Lung function and breathing patterns in hospitalised COVID-19 survivors: a review of post-COVID-19 Clinics

James A Stockley, Eyas A Alhuthail, Andrew M Coney, Dhruv Parekh, Tarekegn Geberhiwot, Nandan Gautum, Shyam C Madathil, Brendan G Cooper

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Introduction: There is relatively little published on the effects of COVID-19 on respiratory physiology, particularly breathing patterns. We sought to determine if there were lasting detrimental effect following hospital discharge and if these related to the severity of COVID-19. Methods: We reviewed lung function and breathing patterns in COVID-19 survivors > 3 months after discharge, comparing patients who had been admitted to the intensive therapy unit (ITU) (n = 47) to those who just received ward treatments (n = 45). Lung function included spirometry and gas transfer and breathing patterns were measured with structured light plethysmography. Continuous data were compared with an independent t-test or Mann Whitney-U test (depending on distribution) and nominal data were compared using a Fisher’s exact test (for 2 categories in 2 groups) or a chi-squared test (for > 2 categories in 2 groups). A p-value of < 0.05 was taken to be statistically significant. Results: We found evidence of pulmonary restriction (reduced vital capacity and/or alveolar volume) in 65.4% of all patients. 36.1% of all patients has a reduced transfer factor (TL CO) but the majority of these (78.1%) had a preserved/increased transfer coefficient (K CO), suggesting an extrapulmonary cause. There were no major differences between ITU and ward lung function, although K CO alone was higher in the ITU patients (p = 0.03). This could be explained partly by obesity, respiratory muscle fatigue, localised microvascular changes, or haemosiderosis from lung damage. Abnormal breathing patterns were observed in 18.8% of subjects, although no consistent pattern of breathing pattern abnormalities was evident. Conclusions: An “extrapulmonary restrictive” like pattern appears to be a common phenomenon in previously admitted COVID-19 survivors. Whilst the cause of this is not clear, the effects seem to be similar on patients whether or not they received mechanical ventilation or had ward based respiratory support/supplemental oxygen.

Original languageEnglish
Article number255
Number of pages12
JournalRespiratory research
Issue number1
Publication statusPublished - 27 Sept 2021

Bibliographical note

Funding Information:
Dr Dhruv Parekh is supported but United Kingdom Research and Innovation (UKRI) and the National Institute for Health Research (NIHR).

Publisher Copyright:
© 2021, The Author(s).


  • Interstitial Lung Disease
  • Respiratory Physiology
  • Ventilation
  • Infectious Disease
  • Critical Care and
  • Emergency Medicine


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