Exercise responses and mental health symptoms in COVID-19 survivors with dyspnoea

Kathryn M Milne; Juthaporn Cowan; Michele R Schaeffer; Nha Voduc; Vicente Corrales-Medina; Kim L Lavoie; Julio A Chirinos; Joseph H Puyat; Sara J Abdallah; Jordan A Guenette

doi:10.1183/23120541.00606-2022

Exercise responses and mental health symptoms in COVID-19 survivors with dyspnoea

ERJ Open Res. 2023 Jun 19;9(3):00606-2022. doi: 10.1183/23120541.00606-2022. eCollection 2023 May.

Authors

Kathryn M Milne^{1

2}, Juthaporn Cowan^{3

4

5}, Michele R Schaeffer^{1

6}, Nha Voduc³, Vicente Corrales-Medina⁴, Kim L Lavoie^{7

8}, Julio A Chirinos⁹, Joseph H Puyat¹⁰, Sara J Abdallah⁴, Jordan A Guenette^{1

2

6}

Affiliations

¹ Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St Paul's Hospital, Vancouver, BC, Canada.
² Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada.
³ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁴ Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada.
⁶ Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada.
⁷ Montréal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, QC, Canada.
⁸ Department of Psychology, University of Québec at Montréal, Montréal, QC, Canada.
⁹ Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹⁰ Centre for Health Evaluation and Outcome Sciences, Providence Research, St Paul's Hospital, Vancouver, BC, Canada.

Abstract

Objectives: Dyspnoea is a common persistent symptom post-coronavirus disease 2019 (COVID-19) illness. However, the mechanisms underlying dyspnoea in the post-COVID-19 syndrome remain unclear. The aim of our study was to examine dyspnoea quality and intensity, burden of mental health symptoms, and differences in exercise responses in people with and without persistent dyspnoea following COVID-19.

Methods: 49 participants with mild-to-critical COVID-19 were included in this cross-sectional study 4 months after acute illness. Between-group comparisons were made in those with and without persistent dyspnoea (defined as modified Medical Research Council dyspnoea score ≥1). Participants completed standardised dyspnoea and mental health symptom questionnaires, pulmonary function tests, and incremental cardiopulmonary exercise testing.

Results: Exertional dyspnoea intensity and unpleasantness were increased in the dyspnoea group. The dyspnoea group described dyspnoea qualities of suffocating and tightness at peak exercise (p<0.05). Ventilatory equivalent for carbon dioxide (V'_E/V'_CO₂) nadir was higher (32±5 versus 28±3, p<0.001) and anaerobic threshold was lower (41±12 versus 49±11% predicted maximum oxygen uptake, p=0.04) in the dyspnoea group, indicating ventilatory inefficiency and deconditioning in this group. The dyspnoea group experienced greater symptoms of anxiety, depression and post-traumatic stress (all p<0.05). A subset of participants demonstrated gas-exchange and breathing pattern abnormalities suggestive of dysfunctional breathing.

Conclusions: People with persistent dyspnoea following COVID-19 experience a specific dyspnoea quality phenotype. Dyspnoea post-COVID-19 is related to abnormal pulmonary gas exchange and deconditioning and is linked to increased symptoms of anxiety, depression and post-traumatic stress.