Exercise ventilatory response after COVID-19 : comparison between ambulatory and hospitalized patients

Article Article scientifique Article Exercise ventilatory response after COVID-19 : comparison between ambulatory and hospitalized patients eng 2023-10-24 2023-12-01 author Guerreiro Ivan 0000-0002-4295-3024 Division of Pneumology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland. 631408 author Bringard Aurélien 0000-0003-2747-5068 Division of Pneumology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland. 683056 author Nehme Mayssam Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland. 840942 author Guessous Idris Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland. 760565 Médecine de premier recours hospitalo-universitaire (MPRHU) author Benzakour Lamyae 0000-0002-1298-9659 Liaison Psychiatry and Crisis Intervention Service, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland. 889158 Département de psychiatrie (PSYAT) author Juillet De St-Lager Alix 0000-0003-2990-6351 Division of Radiology, Department of Imaging and Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland. 659630 author Taboni Anna 0000-0002-8198-6574 Division of Pneumology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland. 913462 author Lador Frédéric 0000-0002-4276-635X Division of Pneumology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland. 89384 Département de médecine (DEMED) L756-L764 10.1152/ajplung.00142.2023 37874657 1040-0605 https://journals.physiology.org/doi/full/10.1152/ajplung.00142.2023 Inefficient ventilatory response during cardiopulmonary exercise testing (CPET) has been suggested as a cause of post-COVID-19 dyspnea. It has been described in hospitalized patients (HOSP) with lung parenchymal sequelae but also after mild infection in ambulatory patients (AMBU). We hypothesize that AMBU and HOSP have different ventilatory responses to exercise, due to different etiologies. We analyzed CPET realized between July 2020 and May 2022 of patients with persisting respiratory symptoms 3 mo after COVID-19. Chest computed tomography (CT) scan, pulmonary function tests, quality of life, and respiratory questionnaires were collected. CPET data were specifically explored as a function of ventilation (V̇e) and time. Seventy-nine consecutive patients were included (42 AMBU and 37 HOSP, median: 54 [44-60] yr old, 57% female). Patients were hospitalized for a median of 20 [8-34] days, with pneumonia (41%) or acute respiratory distress syndrome (ARDS; 30%). Among HOSP, 12(32%) patients had abnormal values for spirometry and 18(51%) for carbon monoxide diffusing capacity (P< 0.001). CPET showed no differences between AMBU and HOSP in peak absolute O2uptake (V̇o2) (1.59 [1.22-2.11] mL·min-1;P= 0.65). Tidal volume (VT) as a function of V̇e, was lower in AMBU than in HOSP (P< 0.01) toward the end of exercise. The slope of the V̇e-CO2production was higher than normal in both groups (30.9 [26.1-34.3];P= 0.96). In conclusion, the severity of COVID-19 did not influence the exercise capacity, but AMBU demonstrated a less efficient ventilatory response to exercise as compared with HOSP. CPET with exploration of data as a function of V̇e and throughout the exercise better unveil ventilatory inefficiency. NEW & NOTEWORTHY We evaluated the exercise ventilatory response in patients with persisting dyspnea after severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. We found that despite similar peak power and peak absolute O2uptake, tidal volume as a function of ventilation was lower in ambulatory than in hospitalized patients toward the end of exercise, reflecting ventilatory inefficiency. We call for evaluation of minute ventilation with the exploration of data throughout the exercise and not only peak data to better unveil ventilatory inefficiency. Cardiopulmonary exercise testing Dyspnea Hyperventilation syndrome Post-COVID-19 Ventilatory response Humans Female Male Quality of Life COVID-19 / complications SARS-CoV-2 Exercise Test / adverse effects Exercise Test / methods Dyspnea / etiology Respiration Exercise Tolerance / physiology Oxygen Consumption Dewey 613 Dewey 616.0757 Dewey 616 56 Département de médecine 221 201 Institut de médecine de premier recours 22A9 62 Département de radiologie et informatique médicale 227 false 1313 Médecine de 1er recours 1020 American journal of physiology. Lung cellular and molecular physiology 325 6 b06711d6-df79-4852-a8ca-fa95cd968085 Article (Published version) Public Exercise ventilatory response after.pdf 1022653 application/pdf CC BY-4.0 d76e62a12df2e674cf07cc441dea02f1ef2fd233d7deefd60f1930a0b17ab380 d2da61b7-c889-46ab-bb47-69ed65bc1dcc Supplemental data Public Table S1.pdf 128633 application/pdf aa009958c64951b78e4e91a162e9a0d6ea186c8051af6ecbf33fe3eaf927e048 4e2c44dd-0463-4bd3-bc2c-c76b35bb6354 Supplemental data Public Table_S2.pdf 91437 application/pdf fb88ced4f449b5d8bc85fa8c47355b7fb3120ec46f21105149f3fea86298fd9d Vignette Public images_medium_l-00142-2023r01.png 62439 image/png openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut de médecine de premier recours Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale

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