients had no significant change in outcome.
Association of outcome vs. Clinical Types was statistically significant (p<0.0001).
Chi-square value: 20.3947; p-value:<0.0001.
Discussion
A single-center, hospital-based, observational, cross-sectional study was conducted on indoor and OPD patients in the Department of Respiratory Medicine, Indraprastha Apollo Hospitals, New Delhi, from 25 August 2020 to 25 June 2021.
Patients with ICMR laboratory confirmed RT-PCR/ Gene-expert positive non critical COVID-19 cases and Patients/ Guardians given informed written consent for the same were included in this study.
In our study, 4 (5.0%) patients were ≤30 years old, 13 (16.3%) patients were 31-40 years old, 26 (32.5%) patients were 41-50 years old, 22 (27.5%) patients were 51-60 years old and 15 (18.8%) patient were >60 years old. The mean age (mean ± s.d.) of patients was 51.1375 ± 13.4011 years. 25 (31.3%) patients were female and 55 (68.8%) patient were male.
It was found that, 41 (51.3%) patients had non-obese BMI, 9 (11.3%) patients had obese BMI and 30 (37.5%) patients had overweight BMI. The mean BMI (mean ± s.d.) of patients was 24.4750 ± 3.9399 kg/m2.
We found that , 16 (20.0%) patients had Mild restriction at PFT Spirometry Finding-x, 34 (42.5%) patients had Moderate restriction at PFT Spirometry Finding-x, 23 (28.8%) patients had Moderately severe restriction at PFT Spirometry Finding-x and 7 (8.8%) patients had Severe restriction at PFT Spirometry Finding-x.
Our study showed that, 25 (31.3%) patients had restrictive lung disorder with mild diffusion restriction, 48 (60.0%) patients had restrictive lung disorder with moderate diffusion restriction and 7 (8.8%) patients had restrictive lung disorder with severe diffusion restriction.
In our study, 57 (71.3%) patients had Mild restriction at PFT Spirometry Finding-y, 7 (8.8%) patients had Moderately severe restriction at PFT Spirometry Finding-y, 9 (11.3%) patients had Normal spirometry at PFT Spirometry Finding-y and 7 (8.8%) patients had Severe restriction at PFT Spirometry Finding-y.
It was found that, 9 (11.3%) patients had Mild diffusion restriction at PFT Interpretation- y, 34 (42.5%) patients had Restrictive lung disorder with mild diffusion restriction at PFT Interpretation-y, 30 (37.5%) patients had restrictive lung disorder with moderate diffusion restriction at PFT Interpretation-y and 7 (8.8%) patients had Restrictive lung disorder with severe diffusion restriction at PFT Interpretation-y.
In our study, the mean DLCO-x (mean ± s.d.) of patients was 50.4500 ± 14.1143. The mean DLCO/Va-x (mean ± s.d.) of patients was 88.4500 ± 19.7169. The mean TLC-x (mean ± s.d.) of patients was 64.9500 ± 18.2991. The mean RV/TLC-x (mean ± s.d.) of patients was 100.8875 ± 33.8758. The mean FEV1(% of predicted)-x (mean ± s.d.) of patients was 67.0000 ± 9.9365. The mean FVC(% of predicted)-x (mean ± s.d.) of patients was 62.0125 ± 11.2154. The mean FEV1/FVC-x (mean ± s.d.) of patients was 99.0600 ± 12.7026. The mean DLCO-y (mean ± s.d.) of patients was 55.2875 ± 13.9340. The mean DLCO/Va-y (mean ± s.d.) of patients was 91.9000 ± 22.8377. The mean TLC-y (mean ± s.d.) of patients was 71.1500 ± 20.8242. The mean RV/TLC-y (mean ± s.d.) of patients was 92.1250 ± 23.7995. The mean FEV1(% of predicted)-y (mean ± s.d.) of patients was 75.6375± 14.1647. The mean FVC (% of predicted)-y (mean ± s.d.) of patients was 72.4375 ± 14.6519. The mean FEV1/FVC-y (mean ± s.d.) of patients was 97.0675 ± 14.2298.
Our study showed that in Mild Clinical Types, 14 (87.5%) patients were 41-50 years old, 1 (6.3%) patients were 51-60 years old and 1 (6.3%) patient were >60 years old. In Moderate Clinical Types, 4 (8.0%) patients were ≤30years old, 10(20.0%) patients were 31-40 years old, 8 (16.0%) patients were 41-50 years old, 15 (30.0%) patients were 51-60 years old and 13 (26.0%) patient were >60 years old. In Severe Clinical Types, 3(21.4%) patients were 31-40 years old, 4 (28.6%) patients were 41-50 years old, 6(42.9%) patients were 51-60 years old and 1(7.1%) patient were >60 years old. It was statistically significant (p<0.0001).
We observed that In Mild Clinical Types, 9 (56.3%) patients had Moderate Restriction at PFT Spirometry Finding-x and 7 (43.8%) patients had Moderately severe restriction at PFT Spirometry Finding-x. In Moderate Clinical Types, 16 (32.0%) patients had Mild restriction at PFT Spirometry Finding-x, 25 (50.0%) patients had Moderate restriction at PFT Spirometry Finding-x and 9 (18.0%) patients had Moderately severe restriction at PFT Spirometry Finding-x. In Severe Clinical Types, 7 (50.0%) patients had Moderately severe restriction at PFT Spirometry Finding-x and 7 (50.0%) patients had Severe restriction at PFT Spirometry Finding-x. This was statistically significant (p<0.0001).
Present study showed that in Mild Clinical Types, 9 (56.3%) patients had Restrictive lung disorder with mild diffusion restriction and 7 (43.8%) patients had Restrictive lung disorder with moderate diffusion restriction. In Moderate Clinical Types, 16 (32.0%) patients had restrictive lung disorder with mild diffusion restriction and 34 (68.0%) patients had restrictive lung disorder with moderate diffusion restriction. In Severe Clinical Types, 7 (50.0%) patients had restrictive lung disorder with moderate diffusion restriction and 7 (50.0%) patients had restrictive lung disorder with severe diffusion restriction. This was statistically significant (p<0.0001).
Our study showed that in Mild Clinical Types, 7 (43.8%) patients had Moderate restriction at PFT Spirometry Finding-y and 9 (56.3%) patients had Normal spirometry at PFT Spirometry Finding-y. In Moderate Clinical Types, 50 (100.0%) patients had Mild restriction at PFT Spirometry Finding-y. In Severe Clinical Types, 7 (50.0%) patients had Mild restriction at PFT Spirometry Finding-y and 7 (50.0%) patients had Severe restriction at PFT Spirometry Finding-y. It was statistically significant (p<0.0001).
We examined that in Mild Clinical Types, 9 (56.3%) patients had Mild diffusion restriction at PFT Interpretation- y and 7 (43.8%) patients had restrictive lung disorder with moderate diffusion restriction at PFT Interpretation- y. In Moderate Clinical Types, 34 (68.0%) patients had restrictive lung disorder with mild diffusion restriction at PFT Interpretation- y and 16(32.0%) patients had restrictive lung disorder with moderate diffusion restriction at PFT Interpretation-y. In Severe Clinical Types, 7 (50.0%) patients had restrictive lung disorder with moderate diffusion restriction at PFT Interpretation- y and 7 (50.0%) patients had restrictive lung disorder with severe diffusion restriction at PFT Interpretation- y. This was statistically significant (p<0.0001).
Our study showed that in Mild Clinical Types, the mean Age (years) (mean ± s.d.) of patients was 47.3125 ± 6.1830. In Moderate Clinical Types, the mean age (years) (mean ± s.d.) of patients was 52.7600 ± 15.7837. In Severe Clinical Types, the mean age (years) (mean ± s.d.) of patients was 49.7143 ± 8.8268. This was not statistically significant (p=0.3381).
Present study showed that in Mild Clinical Types, the mean DLCO-x (mean ± s.d.) of patients was 53.25± 2.05. In Moderate Clinical Types, the mean DLCO-x (mean ± s.d.) of patients was 56.40 ± 10.29. In Severe Clinical Types, the mean DLCO-x (mean ± s.d.) of patients was 26.00 ± 4.1510. This was statistically significant (p<0.0001).
We observed that in Mild Clinical Types, the mean DLCO/Va-x (mean ± s.d.) of patients was 79.0625 ± 19.9816. In Moderate Clinical Types, the mean DLCO/Va-x (mean± s.d.) of patients was 95.3600 ± 11.8058. In Severe Clinical Types, the mean DLCO/Va-x (mean ± s.d.) of patients was 74.5000 ± 29.5758. This was statistically significant (p<0.0001).
We examined that in Mild Clinical Types, the mean FEV1(% of predicted)-x (mean ± s.d.) of patients was 62.7500 ± 6.1482. In Moderate Clinical Types, the mean FEV1(% of predicted)-x (mean ± s.d.) of patients was 71.1600 ± 8.1800. In Severe Clinical Types, the mean FEV1(% of predicted)-x (mean ± s.d.) of patients was 57.0000 ± 10.3775. It was statistically significant (p<0.0001).
In our study in Mild Clinical Types, the mean FVC (% of predicted)-x (mean± s.d.) of patients was 58.2500 ± 2.0494. In Moderate Clinical Types, the mean FVC (% of predicted)-x (mean ± s.d.) of patients was 67.4200 ± 9.6110. In Severe Clinical Types, the mean FVC (% of predicted)-x (mean ± s.d.) of patients was 47.0000 ± 6.2265. This was statistically significant (p<0.0001).
Our study showed that in Mild Clinical Types, the mean FEV1/FVC-x (mean± s.d.) of patients was 83.9313 ± 4.7648. In Moderate Clinical Types, the mean FEV1/FVC-x (mean ± s.d.) of patients was 102.4200 ± 10.9621. In Severe Clinical Types, the mean FEV1/FVC-x (mean ± s.d.) of patients was 104.3500 ± 12.0898. It was statistically significant (p<0.0001).
We found that In Mild Clinical Types, the mean DLCO-y (mean± s.d.) of patients was 56.3750 ± 3.0741. In Moderate Clinical Types, the mean DLCO-y (mean ± s.d.) of patients was 61.0400 ± 11.7716. In Severe Clinical Types, the mean DLCO-y (mean ± s.d.) of patients was 33.5000 ± 2.5944. It was statistically significant (p<0.0001).
Our study showed that in Mild Clinical Types, the mean DLCO/Va- y (mean ± s.d.) of patients was 84.5000 ± 20.4939. In Moderate Clinical Types, the mean DLCO/Va- y (mean ± s.d.) of patients was 99.4200 ± 15.4340. In Severe Clinical Types, the mean DLCO/Va- y (mean ± s.d.) of patients was 73.5000 ± 33.7268 which was statistically significant (p<0.0001).
Present study showed that In Mild Clinical Types, the mean FEV1(%of of predicted)-y (mean ± s.d.) of patients was 85.2500 ± 26.6421. In Moderate Clinical Types, the mean FEV1(% of predicted)-y (mean ± s.d.) of patients was 75.5400 ± 3.0184. In Severe Clinical Types, the mean FEV1(% of predicted)-y (mean ± s.d.) of patients was 65.0000 ± 11.4152 which was statistically significant (p=0.0003).
We found that in Mild Clinical Types, the mean FVC (% of predicted)-y (mean ± s.d.) of patients was 80.7500 ± 22.5433. In Moderate Clinical Types, the mean FVC (% of predicted)-y (mean ± s.d.) of patients was 74.2400 ± 7.3694. In Severe Clinical Types, the mean FVC (% of predicted)-y (mean ± s.d.) of patients was 56.5000 ± 11.9341. It was statistically significant (p<0.0001).
We also found that In Mild Clinical Types, the mean FEV1/FVC-y (mean± s.d.) of patients was 79.5875 ± .7173. In Moderate Clinical Types, the mean FEV1/FVC-y (mean ± s.d.) of patients was 102.9600 ± 11.6092. In Severe Clinical Types, the mean FEV1/FVC-y (mean ± s.d.) of patients was 96.0000 ± 14.5285. It was statistically significant (p<0.0001).
It was found that in Mild Clinical Types, 9 (56.3%) patients had improved in Outcome and 7 (43.8%) patients had No significant change in Outcome. In Moderate Clinical Types, 34 (68.0%) patients had improved in Outcome and 16 (32.0%) patients had No significant change in Outcome. In Severe Clinical Types, 14 (100.0%) patients had No significant change in Outcome which was statistically significant (p<0.0001).
Summary and Conclusion
In our study, 4 (5.0%) patients were ≤30 years old, 13 (16.3%) patients were 31-40 years old, 26 (32.5%) patients were 41-50 years old, 22 (27.5%) patients were 51-60 years old and 15 (18.8%) patient were >60 years old.
In our study, 25 (31.3%) patients were Female and 55 (68.8%) patient were male.
In our study, 16 (20.0%) patients had Mild restriction at PFT Spirometry Finding-x, 34 (42.5%) patients had Moderate Restriction at PFT Spirometry Finding-x, 23 (28.8%) patients had Moderately severe Restriction at PFT Spirometry Finding-x and 7 (8.8%) patients had Severe restriction at PFT Spirometry Finding-x.
In our study, 25 (31.3%) patients had Restrictive lung disorder with mild diffusion restriction, 48 (60.0%) patients had Restrictive lung disorder with moderate diffusion restriction and 7 (8.8%) patients had Restrictive lung disorder with severe diffusion restriction.
In our study, 9 (11.3%) patients had Mild diffusion restriction at PFT Interpretation- y, 34 (42.5%) patients had Restrictive lung disorder with mild diffusion restriction at PFT Interpretation- y, 30 (37.5%) patients had Restrictive lung disorder with moderate diffusion restriction at PFT Interpretation- y and 7 (8.8%) patients had Restrictive lung disorder with severe diffusion restriction at PFT Interpretation- y.
In our study, 43 (53.8%) patients had Improved in Outcome and 37 (46.3%) patients had No significant change in Outcome.
In our study, 16 (20.0%) patients were Mild Clinical Types, 50 (62.5%) patients were Moderate Clinical Types and 14 (17.5%) patients were Severe Clinical Types.
Higher age group (>50 years) was more affected in moderate and severe disease which was statistically significant.
Males were more affected in moderate and severe disease which was statistically significant.
In PFT Spirometry Finding-x, Severe restriction was more in moderate and severe disease . PFT Spirometry Finding-x was significantly associated with severity of the disease.
Both PFT Interpretation -x and PFT Interpretation- y were significantly associated with severity of the disease.
Poor outcome was observed in severe disease followed by mild and moderate disease which was statistically significant.
DLCO-x was less in severe disease compared to mild and moderate disease which was statistically significant. DLCO-y was less in severe disease followed by mild and moderate disease which was statistically significant.
DLCO/Va-x was less in severe disease followed by mild and moderate disease which was statistically significant. DLCO/Va-y was less in severe disease followed by mild and moderate disease which was statistically significant.
Both TLC-x and TLC-y were less in severe disease compared to mild and moderate disease which was statistically significant.
FEV1 (% of predicted)-x was less in severe disease followed by mild and moderate disease which was statistically significant.
FEV1 (% of predicted)-y was less in severe disease followed by moderate and mild disease which was statistically significant.
FVC(% of predicted)-x was less in severe disease followed by mild and moderate disease which was statistically significant.
FVC (% of predicted)-y was less in severe disease followed by moderate and mild disease which was statistically significant.
Influence of corona virus disease 2019 on pulmonary function was changed in post covid-19 discharged patients
The respiratory function changes were improved associated with COVID-19 in Mild and Moderate cases mainly , and not in Severe cases.
The majority of patients in our study were advised to practice deep breathing exercises, incentive spirometry and Yoga. We observed improvement in symptoms of post-COVID patients of Mild and Moderate disease category. Various research studies support this observation are: 1) Senthil & Sivabackiya , 2020 2) Liu et al., 2020 3) Zha et al., 2020.[14], [15], [16]
Senthil and Sivabackiya (2020) explain the case report of a 72-year-old male with COVID-19 and diabetes mellitus who complained of difficulty breathing even while sleeping.[14] In this research, patients agreed and followed the intervention consisting of percussion technique on pulmonary, deep breathing, and thorax mobility exercises that would be performed for 30 minutes every two times a week. This breathing exercise is implemented for three weeks. This exercise consists of pulmonary percussion with shaking and vibration manually by the physiotherapist for 10 minutes, followed by breathing exercises, thorax mobility, and incentive spirometry exercises. This breathing exercise intervention has shown significant presence in the restoration of ability.
Liu et al. (2020) 22 study was conducted to identify the effects of respiratory rehabilitation, activity daily living (ADL), quality of life, and psychological status in elderly patients with COVID-19 after being discharged from the hospital.[15] The rehabilitation program consists of respiratory rehabilitation, two sessions per week for six weeks, once a day for 10 minutes. The intervention includes respiratory muscle training, cough exercise, diaphragmatic training, stretching exercise, and home exercise. Breathing muscle exercises are performed in three sets with 10 times breaths in each set using a commercial handheld device.
Breathing exercise and physical exercise after COVID-19 are part of the pulmonary rehabilitation program which has been shown to have a positive impact on repairing damage due to lung disease by COVID-19 pneumonia.
Limitations of the Study
In spite of every sincere effort, my study has lacunae.
The notable short comings of this study are:
The sample size was small. Only 80 cases are not sufficient for this kind of study.
The study was done in a single-center.
The study was carried out in a tertiary care hospital, so hospital bias cannot be ruled out.
Abbreviations
PFT: Pulmonary function test2: Peripheral capillary oxygen saturationX: First monthY: Third monthCT: Computed tomographyPCR: Polymerase chain reaction
Source of Funding
None.
Conflict of Interest
None.
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- Introduction
- Aim and Objectives
- Materials and Methods
- Study design
- Study site
- Inclusion criteria
- Exclusion criteria
- Sample size calculation
- Statistical analysis
- Result and Analysis
- Distribution of mean FEV1 (% of predicted)-x: Clinical types
- Distribution of mean FEV1 (% of predicted)-y: Clinical types
- Distribution of mean FVC (% of predicted)-x: Clinical types
- Distribution of mean FVC(% of predicted)-y: Clinical types
- Distribution of mean FEV1/FVC-x: Clinical types
- Distribution of mean FEV1/FVC-y : Clinical types
- Distribution of mean DLCO-x: Clinical types
- Distribution of mean DLCO-y: Clinical types
- Distribution of mean TLC-x: Clinical types
- Distribution of mean TLC-y: Clinical types
- Association between PFT interpretation-x: Clinical types
- Association between PFT interpretation-y: Clinical types
- Association between outcome: Clinical types
- Discussion
- Summary and Conclusion
- Limitations of the Study
- Abbreviations
- Source of Funding
- Conflict of Interest