Pulmonary rehabilitation in patients with prior COVID-19 infections

Abstract Background: Patients with prior COVID-19 infections can develop persistent dyspnea and physical limitation.  This may reflect chronic lung disease, chronic heart disease, or neuromuscular disease.  Treatment approaches include pulmonary rehabilitation.  This study analyzed the benefits of conventional pulmonary rehabilitation in patients with chronic symptoms following COVID-19 infections. Methods: Twenty-eight patients completed pulmonary rehabilitation at University Medical Center in Lubbock, Texas.  The primary outcome was the time spent on four different types of exercise equipment during aerobic exercise sessions. Results: This study included 15 women and 13 men, with a mean age of 54.4 years.  The racial distribution included 12 White patients, 10 Hispanic patients, and 6 Black patients.  Ten patients had a smoking history, 19 patients used supplemental oxygen, 14 patients had hypertension, and 11 patients had diabetes.  The median COPD Assessment Test  (CAT) score was 21.5 (Q1, Q3: 17.5,29), the median Patient Health Questionnaire-9 (PHQ-9) score was 8 (Q1, Q3: 4.5,15.5), and the median Medical Research Council (MRC) score was 2.  Twenty-six patients had the abnormal chest x-rays within 3 months of starting the rehabilitation program; these included 5 patients with focal interstitial infiltrates, 9 patients with diffuse interstitial infiltrates, 6 patients with focal opacities, and 6 patients with bilateral opacities.  These patients completed 22.9 (Q1, Q3: 6.8,36) exercise sessions.  There were statistically significant increases in all machine times on all 4 machines. Conclusion: This study indicates pulmonary rehabilitation can significantly increase aerobic activity levels in patients with prior COVID-19 infections.  This improvement occurred in patients with important comorbidity, abnormal chest x-rays, and chronic oxygen supplementation requirements.  Patients with prior COVID-19 infections and persistent respiratory symptoms should be referred to pulmonary rehabilitation.   Key words: COVID-19, long COVID, rehabilitation