COVID-19 patients can suffer long-term lung and heart damage but, for lots of, this has a tendency to fortify over the years, according to the first, prospective follow-up of patients infected with the coronavirus, presented at the European Respiratory Society International Congress.
Researchers in the COVID-19 ‘hot spot’ in the Tyrolean region of Austria recruited consecutive coronavirus patients to their study, who were hospitalised at the University Clinic of Internal Medicine in Innsbruck, the St Vinzenz Hospital in Zams or the cardio-pulmonary rehabilitation centre in Munster, Austria. In their presentation to the virtual congress, they reported on the first 86 patients enrolled between 29 April and 9 June, even if now they have got over 150 patients participating.
The patients were scheduled to go back for evaluation six, 12 and 24 weeks after their discharge from hospital. Right through these visits, clinical examinations, laboratory tests, analysis of the amounts of oxygen and carbon dioxide in arterial blood, lung operate tests, computed tomography (CT) scans and echocardiograms were carried out.
At the time of their first visit, more than half of the patients had no less than one persistent symptom, predominantly breathlessness and coughing, and CT scans still showed lung damage in 88% of patients. Alternatively, by the point of their next visit 12 weeks after discharge, the symptoms had improved and lung damage used to be reduced to 56%. At this stage, it is too early to have resulted from the evaluations at 24 weeks.
“The naughty news is that people show lung impairment from COVID-19 weeks after discharge; the excellent news is that the impairment has a tendency to ameliorate over the years, which suggests the lungs have a mechanism for repairing themselves,” said Dr Sabina Sahanic, who is a clinical PhD student at the University Clinic in Innsbruck and a part of the team that carried out the study, which includes Associate Professor Ivan Tancevski, Professor Judith Loffler-Ragg and Dr Thomas Sonnweber in Innsbruck.
The average age of the 86 patients included in this presentation used to be 61 and 65% of them were male. Almost half of them were current or former smokers and 65% of hospitalised COVID-19 patients were overweight or obese. Eighteen (21%) had been in an intensive care unit (ICU), 16 (19%) had had invasive mechanical ventilation, and the average length of stay in hospital used to be 13 days.
A complete of 56 patients (65%) showed persistent symptoms at the time of their six-week visit; breathlessness (dyspnoea) used to be the commonest symptom (40 patients, 47%), followed by coughing (13 patients, 15%). By the 12-week visit, breathlessness had improved and used to be present in 31 patients (39%); on the other hand, 13 patients (15%) were still coughing
Tests of lung operate included FEV1 (the amount of air that may be expelled forcibly in one second), FVC (the complete volume of air expelled forcibly), and DLCO (a test to measure how polite oxygen passes from the lungs into the blood). These measurements also improved between the visits at six and 12 weeks. At six weeks, 20 patients (23%) showed FEV1 as less than 80% of normal, making improvements to to 18 patients (21%) at 12 weeks, 24 patients (28%) showed FVC as less than 80% of normal, making improvements to to 16 patients (19%) at 12 weeks, and 28 patients (33%) showed DLCO as less than 80% of normal, making improvements to to 19 patients (22%) at 12 weeks.
The CT scans showed that the score that defines the severity of overall lung damage decreased from eight points at six weeks to four points at twelve weeks. Damage from inflammation and fluid in the lungs caused by the coronavirus, which shows up on CT scans as white patches referred to as ‘ground-glass’, also improved; it used to be present in 74 patients (88%) at six weeks and 48 patients (56%) at 12 weeks.
At the six-week visit, the echocardiograms showed that 48 patients (58.5%) had dysfunction of the left ventricle of the heart at the point when it is relaxing and dilating (diastole). Organic indicators of heart damage, blood clots and inflammation were all significantly elevated.
Dr Sahanic said: “We don’t consider left ventricular diastolic dysfunction is particular to COVID-19, but more a signal of the severity of the disease in general. Fortunately, in the Innsbruck cohort, we did not observe any severe coronavirus-associated heart dysfunction in the post-acute phase. The diastolic dysfunction that we observed also tended to fortify with time.”
She concluded: “The findings from this study show the importance of executing structured follow-up handle patients with severe COVID-19 infection. Importantly, CT unveiled lung damage in this patient group that used to be not identified by lung operate tests. Knowing how patients have been affected long-term by the coronavirus might enable symptoms and lung damage to be treated much earlier and might have a remarkable affect on further medical recommendations and advice.”
In a second poster presentation to the Congress, Ms Yara Al Chikhanie, a PhD student at the Dieulefit Sante clinic for pulmonary rehabilitation and the Hp2 Lab at the Grenoble Alps University, France, said that the sooner COVID-19 patients started a pulmonary rehabilitation programme after coming off ventilators, the better and faster their recovery.
Patients with severe COVID-19 can spend weeks in intensive care on ventilators. The lack of physical movement, on top of the severe infection and inflammation, ends up in severe muscle loss. The muscles for breathing are also affected, which weakens the breathing capacity. Pulmonary rehabilitation, which involves physical exercises and advice on managing symptoms, including shortness of breath and post-traumatic stress disorder, is the most important for helping patients to recuperate fully.
Ms Al Chikhanie used a walking test to assess the weekly progress of 19 patients  who had spent an average of three weeks in intensive care and two weeks in a pulmonary ward before being transferred to the Dieulefit Sante clinic for pulmonary rehabilitation. Most were still unable to walk when they arrived, and they spent an average of three weeks in rehabilitation. The walking test measured how far the patients could walk in six minutes. To start with, they were ready to walk an average of 16% of the distance that, in theory, they must be capable of walk usually whether healthy. After three weeks of pulmonary rehabilitation, this increased to an average of 43%, which used to be a remarkable gain but still a serious impairment.
Ms Al Chikhanie said: “An important finding used to be that patients who were admitted to pulmonary rehabilitation shortly after leaving intensive care, progressed faster than those who spent a longer period in the pulmonary ward where they remained inactive. The sooner rehabilitation started and the longer it lasted, the faster and better used to be the improvement in patients’ walking and breathing capacities and muscle gain. Patients who started rehabilitation in the week after coming off their ventilators progressed faster than those who were admitted after two weeks. But how soon they are able to start rehabilitation depends on the patients being judged medically steady by their doctors. Despite the remarkable improvement, the average period of three weeks in rehabilitation wasn’t enough for them to recuperate totally.
“These findings propose that doctors must start rehabilitation as soon as conceivable, that patients must try to spend as little time as conceivable being inactive and that they must enrol with motivation in the pulmonary rehabilitation programme. Whether their doctors pass judgement on it to be secure, patients must start physical therapy exercises while still in the hospital’s pulmonary ward.”
Thierry Troosters, who used to be not involved in the study, is President of the European Respiratory Society and Professor in Rehabilitation Sciences at KU Leuven, Belgium. He said: “Anecdotal evidence has been emerging since the start of the COVID-19 pandemic that many patients suffer debilitating long-term after-effects from the coronavirus. Dr Sahanic’s presentation is important because it is without doubt one of the first, comprehensive prospective follow-ups of these patients and shows the serious, long-term affect of COVID-19 on the lungs and heart. It is sobering to hear that more than half of the patients in this study showed damage to their lungs and hearts 12 weeks after hospital discharge, and that almost 40% were still suffering from symptoms such as breathlessness. The excellent news, on the other hand, is that patients do fortify and this surely will help the rehabilitation process, as discussed in the second one presentation.
“Ms Al Chikhanie’s research complements this information and shows how fundamental it is for patients to begin pulmonary rehabilitation as soon as they’re physically ready to take action. For this reason rehabilitation may also be started in the ward whether programmes are adapted to the capabilities of the patient. This is perfectly in line with a recent remark of our Society where we also advocate for tailor-made rehabilitation. It is lucid from both these studies that rehabilitation, including physical and psychologic components, must be to be had for patients as soon as conceivable and it must continue for weeks whether not months after they have got been discharged from hospital with a view to give patients the most efficient chances of a good recovery. Governments, national health services and products and employers must be made aware of these findings and plan accordingly.”
(This story has been published from a wire agency feed without modifications to the text. Only the headline has been changed.)
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