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. 2023 Feb 20;9(1):00274-2022.
doi: 10.1183/23120541.00274-2022. eCollection 2023 Jan.

Characteristics and risk factors for post-COVID-19 breathlessness after hospitalisation for COVID-19

Luke Daines  1 , Bang Zheng  1 , Omer Elneima  2 , Ewen Harrison  1 , Nazir I Lone  1 , John R Hurst  3 , Jeremy S Brown  3 , Elizabeth Sapey  4 , James D Chalmers  5 , Jennifer K Quint  6 , Paul Pfeffer  7 , Salman Siddiqui  2 , Samantha Walker  8 , Krisnah Poinasamy  8 , Hamish McAuley  2 , Marco Sereno  2 , Aarti Shikotra  2 , Amisha Singapuri  2 , Annemarie B Docherty  1 , Michael Marks  9 , Mark Toshner  10 , Luke S Howard  11 , Alex Horsley  12 , Gisli Jenkins  6 , Joanna C Porter  3 , Ling-Pei Ho  13 , Betty Raman  14 , Louise V Wain  15 , Christopher E Brightling  2 , Rachael A Evans  2 , Liam G Heaney  16 , Anthony De Soyza  17 , Aziz Sheikh  1
Affiliations

Characteristics and risk factors for post-COVID-19 breathlessness after hospitalisation for COVID-19

Luke Daines et al. ERJ Open Res. .

Abstract

Background: Persistence of respiratory symptoms, particularly breathlessness, after acute coronavirus disease 2019 (COVID-19) infection has emerged as a significant clinical problem. We aimed to characterise and identify risk factors for patients with persistent breathlessness following COVID-19 hospitalisation.

Methods: PHOSP-COVID is a multicentre prospective cohort study of UK adults hospitalised for COVID-19. Clinical data were collected during hospitalisation and at a follow-up visit. Breathlessness was measured by a numeric rating scale of 0-10. We defined post-COVID-19 breathlessness as an increase in score of ≥1 compared to the pre-COVID-19 level. Multivariable logistic regression was used to identify risk factors and to develop a prediction model for post-COVID-19 breathlessness.

Results: We included 1226 participants (37% female, median age 59 years, 22% mechanically ventilated). At a median 5 months after discharge, 50% reported post-COVID-19 breathlessness. Risk factors for post-COVID-19 breathlessness were socioeconomic deprivation (adjusted OR 1.67, 95% CI 1.14-2.44), pre-existing depression/anxiety (adjusted OR 1.58, 95% CI 1.06-2.35), female sex (adjusted OR 1.56, 95% CI 1.21-2.00) and admission duration (adjusted OR 1.01, 95% CI 1.00-1.02). Black ethnicity (adjusted OR 0.56, 95% CI 0.35-0.89) and older age groups (adjusted OR 0.31, 95% CI 0.14-0.66) were less likely to report post-COVID-19 breathlessness. Post-COVID-19 breathlessness was associated with worse performance on the shuttle walk test and forced vital capacity, but not with obstructive airflow limitation. The prediction model had fair discrimination (concordance statistic 0.66, 95% CI 0.63-0.69) and good calibration (calibration slope 1.00, 95% CI 0.80-1.21).

Conclusions: Post-COVID-19 breathlessness was commonly reported in this national cohort of patients hospitalised for COVID-19 and is likely to be a multifactorial problem with physical and emotional components.

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Conflict of interest statement

Conflict of interest: C.E. Brightling, A. Shikotra and M. Sereno report grants from UKRI–MRC/DHSC–NIHR during the conduct of the study. J.D. Chalmers reports grants and personal fees from AstraZeneca and BI, personal fees from Chiesi, grants from Gilead Sciences, grants and personal fees from GSK and Insmed, personal fees from Janssen, grants and personal fees from Novartis, and personal fees from Zambon outside the submitted work, and is an associate editor of this journal. A. De Soyza reports grants, personal fees and other support from AstraZeneca, Bayer, BI, Chiesi, Forest Labs, GSK, Grifols, Insmed, MedImmune, Novartis, Pfizer and 30T outside the submitted work. R.A. Evans reports grants from UKRI/MRC/NIHR during the conduct of the study and speaker fees from BI. A. Horsley reports funding from NIHR Manchester Biomedical Research Centre, grants from the Cystic Fibrosis Foundation, JP Moulton Trust and NIHR, and personal fees from Vertex Pharmaceuticals and Mylan Healthcare, all outside the submitted work. L.G. Heaney reports support from AstraZeneca, BI, Chiesi, GSK and Napp Pharmaceuticals, personal fees from Novartis, Hoffman la Roche/Genentech Inc., Sanofi, Evelo Biosciences, GSK, AstraZeneca, Teva, Theravance and Circassia, grants from Medimmune, Novartis UK, Roche/Genetech Inc and GSK, Amgen, Genetech/Hoffman la Roche, AZ, Medimmune, GSK, Aerocrine and Vitalograph, outside the submitted work. J.R. Hurst reports grants, personal fees and nonfinancial support from pharmaceutical companies that make medicines to treat respiratory disease, outside the submitted work. G. Jenkins reports grants from GSK, grants and personal fees from Pliant Therapeutics, and grants from Biogen, during the conduct of the study; personal fees from Galapagos, other support from Galecto, personal fees and other support from GSK and AstraZeneca, personal fees from Boehringer Ingelheim, Pliant, Bristol Myers Squibb, Chiesi and Roche/Promedior, personal fees and other support from RedX, other support from NuMedii and Nordic Biosciences, personal fees from Veracyte, PatientMPower, Resolution Therapeutics and Vicore, outside the submitted work; and is supported by a National Institute of Health Research Professorship (NIHR ref. RP-2017-08-ST2-014) and is trustee for Action for Pulmonary Fibrosis. P. Pfeffer reports grants from NIHR outside the submitted work. J.K. Quint reports grants and personal fees from AstraZeneca, grants from Bayer, grants and personal fees from BI, Chiesi and GSK, grants from MRC, The Health Foundation and AUK/BLF, outside the submitted work. B. Raman is supported by the British Heart Foundation Oxford Centre of Research Excellence (RE/18/3/34214). A. Sheikh reports grants from HDRUK, NIHR, MRC and ICSF, during the conduct of the study; and is a Member of the Scottish Government's CMO COVID-19 Advisory Group and Standing Committee on Pandemics. A. Singapuri reports grants from MRC during the conduct of the study. S. Siddiqui reports grants from NIHR Leicester Biomedical Research Centre and NIHR PHOSP COVID, personal fees from AstraZeneca, GSK, CSL Behring, Knopp Biosciences, Owlstone Medical and Chiesi, outside the submitted work; and has a patent pending for volatile breath biomarkers of breathlessness. M. Toshner reports personal fees from Actelion/J&J and GSK, and other support from Morphogen-IX, outside the submitted work. L.V. Wain reports grants from GSK and Orion, outside the submitted work. All other authors declare no competing interests.

Figures

FIGURE 1
FIGURE 1
Flow diagram of participants. PSQ: patient symptom questionnaire; BNP: B-type natriuretic peptide; NT-pro-BNP: N-terminal pro-BNP.
FIGURE 2
FIGURE 2
Dates of discharge and research visit for the 1226 study participants.
FIGURE 3
FIGURE 3
Multivariable logistic regression for post-COVID-19 breathlessness. BMI: body mass index; WHO: World Health Organization.
See this image and copyright information in PMC

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