Fatigue persists as lung function improves months after COVID-19 hospitalization

COVID-19 patients remain on the recovery phase 6 months after hospital admission, with persistent fatigue but improving lung function and quality of life, according to a study.

“To develop targeted and efficient follow-up programs for patients hospitalized with COVID-19, structured and detailed insights in recovery trajectory are required,” the researchers said.

“Home monitoring programs enable long-term detailed monitoring of patients and can facilitate personalized follow-up strategies in the future for patients with COVID-19 at low burden for patients and for the healthcare system,” they noted.

This prospective multicentre study used an online home monitoring program in adults hospitalized due to COVID-19 with radiological abnormalities to gain insights into long-term recovery following infection. Patients collected weekly home spirometry and pulse oximetry measurements and reported visual analogue scales on cough, dyspnoea, and fatigue for 6 months after discharge.

In addition, patients completed the fatigue assessment scale (FAS), global rating of change (GRC), EuroQol-5D-5L (EQ-5D-5L), and online tool for the assessment of burden of COVID-19 (ABCoV tool). The authors then analysed the results using mixed models.

Of the 133 patients (mean age 60 years) included in this study, 70.1 percent were male. Their mean baseline forced vital capacity was 3.25 L (95 percent confidence interval, 2.99‒3.44), which showed a 19.1-percent linear increase in 6 months (Δ0.62 L; p<0.005). [Respirology 2022;27:501-509]

Substantial fatigue was reported, with no improvement over time, but health status improved substantially. After 6 months, the general well-being of these patients was similar as before COVID-19. In addition, patients found the home spirometry useful and not burdensome.

In other studies, most patients hospitalized for COVID-19 had improved lung function over time. [Lancet 2021;398:747-758; Lancet Respir Med 2021;9:747-754; J Infect 2021;83:381-412]

“Compared with previous studies, we were able to describe a more granular overview of lung function recovery over time, because of the frequent home spirometry measurements,” the researchers said.

Most feared complication

The development of pulmonary fibrosis with progressive lung function impairment was one of the most feared complications of COVID-19 early in the pandemic.

Several reasons were suggested for such apprehension, including similarities in the pathophysiology of acute respiratory distress syndrome and pulmonary fibrosis, as well as the development of pulmonary fibrosis in some patients following severe acute respiratory distress syndrome coronavirus in 2003 and the Middle East respiratory syndrome coronavirus infection. [Thorax 2005;60:401-409; Indian J Radiol Imaging 2017;27:342-349]

Of note, at least five studies (ie, NCT04856111, NCT04282902, NCT04541680, NCT04607928, and NCT04619680) are currently ongoing to assess the use of antifibrotic medication in patients with post-COVID fibrosis.

“[A]lthough there may be a mechanistic rationale for the use of antifibrotic medication post-COVID, our data suggest that the target population for the use of antifibrotic medication post-COVID-19 will be limited,” the researchers said. [Front Med 2020;7:539; Lancet Respir Med 2020;8:807-815]

Overall, home monitoring is useful at obtaining better insights into the recovery trajectory of individual COVID-19 patients and providing personalized care following hospitalization.

“In-hospital follow-up could be discontinued earlier, guided by home monitoring results,” the researchers said. “In addition, home monitoring has the potential to identify the small group of patients with abnormal recovery trajectories or who may develop progressive pulmonary fibrosis.”