Post-COVID dyspnea: prevalence, predictors, and outcomes in a longitudinal, prospective cohort.

BACKGROUND: The pathophysiology, evolution, and associated outcomes of post-COVID dyspnea remain unknown. The aim of this study was to determine the prevalence, severity, and predictors of dyspnea 12 months following hospitalization for COVID-19, and to describe the respiratory, cardiac, and patient-reported outcomes in patients with post-COVID dyspnea. METHODS: We enrolled a prospective cohort of all adult patients admitted to 2 academic hospitals in Vancouver, Canada with PCR-confirmed SARS-CoV-2 during the first wave of COVID between March and June 2020. Dyspnea was measured 3, 6, and 12 months after initial symptom onset using the University of California San Diego Shortness of Breath Questionnaire. RESULTS: A total of 76 patients were included. Clinically meaningful dyspnea (baseline score > 10 points) was present in 49% of patients at 3 months and 46% at 12 months following COVID-19. Between 3 and 12 months post-COVID-19, 24% patients had a clinically meaningful worsening in their dyspnea, 49% had no meaningful change, and 28% had a clinically meaningful improvement in their dyspnea. There was worse sleep, mood, quality of life, and frailty in patients with clinically meaningful dyspnea at 12 months post-COVID infection compared to patients without dyspnea. There was no difference in PFT findings, troponin, or BNP comparing patients with and without clinically meaningful dyspnea at 12 months. Severity of dyspnea and depressive symptoms at 3 months predicted severity of dyspnea at 12 months. CONCLUSIONS: Post-COVID dyspnea is common, persistent, and negatively impacts quality of life. Mood abnormalities may play a causative role in post-COVID dyspnea in addition to potential cardiorespiratory abnormalities. Dyspnea and depression at initial follow-up predict longer-term post-COVID dyspnea, emphasizing that standardized dyspnea and mood assessment following COVID-19 may identify patients at high risk of post-COVID dyspnea and facilitating early and effective management.

The opportunities and challenges of social media in interstitial lung disease: a viewpoint.

Social media is an increasingly popular source of health information, and the rarity and complexity of interstitial lung disease (ILD) may particularly draw patients with ILD to social media for information and support. The objective of this viewpoint is to provide an overview of social media, explore the benefits and limitations of ILD-related social media use, and discuss future development of healthcare information on social media. We describe the value of integrating social media into the practice of ILD health professionals, including its role in information dissemination, patient engagement, knowledge generation, and formation of health policy. We also describe major challenges to expanded social media use in ILD, including limited access for some individuals and populations, abundance of misinformation, and concerns about patient privacy. Finally, for healthcare professionals looking to join social media, we provide practical guidance and considerations to optimize the potential benefits and minimize the potential pitfalls of social media.

Role of a Regional Multidisciplinary Conference in the Diagnosis of Interstitial Lung Disease.

RATIONALE: The interstitial lung disease (ILD) specialists in Vancouver participate in a multidisciplinary discussion (MDD) that is primarily used internally for patients seen by these specialists. The MDD is also used remotely (externally) by general pulmonologists to increase access to this service. OBJECTIVES: To describe the impact of an MDD on the diagnosis and management of ILD in these two patient cohorts, and to report the satisfaction of referring pulmonologists with this service. METHODS: This retrospective cross-sectional study included patients who underwent MDD review between March 2014 and June 2017. Data were extracted from standardized MDD records and comparisons were made between the internal and external ILD cohorts. Pulmonologists who used the external review service completed an anonymous survey addressing their satisfaction with components of the MDD. RESULTS: The 209 internal patients and 91 external patients had similar clinical characteristics. MDD review led to a change in diagnosis in 40% of patients, including 36% of internal patients and 48% of external patients (P = 0.04). For patients without a working diagnosis, 44% were provided a confident ILD diagnosis following MDD, including 78% of patients with a surgical lung biopsy and 37% of patients without a surgical lung biopsy (P < 0.001). After MDD review, treatment was started in 45% of patients on no ILD therapy, and treatment was changed in 45% of patients on ILD therapy. Overall, 93% of the 14 respondents (out of 16 surveyed) were very or somewhat satisfied with the MDD external review service. CONCLUSIONS: Similar to previous publications, our study suggests an important role of MDD in the diagnosis and management of ILD, and further demonstrates that MDD of external patients is a viable service that allows greater and more rapid access to ILD expertise.