Persistent Dyspnea After COVID-19 May Have Another Cause

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data-module="label-float"> <label for="site-search"> <span class="nav-search__label--desktop">What are you searching for?</span> <span class="nav-search__label--mobile">Search</span> </label> <input type="search" id="site-search" value=""> <button class="fat-button"><span class="a11y-sr-only">Submit</span></button> </p> </div> </li> </ul> </nav> </header>    <main class="site-main" id="main-content" tabindex="-1"> <div id="panelMainContent"> <article dcrname ="iwDCR0_041504"> <header class="-padding--horizontal" itemscope itemtype="http://schema.org/ScholarlyArticle"> <div class="content-header content-container -width--wide -centered"> <div class="tags"> <ul class="tag__list"> <li class="tag__item"> <a class="tag__link" href="/pulmonary/topic.aspx?id=1058">ARDS</a> </li> <li class="tag__item"> <a class="tag__link" href="/research-and-innovation/topic.aspx?id=1056">COVID-19</a> </li> <li class="tag__item"> <a class="tag__link" href="/pulmonary/specialty.aspx?id=1012">Pulmonary and Critical Care</a> </li> </ul> </div> <h1 class="content-header__heading" itemprop="name">Persistent Dyspnea After COVID-19 May Have Another Cause</h1> <div class="content-header__metadata"> <p class="content-metadata"> <span class="content-metadata__media -journal">Journal</span> <time class="date" datetime="2021-10-15" itemprop="datePublished">Published on October 15, 2021 </time> </p> <p data-module="share-links"> </p> <p class="citation"> Originally published on <cite itemprop="citation"><a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00346-1/fulltext">EClinicalMedicine</a></cite> </p> </div> </div> </header> <div class="-padding--vertical -padding--horizontal"> <div class="layout-columns -width--wide -centered"> <div class="layout-columns__main"> <div class="layout-columns__main__content"> <div class="content-summary"> <h3 class="content-summary__heading">Key findings</h3> <ul> <li>The aim of this study was to characterize dyspnea and exercise limitation in 18 patients with pulmonary post-acute sequelae of SARS-CoV-2 infection (PASC) and 18 age- and sex-matched controls who presented in the pre–COVID-19 era</li> <li>Cardiopulmonary exercise testing (CPET) results were normal in 67% of patients in both groups</li> <li>The two groups were similar with respect to resting heart rate, peak workload, peak oxygen consumption, ventilatory anaerobic threshold, oxygen pulse and ventilatory efficiency</li> <li>Pulmonary vascular disease and hyperventilatory response to exercise, hypothesized to be part of the pathology of PASC, did not seem to be features of PASC in this cohort. Physiologic abnormalities on CPET were mild across a range of initial COVID-19 severity</li> <li>These results suggest persistent dyspnea/exercise intolerance after COVID-19 is due to heterogeneous pathophysiology. The similarity of the COVID-19 patients compared to pre-COVID patients with unexplained dyspnea suggests that in many patients, dyspnea after mild COVID-19 may be caused by disorders not directly related to COVID-19</li> </ul> </div> <p>About 10% of people who recover from <a href="https://advances.massgeneral.org/research-and-innovation/topic.aspx?id=1056" target="_blank" rel="noopener noreferrer">COVID-19</a> experience symptoms lasting at least one month, and about 2.5% have symptoms for more than three months. Among the most common symptoms of long COVID, more formally termed post-acute sequelae of SARS-CoV-2 infection (PASC), are dyspnea and exercise intolerance.</p><div class="article__signup-container"> <div class="email-signup-inline__container -background--white"> <style> #email-signup-inline { /* 540px */ background-image: url(/assets/raw/email-signup/cardiovascular-sub-callout.jpg); } @media only screen and (-webkit-min-device-pixel-ratio: 2), only screen and (min--moz-device-pixel-ratio: 2), only screen and (-moz-min-device-pixel-ratio: 2), only screen and (-o-min-device-pixel-ratio: 2/1), only screen and (min-device-pixel-ratio: 2), only screen and (min-resolution: 192dpi), only screen and (min-resolution: 2dppx) { #email-signup-inline { /* 1080 width */ background-image: url(/assets/raw/email-signup/cardiovascular-sub-callout.jpg); } } </style> <div class="content-container -width--wide -centered email-signup-inline__wrapper" id="email-signup-inline"> <div class="email-signup-inline__logo"> <img alt="Massachusetts General Hospital building" src="/assets/logos/logo-white.svg"> </div> </div> <div class="email-signup-inline"> <h3 class="email-signup-inline__heading">Subscribe to the latest updates from Pulmonary & Critical Care Advances in Motion</h3> <p class="email-signup-inline__subheading"></p>  <meta http-equiv="Content-Type" content="text/html; 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Prior studies that made use of cardiopulmonary exercise testing (CPET) have detected ventilatory inefficiency, impaired heart rate recovery, and skeletal muscle deconditioning after acute COVID-19, but this research was conducted close to the time of hospital discharge.</p> <p>Now, <a href="https://advances.massgeneral.org/contributors/contributor.aspx?id=1587" target="_blank" rel="noopener noreferrer">Corey Hardin, MD, PhD</a>, and <a href="https://advances.massgeneral.org/contributors/contributor.aspx?id=1759" target="_blank" rel="noopener noreferrer">George A. Alba, MD</a>, both physicians in the <a href="https://www.massgeneral.org/medicine/pulmonary/" target="_blank" rel="noopener noreferrer">Division of Pulmonary and Critical Care Medicine</a> at Massachusetts General Hospital, and colleagues have conducted CPET in COVID-19 patients with long-term symptoms. In <em><a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370%2821%2900346-1/fulltext" target="_blank" rel="noopener noreferrer">EClinicalMedicine</a></em>, they describe the remarkable similarities between those patients and matched controls who presented with unexplained dyspnea in the pre–COVID-19 era.</p> <h2>Study Methods</h2> <p>The researchers compared two groups of adult outpatients who underwent CPET at Mass General:</p> <ul> <li><strong>PASC group</strong>—The first 18 patients referred by the Coronavirus Recovery Pulmonary Clinic for CPET because of persistent dyspnea and/or exercise intolerance; they were evaluated between August 1, 2020, and March 1, 2021, at a median of 258 days since infection</li> <li><strong>Comparator group</strong>—18 patients age- and sex-matched to the PASC group who underwent CPET between January 1, 2019, and January 1, 2020, for unexplained dyspnea and/or exercise intolerance</li> </ul> <h2>CPET Results</h2> <h4>PASC group</h4> <ul> <li>Normal—12 patients (67%)</li> <li>Abnormal cardiovascular response with impaired cardiac output during ventriculography—2 patients</li> <li>Early ventilatory anaerobic threshold (VAT)—2 patients</li> <li>Decreased oxygen pulse—4 patients, of whom three had normal cardiac function; in the other patient, invasive CPET showed impaired peripheral oxygen extraction was the chief exercise limitation</li> </ul> <h4>Comparator group</h4> <ul> <li>Normal—12 patients (67%)</li> <li>Abnormal cardiovascular response due to chronotropic incompetence—2 patients</li> <li>Doubling in VO2 at the onset of unloaded exercise suggesting a high internal cost of work observed in obesity—1 patient</li> <li>Decreased oxygen pulse—3 patients; in one of them invasive CPET confirmed impaired peripheral oxygen extraction</li> </ul> <h2>Comparison of Physiologic Variables</h2> <p>The PASC and comparator groups were similar with respect to resting heart rate, peak workload, peak oxygen consumption, VAT, oxygen pulse and ventilatory efficiency. Neither pulmonary vascular disease nor hyperventilatory response to exercise seemed to be a feature of PASC in this sample.</p> <p>Physiologic abnormalities on CPET were generally mild regardless of initial COVID-19 severity. The exceptions were observed in the two survivors of acute respiratory distress syndrome: one had impaired cardiac output due to chronotropic incompetence and the other had residual cardiomyopathy.</p> <h2>Applying the Findings to Practice</h2> <p>These results suggest persistent dyspnea/exercise intolerance after COVID-19 is due to heterogeneous pathophysiology. It is important to investigate the cause, especially as other conditions may develop concurrently with SARS-CoV-2 infection. This study further highlights the importance of non-COVID-19 controls in studies of PASC.</p> <p>In this study, most patients in both groups had normal findings on routine diagnostics, such as pulmonary function testing and high-resolution computed tomography. CPET may be needed to guide diagnosis and treatment.</p><p class="fat-link__wrapper u-text-right"> <a class="fat-link -caret -large" href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00346-1/fulltext">view original journal article <em>Subscription may be required</em></a> </p> <div class="article-attribution" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="article-attribution__logo" itemscope itemtype="http://schema.org/Periodical"> <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00346-1/fulltext"> <span class="a11y-sr-only" itemprop="name">EClinicalMedicine</span> </a> </p> <p class="article-attribution__metadata" itemscope itemtype="http://schema.org/PublicationIssue"> <span> Journal Article Published: <time datetime="2021-08-28" itemprop="datePublished">August 28, 2021</time> </span> <span> Dates of Study: <time datetime="2019-01-01" itemprop="startDate">January 1, 2019</time> - <time datetime="2021-03-01" itemprop="endDate">March 1, 2021</time> </span> </p> </div> <p class="cta">Learn more about the <a href="https://www.massgeneral.org/medicine/pulmonary/">Division of Pulmonary and Critical Care Medicine</a></p> <p class="cta">Learn about research in the <a href="https://www.massgeneral.org/medicine/pulmonary/about/contact">Division of Pulmonary and Critical Care Medicine</a></p> </div> </div> <aside class="layout-columns__sidebar -article__contributors"> <div class="layout-columns__sidebar__content"> <div class="profile-compact__wrapper"> <p class="u-no-margin"> <strong>Contributors</strong> </p> <div class="profile -compact" itemscope itemtype="http://schema.org/Person"> <div class="profile__content"> <h3 class="profile__name" itemprop="name"> <a href="/contributors/contributor.aspx?id=1587" itemprop="url">Charles Corey Hardin, MD, PhD ›</a></h3><p class="profile__title" itemprop="jobTitle">Physician, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Assistant Professor of Medicine, Harvard Medical School, Physician Investigator, Pulmonary, Mass General Research Institute</p> </div> <p class="profile__image"> <img alt="" itemprop="image" srcset="/assets/images/contributors/corey-hardin_advances.png, /assets/images/contributors/corey-hardin_advances_2x.png 2x" src="/assets/images/contributors/corey-hardin_advances.png"> </p> </div> <div class="profile -compact" itemscope itemtype="http://schema.org/Person"> <div class="profile__content"> <h3 class="profile__name" itemprop="name"> <a href="/contributors/contributor.aspx?id=1759" itemprop="url">George A. Alba, MD ›</a></h3><p class="profile__title" itemprop="jobTitle">Pulmonary and Critical Care Physician, Instructor of Medicine at Harvard Medical School</p> </div> <p class="profile__image"> <img alt="Dr. George Alba" itemprop="image" srcset="/assets/images/contributors/george_alba_advances.png, /assets/images/contributors/george_alba_advances_2x.png 2x" src="/assets/images/contributors/george_alba_advances.png"> </p> </div> </div> </div> </aside> <section class="topics-layout -article__related"> <div class="topics-layout__inner"> <div class="topics-layout__sidebar"> <h2 class="section-heading">Related topics</h2> </div> <div class="topics-layout__main"> <ul class="topics-list" data-module="topics-list"> <li><a href="/pulmonary/topic.aspx?id=1058">ARDS</a></li> <li><a href="/research-and-innovation/topic.aspx?id=1056">COVID-19</a></li> </ul> </div> </div> </section> <section class="-padding--horizontal -padding--vertical -article__related"> <div class="layout-columns -width--wide -centered"> <div class="layout-columns__pod--half"> <div class="content-tease" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="content-tease__topic"> <span class="highlight">Related</span> </p> <h3 class="content-tease__heading" itemprop="name"> <a href="/research-and-innovation/case-study.aspx?id=1007" itemprop="url">Pathways Case Record: An Epigenetic Memory of Infection in the Lung</a> </h3> <p itemprop="description"> <p></p> <p>The Pathways Consult Service at Massachusetts General Hospital investigated the case of a 75-year-old woman who was admitted for dyspnea and cachexia stemming from severe and progressive allergic bronchopulmonary aspergillosis and bronchiectasis.</p> <p></p> <p></p></p> <p class="content-tease__related"> <a href="/research-and-innovation/topic.aspx?id=1078" itemprop="relatedLink">Pathways</a>, <a href="/pulmonary/specialty.aspx?id=1012" itemprop="relatedLink">Pulmonary and Critical Care</a>, <a href="/research-and-innovation/specialty.aspx?id=1011" itemprop="relatedLink">Research and Innovation</a> </p> <p class="content-metadata"> <span class="content-metadata__media -case-study">Case Study</span> <time class="date" datetime="2021-08-31" itemprop="datePublished">August 31, 2021</time> </p> </div> </div> <div class="layout-columns__pod--half"> <div class="content-tease" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="content-tease__topic"> <span class="highlight">Related</span> </p> <h3 class="content-tease__heading" itemprop="name"> <a href="/pulmonary/journal.aspx?id=2049" itemprop="url">Plasma sST2 Provides Prognostic Information in COVID-19 Respiratory Failure</a> </h3> <p itemprop="description"> <p>Jehan W. Alladina, MD, and Benjamin D. Medoff, MD, of the Division of Pulmonary and Critical Care Medicine, and colleagues advise that high plasma concentrations of soluble suppression of tumorigenicity-2 may signify persistent lung injury in COVID-19 respiratory failure and the need for continued ventilatory support.</p></p> <p class="content-tease__related"> <a href="/research-and-innovation/topic.aspx?id=1056" itemprop="relatedLink">COVID-19</a>, <a href="/pulmonary/specialty.aspx?id=1012" itemprop="relatedLink">Pulmonary and Critical Care</a>, <a href="/research-and-innovation/specialty.aspx?id=1011" itemprop="relatedLink">Research and Innovation</a> </p> <p class="content-metadata"> <span class="content-metadata__media -journal">Journal</span> <time class="date" datetime="2021-09-16" itemprop="datePublished">September 16, 2021</time> </p> </div> </div> </div> </section> </div> </div> </article> </div> </main>  <footer class="site-footer"> <div class="-padding--horizontal"> <nav aria-label="Footer links" 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Persistent Dyspnea After COVID-19 May Have Another Cause - Mass General Advances in Motion