Functional respiratory complaints among COVID-19 survivors: a prospective cohort study
- Antoine Beurnier1,2,3,15,
- Laurent Savale1,2,4,15,
- Xavier Jaïs1,2,4,
- Romain Colle1,5,
- Tai Pham1,6,7,
- Luc Morin1,8,
- Sophie Bulifon1,2,4,
- Nicolas Noël1,9,
- Athénaïs Boucly1,2,4,
- Benoit Delbarre4,
- Nathan Ebstein1,2,4,
- Samy Figueiredo1,10,
- Matthieu Gasnier1,5,
- Anatole Harrois1,10,
- Etienne-Marie Jutant1,2,4,
- Mitja Jevnikar1,2,4,
- Sophia Keddache1,2,4,
- Anne-Lise Lecoq1,11,
- Olivier Meyrignac1,12,
- Florence Parent1,2,4,
- Jérémie Pichon1,2,4,
- Mariana Preda1,2,4,
- Anne Roche1,2,4,
- Andrei Seferian1,2,4,
- Marie-France Bellin1,12,
- Thomas Gille13,14,
- Emmanuelle Corruble1,5,
- Olivier Sitbon1,2,4,
- Laurent Becquemont1,11,
- Xavier Monnet1,2,6,
- Marc Humbert1,2,4,
- David Montani1,2,4⇑,
- Comebac Investigators
- 1Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- 2INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- 3AP-HP, Department of Physiology – Pulmonary Function Testing, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- 4AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital Bicêtre, DMU 5 Thorinno, Le Kremlin-Bicêtre, France
- 5AP-HP, Service de psychiatrie, Hôpital de Bicêtre, DMU 11, équipe MOODS, INSERM U1178, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Le Kremlin-Bicêtre, France
- 6AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Le Kremlin-Bicêtre, France
- 7INSERM UMR_S1018, Equipe d'Epidémiologie respiratoire intégrative, CESP, Villejuif, France
- 8AP-HP, Service de Réanimation Pédiatrique et Médecine Néonatale, Hôpital de Bicêtre, Santé de l'Enfant et de l'Adolescent, Le Kremlin-Bicêtre, France
- 9AP-HP, Service de médecine interne et immunologie clinique, Hôpital de Bicêtre, DMU 7 Endocrinologie-immunités-inflammations-cancer-urgences, Le Kremlin-Bicêtre, France AP-
- 10HP, Service de réanimation chirurgicale, Hôpital de Bicêtre, DMU 12 Anesthésie, réanimation, douleur, Le Kremlin-Bicêtre, France
- 11AP-HP, Centre de recherche Clinique Paris-Saclay, DMU 13 Santé publique, Information médicale, Appui à la recherche clinique, INSERM U1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations)
- 12AP-HP, Service de radiologie diagnostique et interventionnelle, Hôpital de Bicêtre, DMU 14 Smart Imaging, BioMaps, Le Kremlin-Bicêtre, France
- 13INSERM U1272, Hypoxia and the Lung, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
- 14AP-HP, Department of Physiology and Functional Explorations, DMU NARVAL, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Sites Avicenne (Bobigny) et Jean Verdier (Bondy), France
- 15AB and LS contributed equally
- Corresponding author: David Montani (davidmontani{at}gmail.com)
Abstract
Background Dyspnoea is a common persistent symptom after COVID-19. Whether it is associated with functional respiratory disorders remains unclear.
Methods We assessed the proportion and characteristics of patients with “functional respiratory complaints” (FRCs) (as defined by Nijmegen Questionnaire>22) among 177 post-COVID-19 individuals who benefited from outclinic evaluation in the COMEBAC study (i.e., symptomatic and/or ICU survivors at 4 months). In a distinct explanatory cohort of 21 consecutive individuals with unexplained post-COVID-19 dyspnoea after routine tests, we also analysed the physiological responses to incremental cardio-pulmonary exercise testing (CPET).
Findings In the COMEBAC cohort, 37 had significant FRCs (20.9%, IC95: 14.9–26.9). The prevalence of FRCs ranged from 7.2% (ICU patients) to 37.5% (non-ICU patients). The presence of FRCs was significantly associated with more severe dyspnoea, lower 6-minute walk distance, more frequent psychological and neurological symptoms (cognitive complaint, anxiety, depression, insomnia and post-traumatic stress disorders) and poorer quality of life (all p<0.01). In the explanatory cohort, 7/21 patients had significant FRCs. Based on CPET, dysfunctional breathing was identified in 12/21 patients, 5/21 had normal CPET, 3/21 had deconditioning and 1/21 had evidence of uncontrolled cardiovascular disease.
Interpretation FRCs are common during post-COVID-19 follow-up, especially among patients with unexplained dyspnoea. Diagnosis of dysfunctional breathing should be considered in those cases.
Funding Assistance Publique-Hôpitaux de Paris.
Footnotes
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Conflict of Interest: Antoine Beurnier reports personal fees from Sanofi, personal fees from Astrazeneca, outside the submitted work.
Conflict of Interest: Laurent Savale reports personal fees and non-financial support from Janssen & Janssen, personal fees and non-financial support from MSD, grants, personal fees and non-financial support from GSK, outside the submitted work.
Conflict of Interest: Xavier Jaïs reports grants and personal fees from Janssen, grants and personal fees from MSD, grants from Bayer, grants from GSK, outside the submitted work.
Conflict of Interest: Thomas Gille reports personal fees from ROCHE S.A.S., other from OXYVIE (oxygen provider), other from VIVISOL France (oxygen provider), other from MENANIRI France, outside the submitted work.
Conflict of Interest: Olivier Sitbon reports grants from Acceleron, AOP Orphan, Janssen, GSK, MSD; consulting fees from Altavant, Gossamer Bio, Janssen, MSD; lecture honoraria from AOP Orphan, Janssen, Ferrer, MSD; participation on advisory boards for Acceleron, Altavant, Gossamer Bio, Janssen, MSD, Ferrer; outside the submitted work.
Conflict of Interest: Marc Humbert reports grants from Acceleron, AOP Orphan, Janssen, Merck, Shou Ti; consulting fees from Acceleron, Aerovate, Altavant, AOP Orphan, Bayer, Chiesi, Ferrer, Janssen, Merck, MorphogenIX, Shou Ti, United Therapeutics; lecture honoraria from Janssen, Merck; advisory board participation for Acceleron, Altavant, Janssen, Merck, United Therapeutics; outside the submitted work.
Conflict of Interest: David Montani reports grants from Acceleron, Janssen, Merck; consulting fees from Acceleron; lecture honoraria from Bayer, Janssen, Merck; outside the submitted work.
Conflict of Interest: All other authors have nothing to disclose.
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- Received January 30, 2023.
- Accepted February 6, 2023.
- Copyright ©The authors 2023
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