Assessment of pulmonary function and cardiopulmonary exercise function in patients with coronavirus disease 2019 during the early convalescent period_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

GENG Qian , ZHENG Jinping , LIANG Xiaolin , ZHONG Liping , YU Xinxin , HONG Yi , LI Shaoqiang , LI Shiyue ,  GAO Yi

Department of Pulmonary Diseases, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P. R. China;

Corresponding author：

GAO Yi, Email: misstall2@163.com

Keywords：

Coronavirus disease 2019; Pulmonary function; Cardiopulmonary exercise test; Exercise endurance

DOI：

10.7507/1671-6205.202010035

Video：

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Objective To investigate the static pulmonary function and cardiopulmonary exercise function of convalescent patients with coronavirus disease 2019 (COVID-19) after discharge.Methods Pulmonary function and cardiopulmonary exercise capacity of COVID-19 patients who admitted to our hospital from January to March 2020 were analyzed. The patients were divided into a non-critical group (3 cases of moderate illness, 2 cases of severe illness) and a critical group (5 cases of critical illness). Five of the 10 patients completed spirometry on day 14 after discharge. All patients performed spirometry, diffusion capacity and cardiopulmonary exercise test around 28 days post-discharge. Ten healthy subjects were used as a control group.Results Forced expiratory volume in one second of percent predicted (FEV₁%pred), forced vital capacity of percent predicted (FVC%pred), the FEV₁/FVC ratio (FEV₁/FVC), peak expiratory flow of percent predicted (PEF%pred) and mean forced expiratory flow between 25% and 75% of percent predicted (FEF_25%-75%%pred) of COVID-19 group were all within normal ranges, and there were no significant difference between COVID-19 group and the healthy group (P>0.05). Diffusion capacity (the carbon monoxide diffusion capacity of percent predicted, D_LCO%pred) decreased in 3 patients. The peak oxygen uptake of percent predicted (PeakVO₂%pred), oxygen uptake efficiency slope (OUES), Oxygen pulse of percent predicted (VO₂/HR%pred) in COVID-19 group decreased and were statistically significantly lower than the control group (P<0.05), but there was no significant difference in ventilatory equivalents for carbon dioxide at anaerobic threshold (VE/VCO₂@AT) and the slope of ventilatory equivalent for carbon dioxide (VE/VCO₂ slope) between the two groups (P>0.05). Compared to the non-critical group, the critical group displayed significantly lower FVC%pred and VO₂/HR%pred (P<0.05). A decrease in PeakVO₂%pred was observed in critical group, but the difference did not reach statistical significance (P>0.05). The FVC%pred and PEF%pred were significantly improved in 5 COVID-19 convalescents on Day 28 after discharge when comparing with day 14 (P<0.05).Conclusions In the first month after discharge, recovered COVID-19 patients mainly presented decreased exercise endurance in cardiopulmonary function tests.There are also some survivors with reduced diffusion function, but the impaired lung function of COVID-19 patients might return over time.

Citation： GENG Qian, ZHENG Jinping, LIANG Xiaolin, ZHONG Liping, YU Xinxin, HONG Yi, LI Shaoqiang, LI Shiyue, GAO Yi. Assessment of pulmonary function and cardiopulmonary exercise function in patients with coronavirus disease 2019 during the early convalescent period. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(5): 320-324. doi: 10.7507/1671-6205.202010035 Copy

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1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 2020, 382(8): 727-733.
2. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med, 2020, 382(18): 1708-1720.
3. Zha L, Shen Y, Pan L, et al. Follow-up study on pulmonary function and radiological changes in critically ill patients with COVID-19. J Infect, 2021, 82(1): 159-198.
4. 国家卫生健康委办公厅, 国家中医药管理局办公室. 《新型冠状病毒肺炎诊疗方案(试行第七版)》[EB/OL]. http://www.gov.cn/zhengce/zhengceku/2020-03/04/5486705/files/ae61004f930d47598711a0d4cbf874a9.pdf.
5. 中国医师协会呼吸医师分会肺功能与临床呼吸生理工作委员会, 中华医学会呼吸病学分会呼吸治疗学组肺功能专业组. 新型冠状病毒肺炎疫情防控期间开展肺功能检查的专家共识. 中华结核和呼吸杂志, 2020, 43(4): 302-307.
6. 中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南(第二部分)—肺量计检查. 中华结核和呼吸杂志, 2014, 37(7): 481-486.
7. 中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南—肺弥散功能检查. 中华结核和呼吸杂志, 2015, 38(3): 164-169.
8. Torres-Castro R, Solis-Navarro L, Sitjà-Rabert M, et al. Functional limitations post-COVID-19: a comprehensive assessment strategy. Arch Bronconeumol, 2021, 57 Suppl 1: 7-8.
9. Liu K, Zhang W, Yang Y, et al. Respiratory rehabilitation in elderly patients with COVID-19: a randomized controlled study. Complement Ther Clin Pract, 2020, 39: 101166.
10. Nusair S. Abnormal carbon monoxide diffusion capacity in COVID-19 patients at time of hospital discharge. Eur Respir J, 2020, 56(1): 2001832.
11. Chapman DG, Badal T, King GG, et al. Caution in interpretation of abnormal carbon monoxide diffusion capacity in COVID-19 patients. Eur Respir J, 2021, 57(1): 2003263.
12. Chen R, Gao Y, Chen M, et al. Impaired pulmonary function in discharged patients with COVID-19: more work ahead. Eur Respir J, 2020, 56(1): 2002194.
13. Frija-Masson J, Debray MP, Gilbert M, et al. Functional characteristics of patients with SARS-CoV-2 pneumonia at 30 days post-infection. Eur Respir J, 2020, 56(2): 2001754.
14. Huang Y, Tan C, Wu J, et al. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir Res, 2020, 21(1): 163.
15. American Thoracic Society, American College of Chest Physicians. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med, 2003, 167(2): 211-277.
16. Miyazaki A, Adachi H, Oshima S, et al. Blood flow redistribution during exercise contributes to exercise tolerance in patients with chronic heart failure. Circ J, 2007, 71(4): 465-470.
17. De Giorgio MR, Di Noia S, Morciano C, et al. The impact of SARS-CoV-2 on skeletal muscles. Acta Myol, 2020, 39(4): 307-312.
18. Meo SA, Alhowikan AM, Al-Khlaiwi T, et al. Novel coronavirus 2019-nCoV: prevalence, biological and clinical characteristics comparison with SARS-CoV and MERS-CoV. Eur Rev Med Pharmacol Sci, 2020, 24(4): 2012-2019.
19. Ong KC, Ng AW, Lee LS, et al. Pulmonary function and exercise capacity in survivors of severe acute respiratory syndrome. Eur Respir J, 2004, 24(3): 436-442.

Chinese Journal of Respiratory and Critical Care Medicine

Assessment of pulmonary function and cardiopulmonary exercise function in patients with coronavirus disease 2019 during the early convalescent period

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