The Nottingham recovery from COVID-19 research platform (NoRCoRP): Functional, clinical and patient-reported outcomes in adults referred to a post-COVID respiratory service

TL;DR

This study examines the long-term effects of COVID-19 on non-hospitalized adults, finding that breathing issues, physical deconditioning, and mental health problems are major factors affecting recovery.

Contribution

The study identifies key factors associated with persistent respiratory symptoms post-COVID in non-hospitalized adults using a multidimensional assessment approach.

Findings

Dysregulated breathing, deconditioning, and psychological distress were major contributors to symptom burden in post-COVID patients.

Higher BMI and depression were linked to clinically significant breathlessness.

Female sex, smoking, and mental health issues were associated with dysregulated breathing.

Abstract

To characterise symptoms, function and patient-reported outcome measures (PROMs), and identify associated factors in adults with persisting respiratory symptoms post-COVID.

Cross-sectional analysis of 210 non-hospitalised adults referred to a post-COVID respiratory clinic (December 2020-July 2024) who consented to research. Assessments included demographics, symptoms, lung function, chest CT, and several PROMs: MRC dyspnoea score, Nijmegen Questionnaire score (NQ), Hospital Anxiety and Depression Scale, Chalder Fatigue Scale, Short Physical Performance Battery (SPPB) and Fried Frailty Index. Multivariate logistic regression examined key exposure-outcome associations.

Among participants (mean age 49.4 years; 68% female; median 13.3 months since COVID-19 diagnosis), 95% reported shortness of breath, 54% had clinically significant breathlessness (MRC ≥ 3), 68% had an NQ score (>23) consistent with dysregulated breathing, 32% had a low SPPB score (<10), and 77% were classed as frail/pre-frail, despite the majority being of working age. Nearly half (47%) of those employed pre-infection had not returned to previous hours. Spirometry and CT abnormalities were not common. Higher body mass index (odds ratio = 1.10, 95% confidence interval = 1.05–1.16, n in model = 190) and depression (2.25, 1.13–4.56, n = 164) were associated with MRC ≥ 3. Dysregulated breathing was associated with female sex (3.63, 1.77–7.60, n = 186), current/ex-smoker (2.56, 1.25–5.47, n = 186), fatigue (8.87, 2.59–37.0, n = 162), anxiety (3.57, 1.70–7.69, n = 162) and depression (5.70, 2.59–13.40, n = 162). A low SPPB score was associated with female sex, current smoking, depression, clinically significant breathlessness, dysregulated breathing, and greater deprivation.

In non-hospitalised patients with persistent respiratory symptoms post-COVID, dysregulated breathing, deconditioning and psychological distress were key factors linked with symptom burden. These findings suggest a multidisciplinary approach should be considered to optimise recovery.

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