Pulmonary Function at 1- and 2.5-Months Following Hospital Discharge in Patients with Coronavirus Disease 2019. A Preliminary Study Investigating the Effect of Albuterol Sulfate with or Without Inhaled Corticosteroids

ABSTRACT

Rational The Coronavirus Disease 2019 (COVID-19) pandemic is a growing public health concern, with over 18 million cases reported to-date in the United States. The Centers for Disease Control and Prevention reports that up to 15% of COVID-19 cases warranted hospitalization between March and December 2020 due to symptom severity. With significant respiratory manifestations, there has been increased interest in the characterization of pulmonary function following recovery from COVID-19 and the potential role of inhaled medications. The following represents a single-center study investigating the pulmonary function of patients hospitalized for COVID-19 at 1- and 2.5-months following discharge. Methods: Patients without prior pulmonary pathology (n= 25, mean age= 59.28 ±2.07 years, 52% male) hospitalized for COVID-19 (mean hospitalization= 8.32 ±0.93 days) underwent pulmonary function testing 1-month (27.23 ±2.67 days) following hospital discharge using the Platinum Elite body plethysmograph (MGC Diagnostics, Minnesota, USA). Patients were prescribed albuterol with or without an inhaled corticosteroid according to symptom severity on the modified Medical Research Council dyspnea scale. Subsequent pulmonary testing was conducted at 2.5-months (76.45 ±11.68 days) postdischarge using the EasyOne Plus Spirometer (NND Medical Technologies, Zurich, Switzerland). Results: At 1-month post-discharge, characterization of pulmonary function noted moderately-severe restrictive lung disease (FEV1= 64.36 ±2.86%, FVC= 59.36 ±2.71%, FEV1/FVC= 92.40 ±3.10%) with reduced total lung capacity (TLC= 79.68 ±6.84%) and preserved diffusion capacity for carbon monoxide divided by alveolar volume (DLCO/VA= 97.50 ±8.89%). At 2.5-months post-discharge, significant improvement of FEV1 (+13.82%, p<0.001) and FVC (+13.16%, p<0.001) was found, with an overall restrictive lung disease pattern of mild severity and near-normalization of FEV1 (FEV1= 78.19 ±2.78%, FVC= 72.52 ±2.46%, FEV1/FVC= 95.82 ±4.32%). At 2.5-months post-discharge, patients prescribed albuterol sulfate with an inhaled corticosteroid were found to have a tendency for greater improvement of pulmonary function (n= 12, FEV1= +15.73%, FVC= +12.75%, p<0.01 and p<0.01 respectively) compared to patients prescribed albuterol sulfate alone (n= 11, FEV1= +12.36%, FVC= +10.64%, p<0.05 and p<0.01 respectively). However, this improvement difference did not reach significance. Conclusions: The current study aimed to characterize the pulmonary function of patients hospitalized with COVID-19 at 1- and 2.5-months following hospital discharge. At 1-month post-discharge, patients were found to have moderately-severe restrictive lung disease with reduced total lung capacity and preserved diffusion capacity. Significant improvement in pulmonary function was noted at 2.5-months postdischarge, with FEV1 nearing normalization. Pulmonary function improvement did not differ significantly between patients prescribed albuterol sulfate versus albuterol sulfate with an inhaled corticosteroid.