COVID-19 Outcomes in Patients with Chronic Respiratory Diseases

Pathophysiological Mechanisms

SARS-CoV-2 infiltrates the body through mucosal membranes in the nasopharynx and larynx, primarily affecting the respiratory system 1
COVID-19 infection can cause inflammatory damage to lung parenchyma and decrease lung compliance, creating an imbalance between breathing demands and respiratory muscle capacity in COPD patients 2
COPD patients often have baseline respiratory muscle weakness, which may be exacerbated by COVID-19 infection 3
Patients with severe COVID-19 may develop acute respiratory distress syndrome (ARDS) and respiratory failure requiring mechanical ventilation 1

COVID-19 infection can cause damage to respiratory muscles, contributing to both acute and persistent dyspnea 2, 4
Approximately 82% of hospitalized and 38% of non-hospitalized COVID-19 patients develop dyspnea 2
At 2 months post-hospitalization, 43% of COVID-19 patients may still experience dyspnea 2
Even in non-hospitalized patients, over 71% reported experiencing dyspnea 79 days post-infection 2
COVID-19 can cause reduced respiratory muscle contractility, viral-induced myopathy of respiratory muscles, and in some cases, unilateral diaphragm paralysis due to phrenic nerve injury 4

Screening for respiratory muscle weakness and providing interventions to improve respiratory muscle performance is important for COVID-19 patients, particularly those with pre-existing COPD 2, 4
For severe COVID-19 cases requiring mechanical ventilation, prone positioning should be applied early, especially since SARS-CoV-2 tends to affect peripheral and dorsal areas of the lungs 5
Lung-protective ventilation strategies should be employed with tidal volumes ≤6 mL/kg predicted body weight and plateau pressure ≤30 cm H2O 5

Persistent dyspnea is common in COVID-19 patients, with 10% continuing to report symptoms at both 4 and 12 weeks following diagnosis 2
Respiratory muscle testing should be considered for patients with persistent dyspnea following COVID-19 infection, especially those with pre-existing COPD or asthma 4