Evaluating and Addressing Long COVID Symptoms

A high proportion of patients who survive a COVID-19 infection report lasting symptoms weeks and months later. This condition is known as long COVID. Two posters presented at the European Respiratory Society International Congress 2021 reviewed post–COVID-19 impairment.

The first report from Switzerland evaluated performance status in patients 6 to 12 months after being hospitalized for COVID-19 as part of an ongoing single-center study.¹ The researchers recruited 31 patients and performed a clinical assessment, body plethysmography/lung diffusion for carbon monoxide, nitrogen multiple breath washout, cardiopulmonary exercise testing, and polygraphy 6 months after discharge.

The mean age of the enrolled patients was 63 years and 68% were male. The mean number of comorbidities was 3. More than half were ex-smokers (43%) or current smokers (13%) and 23% were obese.

The interim analysis found 74% of patients still reported symptoms at their follow-up. The most common symptom was weakness (40%), followed by dyspnea (37%) and cough (27%). Half (52%) had lung function impairment, of which 5% had preexisting chronic obstructive pulmonary disease or asthma.

The researchers conducted cardiopulmonary exercise testing in 29 patients and found 59% had some form of limitation. The most prevalent limitation was cardiovascular (35%). The cause of persistent symptoms is unknown, said poster author and presenter Emanuel Cardoso of the University Hospital Basel in Switzerland. He added that guidelines are needed for a holistic approach to post–COVID-19 screening.

“Clinical features at infection might predict the extent of long term exercise capacity impairment,” the authors wrote in the poster.

In the second study, researchers from France analyzed the effects of pulmonary rehabilitation (PR) to treat the major symptoms of long COVID.²

Poster author and presenter Virginie Molinier, PhD, noted that studies on comparable diseases have shown that without intervention, spontaneous recovery of lasting symptoms is unlikely. The study enrolled 15 patients. Their mean age was 51 years and 73% were female. Eleven patients had received home care for their COVID-19, 3 were hospitalized, and 1 was treated in the intensive care unit. One-third (n = 5) had no comorbidities, while 6 had 1 comorbidity, 3 had 2 comorbidities, and 1 patient had more than 2 comorbidities.

PR relieved dyspnea and fatigue in patients. The mean score of the Multidimensional Fatigue Inventory, a 20-item scale, decreased from 65.33 to 47.13 after PR. The mean score of the Dyspnea-12 Questionnaire decreased from 16.20 to 5.60. PR also improved exercise tolerance based on the 6-minute walking test.

“PR seems effective to relieve dyspnea and fatigue in patients with residual COVID-19 symptoms several months after initial infection,” the authors concluded. “In addition, data suggest that PR is safe and feasible.”

Molinier noted that more research in a larger cohort of patients is needed to confirm the preliminary findings and to understand if PR can impact other symptoms reported in long COVID.

References

1. Cardoso E, Darie A, Herrmann M, et al. Post-COVID impairment: objective multidimensional assessment of long term effects in hospitalized, non-ICU patients. Presented at: ERS 2021; September 4-8, 2021. Virtual. Poster 1163.

2. Alexandre F, Castanyer A, Vernet A, et al. Effects of pulmonary rehabilitation on major symptoms of long COVID (post-COVID-19 syndrome): preliminary results. Presented at: ERS 2021; September 4-8, 2021. Virtual. Poster 3896.