Follow-up pulmonary function of COVID-19 patients 4 months after hospital discharge

The end of the acute period of COVID-19 does not mean complete recovery. Observation of patients in the post-COVID-19 period showed that a significant number of people experience shortness of breath, fatigue, muscle weakness, sleep disorders, cough, palpitations, so the term post-COVID-19 syndrome was coined. The examination to identify the causes of complaints of COVID-19 convalescents should include lung function assessment.The aim of the study was to assess the dynamics of lung function 4 months after hospitalization for COVID-19.Methods. 31 patients (26 males, the median age was 49 years) underwent traditional pulmonary function tests (PFTs) (spirometry, body plethysmography, test of diffusing lung capacity) and impulse oscillometry (IOS). Results. During the 1st visit, the average PFTs and IOS parameters were within the normal range in the whole group, apart from the diffusing lung capacity (DLCO), which was reduced mildly (on the border with moderate) in 77% of patients. During the 2nd visit, which was conducted on average 102 days after the 1st one, 58% of patients demonstrated abnormal lung diffusion capacity. The second assessment revealed a statistically significant increase in the slow and forced vital capacity (VC and FVC), the forced exhalation volume in 1 second (FEV1), total lung capacity (TLC), DLCO, and a decrease in the ratio of FEV1/FVC and the residual lung volume to TLC ratio.Conclusion. Post-COVID-19 patients show a statistically significant improvement of their lung function 4 months after hospital discharge. A systematic follow-up is essential for such patients to detect lung function abnormalities and correct them.

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Comparison of Per Cent Predicted and Percentile Values for Pulmonary Function Test Interpretation

Canadian Respiratory Journal ◽

10.1155/2009/912185 ◽

2009 ◽

Vol 16 (6) ◽

pp. 189-193 ◽

Cited By ~ 1

Author(s):

Smita Pakhale ◽

Zoheir Bshouty ◽

Theodore K Marras

Keyword(s):

Lung Function ◽

Pulmonary Function ◽

Pulmonary Function Tests ◽

Residual Volume ◽

European Respiratory Society ◽

Diffusion Capacity ◽

Percentile Method ◽

Lung Capacity ◽

Test Characteristics ◽

The Mean

BACKGROUND: Pulmonary function tests (PFTs) are commonly interpreted as a fraction of predicted normal values, with an abnormal test often defined as less than 80% or greater than 120% of the predicted value. However, recommendations of the American Thoracic Society/European Respiratory Society suggest using a percentile-based approach to define an abnormal test (less than the fifth or greater than the 95th percentiles).OBJECTIVE: To compare PFT values obtained by the per cent predicted method with the percentile-based method for lung function parameters.METHODS: Full PFTs performed between January 2000 and July 2004, at the Health Sciences Centre (Winnipeg, Manitoba) were analyzed. Using the Crapo and Gutierrez equations, per cent predicted and percentile values were calculated. An abnormal test was defined as less than 80% or greater than 120% of predicted (per cent predicted method) or as less than the fifth or greater than the 95th percentiles (percentile method). Using the percentile method as reference standard, the diagnostic test characteristics of the per cent predicted method were calculated.RESULTS: The full PFTs of 2176 men and 1658 women were analyzed using the Crapo and Gutierrez equations. The mean (± SD) age of all subjects was 52±15 years. Per cent agreement between the two tests was more than 94% for all parameters except for reduced residual volume (88%). Per cent predicted methods had suboptimal sensitivity for abnormal total lung capacity (88% to 89%), increased residual volume (83% to 89%) and reduced diffusion capacity (89% with Crapo equations). Suboptimal specificity (83% to 86%) was observed for decreased residual volume.CONCLUSION: The results of the per cent predicted and percentile-based approaches for PFT interpretation were similar for the majority of lung function parameters. These two methods can be used interchangeably for spirometry. However, caution may be warranted in relying solely on per cent predicted methods for assessing lung volume or diffusion capacity.

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Serum biomarker CA 15-3 as predictor of response to antifibrotic treatment and survival in idiopathic pulmonary fibrosis

Biomarkers in Medicine ◽

10.2217/bmm-2020-0165 ◽

2020 ◽

Vol 14 (11) ◽

pp. 997-1007

Author(s):

Sofia A Moll ◽

Ivo A Wiertz ◽

Adriane DM Vorselaars ◽

Pieter Zanen ◽

Henk JT Ruven ◽

...

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Pulmonary Function ◽

Vital Capacity ◽

Mixed Model ◽

Pulmonary Function Tests ◽

Hazard Ratio ◽

Poor Survival ◽

Function Test

Aim: Cancer antigen 15-3 (CA 15-3) is a baseline biomarker in idiopathic pulmonary fibrosis (IPF), but its value during follow-up is unknown. Materials and methods: Associations between serum CA 15-3 and pulmonary function tests during 1-year follow-up were evaluated by a mixed model in 132 IPF treated with pirfenidone or nintedanib. Results: Increased baseline (median: 56 kU/l) and follow-up CA 15-3 levels were inversely associated with forced vital capacity and diffusing capacity of the lung for carbon monoxide (estimates respectively: -5.21 and -4.69; p < 0.001). Baseline and 6-month CA 15-3 above 58.5 (hazard ratio: 1.67; p = 0.031) and 50.5 kU/l (hazard ratio: 2.99; p < 0.001), respectively, showed impaired survival compared with lower levels. Conclusion: CA 15-3 is associated with pulmonary function test during follow-up in IPF on antifibrotic treatment. Higher (follow-up) values are related with poor survival. Therefore, CA 15-3 is a promising follow-up biomarker in IPF.

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Diffusion Capacity Abnormalities for Carbon Monoxide in Patients with COVID-19 At Three-Month Follow-up

European Respiratory Journal ◽

10.1183/13993003.03677-2020 ◽

2021 ◽

pp. 2003677

Author(s):

Wei Qin ◽

Shi Chen ◽

Yunxia Zhang ◽

Fen Dong ◽

Zhu Zhang ◽

...

Keyword(s):

Carbon Monoxide ◽

Pulmonary Function ◽

Clinical Symptoms ◽

Pulmonary Function Tests ◽

Chest Ct ◽

Test Results ◽

Diffusion Capacity ◽

Impaired Lung Function ◽

Multivariable Regression

ObjectiveTo evaluate pulmonary function and clinical symptoms in coronavirus disease 2019 (COVID-19) survivors within 3 months after hospital discharge, and to identify risk factors associated with impaired lung function.Methods and materialCOVID-19 patients were prospectively followed up with pulmonary function tests and clinical characteristics for 3 months following discharge from a hospital in Wuhan, China between January and February 2020.Results647 patients were included. 87 (13%) patients presented with weakness, 63 (10%) with palpitation and 56 (9%) with dyspnea. Prevalences of the three symptoms were markedly higher in severe patients than non-severe patients (19% versus 10% for weakness, p=0.003; 14% versus 7% for palpitation, p=0.007; 12% versus 7% for dyspnea, p=0.014). Results of multivariable regression showed an increased odd in the ongoing symptoms among severe patients (OR: 1.7, 95%CI: 1.1–2.6, p=0.026) or patients with longer hospital stay (OR: 1.03, 95%CI: 1.00–1.05, p=0.041). Pulmonary function test results were available for 81 patients, including 41 non-severe and 40 severe patients. In this subgroup, 44 (54%) patients manifested abnormal diffusion capacity for carbon monoxide (DLCO) (68% severe versus 42% non-severe patients, p=0.019). Chest CT total severity score (TSS)>10.5 (OR: 10.4; 95%CI: 2.5–44.1; p=0.001) on admission and ARDS (OR: 4.6; 95%CI: 1.4–15.5; p=0.014) were significantly associated with impaired DLCO. Pulmonary interstitial damage may be associated with abnormal DLCO.ConclusionPulmonary function, particularly DLCO, declined in COVID-19 survivors. This decrease was associated with TSS of chest CT >10.5 and ARDS occurrence. Pulmonary interstitial damage might contribute to the imparied DLCO.

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Thoracic Volumes Correlated With Pulmonary Function Tests in Adult Scoliosis Patients Following Different Treatments in Adolescence

2017 Design of Medical Devices Conference ◽

10.1115/dmd2017-3364 ◽

2017 ◽

Author(s):

Po-Chih Lee ◽

Charles Ledonio ◽

A. Noelle Larson ◽

Arthur Erdman ◽

David Polly

Keyword(s):

Pulmonary Function ◽

Lung Disease ◽

Vital Capacity ◽

Pulmonary Function Tests ◽

Adult Scoliosis ◽

Pulmonary Mechanics ◽

Spine Deformity ◽

Restrictive Lung Disease ◽

Lung Capacity ◽

Lung Expansion

In clinical settings, doctors classify pulmonary disorders into two main categories, obstructive lung disease and restrictive lung disease. The former is characterized by the airway obstruction which is associated with several disorders like chronic bronchitis, asthma, bronchiectasis, and emphysema [1]. The latter is caused by different conditions where one of the triggers is tied to the spine deformity. In general, a pulmonary function test (PFT) [2] is used to evaluate and diagnose lung function, and physicians depend on the test results to identify the disease patterns of the patients (obstructive or restrictive lung disease). In the PFT, some parameters including total lung capacity (TLC), vital capacity (VC), and residual volume (RV) can infer the lung volume and lung capacity. Other parameters, such as forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), are often employed to assess the pulmonary mechanics. Scoliosis is an abnormal lateral curvature of the spine which involves not only the curvature from side to side but also an axial rotation of the vertebrae. Restrictive lung disease often happens in scoliosis patients, especially with severe spine deformity. Spine deformity if left untreated may lead to progression of the spinal curve, respiratory complications, and the reduction of life expectancy due to the decrease in thoracic volume for lung expansion. However, the relationship between thoracic volume and pulmonary function is not broadly discussed, and anatomic abnormalities in spine deformity (ex: scoliosis, kyphosis, and osteoporosis) can affect thoracic volume. Adequate thoracic volume is needed to promote pulmonary function. Previous literature has shown that the deformity of the thoracic rib cage will have detrimental effects on the respiratory function in adolescent idiopathic scoliosis patients [3–4]. In this paper, we aim to correlate thoracic volume and the parameters in PFTs in adult scoliosis patients 25–35 years after receiving treatments during their adolescence, either with physical bracing or spinal fusion surgery.

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Association of lung diffusion capacity with cardiac remodeling and risk of heart failure: The Framingham heart study

PLoS ONE ◽

10.1371/journal.pone.0246355 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246355

Author(s):

Ibrahim Musa Yola ◽

Albin Oh ◽

Gary F. Mitchell ◽

George O’Connor ◽

Susan Cheng ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Function ◽

Cardiac Remodeling ◽

Pulmonary Function Tests ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Lung Diffusion ◽

Diffusion Capacity ◽

Lower Lung

Background Lung function abnormalities are ubiquitous in heart failure (HF). It is unclear, however, if abnormal lung diffusion capacity is associated with cardiac remodeling and antedates HF. We hypothesized that lower lung diffusion capacity for carbon monoxide (DLCO) is associated with worse left ventricular (LV) systolic and diastolic function cross-sectionally, and with higher risk of HF prospectively. Methods We evaluated 2423 Framingham Study participants (mean age 66 years, 55% women) free of HF who underwent routine echocardiography and pulmonary function tests. We used multivariable regression models to relate DLCO, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) to left ventricular ejection fraction (LVEF), left atrial (LA) emptying fraction (LAEF), E/e’, E/A, LV mass, and LA diameter (LAD). Multivariable-adjusted Cox proportional hazards regression was used to relate DLCO, FEV1, and FVC to incident HF. Results In multivariable-adjusted cross-sectional analyses, DLCO, FEV1, and FVC (dependent variables) were associated positively with LVEF (βDLCO = 0.208, βFEV1 = 0.021, and βFVC = 0.025 per 5% increment in LVEF; p<0.005 for all), and LAEF (βDLCO = 0.707, βFEV1 = 0.058 and βFVC = 0.058 per 5% increment in LAEF; p<0.002 for all). DLCO and FVC were inversely related to E/A (βDLCO = -0.289, βFVC = -0.047 per SD increment in E/A; p<0.001 for all). Additionally, DLCO, FEV1 and FVC were inversely related to HF risk (108 events, median follow-up 9.7 years; multivariable-adjusted hazard ratios per SD increment 0.90, 95% CI 0.86–0.95; 0.42, 95% CI 0.28–0.65, and 0.51, 95% CI 0.36–0.73, respectively). These results remained robust in analyses restricted to non-smokers. Conclusions Our large community-based observations are consistent with the concept that lower lung diffusion capacity and expiratory flow rates are associated with cardiac remodeling and may antedate HF. Additional studies are needed to confirm our findings and to evaluate the prognostic utility of pulmonary function testing for predicting HF.

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Fibrocytes in early and long-standing rheumatoid arthritis: a 6-month trial with repeated synovial biopsy, imaging and lung function test

RMD Open ◽

10.1136/rmdopen-2020-001494 ◽

2021 ◽

Vol 7 (1) ◽

pp. e001494

Author(s):

Søren Andreas Just ◽

Christian Nielsen ◽

Jens Christian Werlinrud ◽

Pia Veldt Larsen ◽

Eva Kildall Hejbøl ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Lung Function ◽

Pulmonary Function ◽

Pulmonary Function Tests ◽

Lung Function Test ◽

Wrist Arthroscopy ◽

Diffusion Capacity ◽

Capacity Level ◽

Registration Number

ObjectivesTo correlate the level of fibrocytes in peripheral blood, synovial tissue and in vitro culture in rheumatoid arthritis (RA) with changes in disease activity, imaging and pulmonary function.MethodsTwenty patients with early RA (ERA) and 20 patients with long-standing RA (LRA) were enrolled in a 6-month prospective study. Sixteen patients undergoing wrist arthroscopy were healthy controls. Patients with RA underwent pulmonary function tests, ultrasound and synovial ultrasound-guided needle biopsy of the same wrist at baseline and 6 months. Wrist MRI was performed at baseline (all) and 6 months (ERA). Circulating fibrocytes were measured by flow cytometry, in vitro by the number of monocytes that were differentiated to fibrocytes and in synovial biopsies by counting in histological sections.ResultsFibrocytes were primarily located around vessels and in the subintimal area in the synovium. Fibrocyte levels did not decline during the trial despite effective RA treatment. In the ERA group, increased synovitis assessed by ultrasound was moderate and strongly correlated with an increase in circulating and synovial fibrocyte levels, respectively. Increased synovitis assessed by MRI during the trial in the ERA group was moderately correlated with both increased numbers of circulating and cultured fibrocytes. Absolute diffusion capacity level was overall weakly negatively correlated with the level of circulating and synovial fibrocytes. The decline in diffusion capacity during the trial was moderately correlated with increased levels of synovial fibrocytes.ConclusionOur findings suggest that fibrocytes are involved in RA pathogenesis, both in the synovium and the reduction in lung function seen in a part of patients with RA.Trial registration numberNCT02652299.

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Reversive Loss of Pulmonary Function Induced by Acute Chest Syndrome: A Report from the National Acute Chest Syndrome Study Group (NACSG).

Blood ◽

10.1182/blood.v106.11.315.315 ◽

2005 ◽

Vol 106 (11) ◽

pp. 315-315 ◽

Cited By ~ 2

Author(s):

Lynne Neumayr ◽

C. Morris ◽

A. Wen ◽

A. Earles ◽

S. Robertson ◽

...

Keyword(s):

Lung Function ◽

Pulmonary Function ◽

Pulmonary Function Tests ◽

Forced Expiratory Volume ◽

Therapeutic Interventions ◽

Acute Chest Syndrome ◽

P Value ◽

Lung Volumes ◽

Expiratory Flow

Abstract Acute Chest Syndrome (ACS) remains the leading cause of death and hospitalization in patients (pts) with sickle cell disease (SCD). There is limited data on the effects of ACS on lung function. From 1993 to 1997, 30 centers participated in the NACSG and prospectively analyzed 671 episodes of ACS in 538 pts. Pulmonary function tests (PFTs) included forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), forced expiratory flow during 25% to 75% of FVC (FEF 25–75), peak expiratory flow rate (PEF) and the ratio of FEV1/FVC. Data is reported as percent-predicted of normal values based on age and height. 128 pts (mean 16yrs, 4 to 52 yr range) had PFTs during an ACS episode (within a mean of 2.5 days of diagnosis) and then 12 weeks later. 94% of pts had abnormal lung volumes, defined as either FEV1 or FVC < 80%. Mean lung volumes during ACS and at follow-up are shown below. Table 1: Decreased Lung Volumes During ACS PFT During ACS Follow-up p-value FEV1 52% 79% <.0001 FVC 55% 83% <.0001 FEF 25–75 50% 69% <.0001 PEF 61% 83% <.0001 Pts with abnormal lung volumes (FEV1 or FVC < 80%) and considered to have an obstructive pattern if the FEV1/FVC ratio was < to 85. Obstructive patterns in pts with abnormal lung volumes and the percent of pts who responded to bronchodilators (15% improvement in either FEV1 or FVC) are shown below. Table 2: Patterns of Abnormal Lung Volumes in SCD SCD Patients During ACS Follow-up Abnormal PFTs 94% 45% Obstructive Pattern 48% 46% Respond to bronchodilators 25% 8% In summary, ACS resulted in decreased pulmonary function in 94% of pts. It is striking that 49% pts had their PFTs reduced by half (FEV1 52% and FVC 55%). In pts with abnormal PFTs, 48% had evidence of obstruction and 25% of all pts tested improved with a bronchodilator. This is the first description of reversible abnormalities of pulmonary function occurring during ACS compared to baseline. An obstructive pattern is identified in a higher percentage of pts with SCD than in the local Oakland African American population (asthma prevalance 16%). While some pts PFTs improved with time, 45% remained abnormal at 12-week follow-up. ACS results in acute and chronic worsening of lung function. Future studies of ACS may reveal common pathogenic mechanisms with asthma, and lead to improved therapeutic interventions.

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Interpretation of pulmonary function tests: beyond the basics

Journal of Investigative Medicine ◽

10.1136/jim-2016-000242 ◽

2016 ◽

Vol 65 (2) ◽

pp. 301-310 ◽

Cited By ~ 5

Author(s):

Bashar S Staitieh ◽

Octavian C Ioachimescu

Keyword(s):

Pulmonary Function ◽

Vital Capacity ◽

Pulmonary Function Tests ◽

Practical Method ◽

Forced Expiratory Volume ◽

European Respiratory Society ◽

Prognostic Information ◽

Lung Capacity ◽

Function Tests ◽

Functional Indices

Although the general framework described in the joint American Thoracic Society/European Respiratory Society guidelines provides a useful and practical method for the interpretation of pulmonary function tests, several other measurements and functional indices, if understood correctly, may help in diagnosis and management of patients with respiratory diseases and in design of research protocols. This review provides information on the underlying physiology, interpretative caveats, and the evidence supporting the use of a number of these indices. Some of these measurements, such as the inspiratory fraction, inspiratory capacity/total lung capacity (IC/TLC), may offer additional prognostic information, while others, such as residual volume (RV)/TLC and forced expiratory volume in 3 s/forced vital capacity (FEV3/FVC), may help fill in the gaps between patient symptoms and more traditional indices of pulmonary function. Although most studies of non-traditional indices focus on airflow-limiting disorders, many can be fruitfully applied in other settings. Understanding the physiology that catalyzed these investigations will undoubtedly enrich the functional assessment armamentarium of the practicing clinician and researcher.

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Three-month pulmonary function and radiological outcomes in COVID-19 survivors: a longitudinal patient cohort study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa540 ◽

2020 ◽

Author(s):

Xuejiao Liao ◽

Ying Wang ◽

Ziyi He ◽

Yongxing Yun ◽

Ming Hu ◽

...

Keyword(s):

Pulmonary Function ◽

Hospital Discharge ◽

Pulmonary Function Tests ◽

Ground Glass Opacity ◽

Ground Glass ◽

High Resolution Computed Tomography ◽

Airway Function ◽

Function Test ◽

Abnormal Pulmonary Function

Abstract Background This study aimed to investigate pulmonary function and radiological outcomes in a group of coronavirus disease 2019 (COVID-19) survivors. Methods 172 COVID-19 survivors in a follow-up clinic in a referral hospital underwent high resolution computed tomography (CT) of the thorax and pulmonary function tests at three month after hospital discharge. Results The median duration from hospital discharge to radiological and pulmonary function test was 90 (interquartile range=88-95) days. The abnormal pulmonary function was found in 11 (6.40%) patients, and abnormal small airway function (FEF25-75%) in 12 (6.98%). Six (3.49%) patients had obstructive ventilation impairment and six (3.49%) had restrictive ventilatory impairment. No significant differences in lung function parameters were observed between the non-severe and severe groups. Of 142 COVID-19 patients performed CT scan, 122 (85.91%) showed residual CT abnormalities and 52 (36.62%) showed chronic and fibrotic changes. The ground-glass opacities absorption in the lungs of severe cases was less satisfactory than that of non-severe patients. The severe paients had higher CT scores than non-severe cases (2.00 versus 0.00, P < 0.001) Conclusion Of the COVID-19 survivors, 6.40% still present pulmonary function abnormality three month after discharge, which did not vary by disease severity during hospitalization. 85.91% patients had abnormalities on chest CT, with fibrous stripes and ground glass opacity as the most common pattern.

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