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Vontetsianos A, Chynkiamis N, Anagnostopoulou C, Lekka C, Zaneli S, Anagnostopoulos N, Rovina N, Kampolis CF, Papaioannou AI, Kaltsakas G, Vogiatzis I, Stratakos G, Bakakos P, Koulouris N. Small Airways Dysfunction and Lung Hyperinflation in Long COVID-19 Patients as Potential Mechanisms of Persistent Dyspnoea. Adv Respir Med 2024; 92:329-337. [PMID: 39311110 PMCID: PMC11417746 DOI: 10.3390/arm92050031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/18/2024] [Accepted: 08/21/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Reticulation, ground glass opacities and post-infection bronchiectasis are present three months following hospitalisation in patients recovering from SARS-CoV-2 infection and are associated with the severity of acute infection. However, scarce data exist on small airways impairment and lung hyperinflation in patients with long COVID-19. AIM To evaluate small airways function and lung hyperinflation in previously hospitalised patients with long COVID-19 and their association with post-COVID-19 breathlessness. METHODS In total, 33 patients (mean ± SD, 53 ± 11 years) with long COVID-19 were recruited 149 ± 90 days following hospital discharge. Pulmonary function tests were performed and lung hyperinflation was defined as RV/TLC ≥ 40%. Small airways function was evaluated by measuring the closing volume (CV) and closing capacity (CC) using the single-breath nitrogen washout technique (SBN2W). RESULTS CC was 115 ± 28% pred. and open capacity (OC) was 90 ± 19. CC was abnormal in 13 patients (39%), CV in 2 patients (6.1%) and OC in 9 patients (27%). Lung hyperinflation was present in 15 patients, whilst the mean mMRC score was 2.2 ± 1.0. Lung hyperinflation was associated with CC (r = 0.772, p = 0.001), OC (r = 0.895, p = 0.001) and mMRC (r = 0.444, p = 0.010). CONCLUSIONS Long COVID-19 patients present with small airways dysfunction and lung hyperinflation, which is associated with persistent dyspnoea, following hospitalisation.
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Affiliation(s)
- Angelos Vontetsianos
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
| | - Nikolaos Chynkiamis
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
- Thorax Research Foundation, 11521 Athens, Greece
| | - Christina Anagnostopoulou
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
| | - Christiana Lekka
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
| | - Stavrina Zaneli
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
| | - Nektarios Anagnostopoulos
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
| | - Nikoleta Rovina
- 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Christos F. Kampolis
- Department of Emergency Medicine, “Hippokration” General Hospital of Athens, 11527 Athens, Greece;
| | - Andriana I. Papaioannou
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
| | - Georgios Kaltsakas
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
- Lane Fox Respiratory Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Centre of Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 1UL, UK
| | - Ioannis Vogiatzis
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne NE1 8ST, UK
| | - Grigorios Stratakos
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
| | - Petros Bakakos
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
| | - Nikolaos Koulouris
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (I.V.); (G.S.); (P.B.); (N.K.)
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Mercan A, Beşe SA, Köksal ZG, Kara SS, Uysal P, Erge D. Impulse oscillometry assessment of respiratory function in pediatric patients with a history of COVID-19. Pediatr Pulmonol 2024; 59:1394-1401. [PMID: 38390766 DOI: 10.1002/ppul.26926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE While coronavirus disease 2019 (COVID-19) is generally considered to exhibit a less severe clinical course in children than in adults, studies have demonstrated that respiratory symptoms can endure for more than 3 months following infection in at least one-third of pediatric cases. The present study evaluates the respiratory functions of children aged 3-15 years within 3-6 months of their recovery from COVID-19 using impulse oscillometry (IOS) and compares them with the values of healthy children. METHODS Included in this prospective cross-sectional study were 63 patients (patient group) aged 3-15 years who contracted COVID-19 between December 2021 and May 2022, as well as 57 healthy children as a control group, matched for age and sex. The demographic, clinical, and laboratory data of the patients were recorded, and respiratory function was assessed based on airway resistance (zR5, zR20, R5-20) and reactance (zX5, zX20, reactance area [AX], resonant frequency [Fres]) using an IOS device. RESULTS There were no significant differences in the age, weight, height, and body weight z score values of the two groups (p > .05). While the zR5 and R5-20 levels of the patient group were higher (p = .008 and p < .001, respectively) than those of the controls, the zR20, AX, and Fres values did not differ significantly between the groups (p > .05). The parameters indicating the reactance, including zX5 and zX20, were significantly lower in the patient group than in the control group (p = .028 and p < .001, respectively). CONCLUSION Total and peripheral airway resistances were found to be elevated in children who had recovered from COVID-19 in the preceding 3-6 months.
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Affiliation(s)
- Adnan Mercan
- Division of Pediatric Immunology and Allergy, Department of Pediatrics, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Simge Atar Beşe
- Division of Pediatric Immunology and Allergy, Department of Pediatrics, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Zeynep Güleç Köksal
- Division of Pediatric Immunology and Allergy, Department of Pediatrics, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Soner Sertan Kara
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Pınar Uysal
- Division of Pediatric Immunology and Allergy, Department of Pediatrics, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Duygu Erge
- Division of Pediatric Immunology and Allergy, Department of Pediatrics, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
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Kostorz-Nosal S, Jastrzębski D, Błach A, Skoczyński S. Window of opportunity for respiratory oscillometry: A review of recent research. Respir Physiol Neurobiol 2023; 316:104135. [PMID: 37536553 DOI: 10.1016/j.resp.2023.104135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/05/2023]
Abstract
Oscillometry has been around for almost 70 years, but there are still many unknowns. The test is performed during tidal breathing and is therefore free from patient-dependent factors that could influence the results. The Forced Oscillation Technique (FOT), which requires minimal patient cooperation, is gaining ground, particularly with elderly patients and children. In pulmonology, it is a valuable tool for assessing obstructive conditions (with a distinction between central and peripheral obstruction) and restrictive disorders (intrapulmonary and extrapulmonary). Its sensitivity allows the assessment of bronchodilator and bronchoconstrictor responses. Different lung diseases show different patterns of changes in FOT, especially studied in asthma and chronic obstructive pulmonary disease. Because of these differences, many studies have analysed the usefulness of this technique in different areas of medicine. In this paper, the authors would like to present the basics of oscillometry with the areas of its most recent clinical applications.
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Affiliation(s)
- Sabina Kostorz-Nosal
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland.
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
| | - Anna Błach
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Szymon Skoczyński
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
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Cherrez-Ojeda I, Osorio MF, Robles-Velasco K, Calderón JC, Cortés-Télles A, Zambrano J, Guarderas C, Intriago B, Gochicoa-Rangel L. Small airway disease in post-acute COVID-19 syndrome, a non-conventional approach in three years follow-up of a patient with long COVID: a case report. J Med Case Rep 2023; 17:386. [PMID: 37691104 PMCID: PMC10494419 DOI: 10.1186/s13256-023-04113-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Small airways disease (SAD), a novel finding described in post-acute COVID-19 patients, should be suspected when respiratory symptoms continue, air trapping persists on expiratory CT scans, and imaging findings fail to improve despite objectively better conventional pulmonary function test (PFT) parameters. The forced oscillation technique (FOT) and Multiple breathing washout (MBW) are both very sensitive methods for detecting anomalies in the peripheral airways. CASE PRESENTATION We discuss the case of a 60-year-old Hispanic patient who had severe COVID-19 pneumonia and developed dyspnea, fatigue, and limited daily activity a year later. The PFTs revealed restrictive lung disease, as seen by significant diffusing capacity of the lungs for carbon monoxide (DLCO) decrease, severe desaturation, and poor 6-min walk test (6MWT) performance. The patient was treated with lowering corticosteroids as well as pulmonary rehabilitation (PR). During the 24-month follow-up, the dyspnea and fatigue persisted. On PFTs, 6MWT performance and restricted pattern improved slightly, but MBW discovered significant ventilatory inhomogeneity. FOT revealed substantial peripheral airway obstructive abnormalities. On CT scans, air trapping and ground-glass opacities (GGO) improved somewhat. The patient used a bronchodilator twice a day and low-dose inhaled corticosteroids (160 µg of budesonide and 4.5 µg of formoterol fumarate dihydrate) for nine months. PR sessions were resuming. The restricting parameters were stabilized and the DLCO had normalized after 36 months, with a 6MWT performance of 87% but significant desaturation. The CT scan revealed traction bronchiectasis, low GGO, and persistent air trapping. Without normalization, FOT and MBW scores improved, indicating small airway disease. CONCLUSIONS The necessity of integrating these tests when detecting SAD is emphasized in our paper. This article lays the foundation for future research into the best ways to manage and monitor SAD in post-acute COVID-19 patients.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador.
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.
| | - Maria F Osorio
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador
| | - Karla Robles-Velasco
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | | | - Arturo Cortés-Télles
- Departamento de Neumología y Cirugía de Tórax, Hospital Regional de Alta Especialidad de Yucatán, Mérida, Mexico
| | - Jorge Zambrano
- Centro de enfermedades respiratorias, rehabilitación y sueño (CERS), Guayaquil, Ecuador
| | - Cristian Guarderas
- Centro de enfermedades respiratorias, rehabilitación y sueño (CERS), Guayaquil, Ecuador
| | - Belen Intriago
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Ciudad de México, Mexico
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