Changes in quality of life and dyspnoea after hospitalization in COVID-19 patients discharged at home
Background: To date, the effects of COVID-19 pneumonia on health-related quality of life (HRQoL) and dyspnea are unknown.
Methods: In a real-life observational study, 20 patients with COVID-19-related pneumonia received usual care plus erdosteine (300 mg twice daily) for 15 days after hospital discharge following local standard operating procedures. At discharge (T0) and on Day 15 (T1), participants completed the St George’s Respiratory Questionnaire (SGRQ), the modified Medical Research Council (mMRC) scale of dyspnoea during daily activity, the BORG scale for dyspnoea during exertion, and Visual Analogue Scale (VAS) for dyspnoea at rest. Paired t-tests compared scores at T0 and T1.
Results: The mean (SD) SGRQ total score decreased from 25.5 (15.5) at T0 to 16.9 (13.2) at T1 (p<0.01); 65% of patients achieved a clinically important change of ≥4 points. SGRQ domain scores (symptoms, activity, and impact) were also significantly reduced (all p<0.01). The mean (SD) VAS score decreased from 1.6 (1.7) to 1.4 (2.5); p<0.01. The mean mMRC score decreased significantly (p=0.031) and 30% of patients achieved a clinically important change of ≥1 point. The mean (SD) Borg score increased from 12.8 (4.2) to 14.3 (2.4); p<0.01.
Conclusion: The present proof of concept study is the first to report HRQoL in patients with COVID-19. During 15 days after hospital discharge, patients reported significant improvements in HRQoL and dyspnoea at rest and during daily activities.
Ye G, Pan Z, Pan Y, Deng Q, Chen L, Li J, et al. Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation. J Infect 2020;80:e14-7. DOI: https://doi.org/10.1016/j.jinf.2020.03.001
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-62. DOI: https://doi.org/10.1016/S0140-6736(20)30566-3
Mo X, Jian W, Su Z, Chen M, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J 2020;55:2001217. DOI: https://doi.org/10.1183/13993003.01217-2020
Zheng Z, Yao Z, Wu K, Zheng J. Patient follow-up after discharge after COVID-19 pneumonia: considerations for infectious control. J Med Virol 2020. DOI: https://doi.org/10.1002/jmv.25994
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20. DOI: https://doi.org/10.1056/NEJMoa2002032
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;95:497-506. DOI: https://doi.org/10.1016/S0140-6736(20)30183-5
Liu L, Gao JY, et al. Clinical characteristics of 51 patients discharged from hospital with COVID-19 in Chongqing, China. MedRxiv 2020. Accessed: 29 June 2020. DOI: https://doi.org/10.1101/2020.02.20.20025536
Wang D, Yin Y, Hu C, Liu X, Zhang X, Zhou S, et al. Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China. Crit Care 2020;24:188. DOI: https://doi.org/10.1186/s13054-020-02895-6
Jain V, Yuan JM. Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. Int J Public Health 2020;65:533-46. DOI: https://doi.org/10.1007/s00038-020-01390-7
Vitacca M, Lazzeri M, Guffanti E, Frigerio P, D’Abrosca F, Gianola S, et al. Italian suggestions for pulmonary rehabilitation in COVID-19 patients recovering from acute respiratory failure: results of a Delphi process. Monaldi Arch Chest Dis 2020;90:1444. DOI: https://doi.org/10.4081/monaldi.2020.1444
Radovanovic D, Rizzi M, Pini S, Saad M, Chiumello DA, Santus P. Helmet CPAP to treat acute hypoxemic respiratory failure in patients with COVID-19: A management strategy proposal. J Clin Med 2020;9:1191. DOI: https://doi.org/10.3390/jcm9041191
Società Italiana di Malattie Infettive e Tropicali (SIMIT). Sezione Regione Lombardia. Vademecum per la cura delle persone con malattia da COVI-19. Ed. 2.0, 13 March 2020. Accessed: 6 August 2020. Available from: https://www.sicp.it/wp-content/uploads/2020/04/SIMIT_Vademecum-cura-pz-Covid19_13-mar-2020.pdf
Bassetti M, Giacobbe DR, Aliberti S, Barisione E, Centanni S, De Rosa FG, al. Balancing evidence and frontline experience in the early phases of the COVID-19 pandemic: current position of the Italian Society of Anti-infective Therapy (SITA) and the Italian Society of Pulmonology (SIP). Clin Microbiol Infect 2020;26:880-94. DOI: https://doi.org/10.1016/j.cmi.2020.04.031
Shang L, Zhao J, Hu Y, Du R, Cao B. On the use of corticosteroids for 2019-nCoV pneumonia. Lancet 2020;395:683-4. DOI: https://doi.org/10.1016/S0140-6736(20)30361-5
Metlay JP, Waterer GW, Long AC. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019;200:e45-67. DOI: https://doi.org/10.1164/rccm.201908-1581ST
Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St George's Respiratory Questionnaire. Am Rev Respir Dis 1992;145:1321-7. 17. Jones PW. St George's Respiratory Questionnaire: MCID. COPD 2005;2:75-9. DOI: https://doi.org/10.1081/COPD-200050513
Fletcher CM. Standardised questionnaire on respiratory symptoms: a statement prepared and approved by the MRC Committee on the Aetiology of Chronic Bronchitis (MRC breathlessness score). Br Med J 1960;2:1665.
Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999;54:581-6. DOI: https://doi.org/10.1136/thx.54.7.581
Crisafulli E, Clini EM. Measures of dyspnea in pulmonary rehabilitation. Multidiscip Respir Med 2010;5:202-10. DOI: https://doi.org/10.1186/2049-6958-5-3-202
de Torres JP, Pinto-Plata V, Ingenito E, Bagley P, Grey A, Berger R, et al. Power of outcome measurements to detect clinically significant changes in pulmonary rehabilitation of patients with COPD. Chest 2002;121:1092-8. DOI: https://doi.org/10.1378/chest.121.4.1092
Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982;14:377-81. DOI: https://doi.org/10.1249/00005768-198205000-00012
WHO. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Accessed: 13 March 2020. Available from: https://www.who.int/publications-detail/clinical-managementof-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infectionis-suspected.pdf
Ferrer M, Villasante C, Alonso J, Sobradillo V, Gabriel R, Vilagut G, et al. Interpretation of quality of life scores from the St George’s Respiratory Questionnaire. Eur Respir J 2002;19:405-13. DOI: https://doi.org/10.1183/09031936.02.00213202
Ahmed H, Patel K, Greenwood DC, Halpin S, Lewthwaite P, Salawu A, et al. Long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS) coronavirus outbreaks after hospitalisation or ICU admission: a systemic review and meta-analysis. J Rehab Med 2020;52:jrm00063. DOI: https://doi.org/10.2340/16501977-2694
Tansey CM, Louie M, Loeb M, Gold WL, Muller MP, de Jager J, et al. One-year outcomes and health care utilisation in survivors of severe acute respiratory syndrome. Arch Int Med 2007;167:1312-20. DOI: https://doi.org/10.1001/archinte.167.12.1312
Ong KC, Wei-Keong A, Lee LS, Kaw G, Kwek SK, Leow MKS, et al. 1-Year pulmonary function and health status in survivors of severe acute respiratory syndrome. Chest 2005;128:1393-400. DOI: https://doi.org/10.1378/chest.128.3.1393
Dowdy DW, Eid MP, Dennison CR, Mendez-Tellez PA, Herridge MS, Guallar E, et al. Quality of life after acute respiratory distress syndrome: a meta-analysis. Intensive Care Med 2006;32:1115-24. DOI: https://doi.org/10.1007/s00134-006-0217-3
Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP. Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 1999;281:354-60. DOI: https://doi.org/10.1001/jama.281.4.354
Hsieh MJ, Lee WC, Cho HY, Wu MF, Hu HC, Kao KC, et al. Recovery of pulmonary functions, exercise capacity, and quality of life after pulmonary rehabilitation in survivors of ARDS due to severe influenza A (H1N1) pneumonitis. Influenza Other Respir Viruses 2018;12:643-8. DOI: https://doi.org/10.1111/irv.12566
Delgado-Roche L, Mesta F. Oxidative stress as key player in Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) infection. Arch Med Res 2020;51:384-7. DOI: https://doi.org/10.1016/j.arcmed.2020.04.019
Polonikov A. Endogenous deficiency of glutathione as the most likely cause of serious manifestations and death in COVID-19 patients. ACS Infect Dis 2020;6:1558-62. DOI: https://doi.org/10.1021/acsinfecdis.0c00288
Silvagno, Vernone A, Pescarmona GP. The role of glutathione in protecting against the severe inflammatory response triggered by COVID-19. Antioxidants (Basel) 2020;9:624. DOI: https://doi.org/10.3390/antiox9070624
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