A close pulmonary follow-up plan for adult patients after acute COVID-19 is not necessary as most clinical variables show no change in the first 6 months after recovery, according to study findings published in Respiratory Medicine.
Previous studies with multiple follow-up visits after acute COVID-19 (especially those with close follow-up in the first 6 months) were underpowered with conflicting results. No consensus exists regarding the best short- of mid-term monitoring plan for this patient population.
This prospective cohort study of 168 adult patients assessed the need for a close pulmonary follow-up plan after recovery from acute COVID-19 pneumonia. All patients completed 3-month and 6-month follow-up visits at a tertiary medical center clinic in Israel between October 2020 and July 2021.
Participants (mean [SD] age, 58 [15] years; 52% who had recovered from critical or severe COVID-19 infection; 40% who currently or formerly smoked; 45% women) all had COVID-19 confirmed by a positive SARS-CoV-2 nasopharyngeal polymerase chain reaction test during the second surge of COVID-19 in Israel. Participants were either invited to take part in the study upon discharge or referred by their general practitioner.
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Most clinical variables did not change during a close follow-up schedule in the first six months after acute COVID-19. Such a follow-up plan does not appear necessary and should be personalized to limit excessive costs and resources.
During the acute phase of COVID-19, two-thirds of study participants were admitted to the hospital; the median hospital length of stay was 7 days (interquartile range, 5-11), and 8% required noninvasive ventilation. Half of all patients had obesity, 41% presented with comorbid hypertension, and 26% had diabetes.
Patients completed the 3-month follow-up visit with a median time to the first clinic visit of 80 days (interquartile range [IQR] 67-107) and the 6-month visit with a median time to second visit of 177 days (IQR, 157-210). Investigators found no change between the 2 visits in diffusing capacity of the lung for carbon monoxide adjusted for hemoglobin (DLCOc; mean, 73% [18%] vs 73% [18%] predicted) or in forced vital capacity (FVC; mean, 90% [16%] vs 89% [16%] predicted).
The investigators noted the modified Medical Research Council scale and the chronic obstructive pulmonary disease (COPD) assessment tool were inversely correlated with the DLCOc and did not change between visits.
The only factor associated with a change in DLCOc during follow-up was occupational exposures (3% decrease; P =.04). No association was found between chest computed tomography improvement at the second visit and a change in pulmonary function tests (PFTs).
Study limitations include the single center design limiting generalizability, selection bias, and unknown and unaccounted-for baseline PFTs prior to COVID-19.
The investigators concluded, “Most clinical variables did not change during a close follow-up schedule in the first six months after acute COVID-19. Such a follow-up plan does not appear necessary and should be personalized to limit excessive costs and resources.”
