Bronchodilator reversibility testing in post-COVID-19 patients undergoing pulmonary rehabilitation

Abstract

Background: The usefulness of bronchodilators in coronavirus diseases 2019 (COVID-19) survivors is still uncertain, especially for patients with a concomitant obstructive lung disease. We aimed at verifying the level of bronchodilator reversibility in COVID-19 patients undergoing multidisciplinary pulmonary rehabilitation after the acute phase.

Methods: We enrolled 105 consecutive patients referring to the Pulmonary Rehabilitation Unit of Istituti Clinici Scientifici Maugeri Spa SB, IRCCS of Telese Terme, Benevento, Italy after being discharged from the COVID-19 acute care ward and after recovering from acute COVID-19 pneumonia. All subjects performed a spirometry before and after inhalation of salbutamol 400 μg to determine the bronchodilation response within 48 h of admission to the unit.

Results: All patients had suffered from a moderate to severe COVID-19, classified 3 or 4 according to the WHO classification, Seventeen patients had concomitant obstructive lung disease (14 suffering from COPD and 3 from asthma). FEV1 after salbutamol improved on average by 41.7 mL in the entire examined sample, by 29.4 mL in subjects without concomitant obstructive lung diseases, by 59.3 mL in COPD patients and by 320.0 mL in asthma patients. Mean FVC after salbutamol improved by 65.7 mL in the entire examined sample, by 52.5 mL in subjects without concomitant obstructive lung diseases, by 120.0 mL in COPD patients, and by 200.0 mL in asthma patients.

Conclusions: This study suggests that a treatment with bronchodilators must always be taken into consideration in post-COVID-19 patients because it can induce a functional improvement that, even if small, can facilitate the breathing of these patients.

Keywords: Bronchodilators; COVID-19; Chronic disease; Disability; Outcome; Rehabilitation.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Figures

Fig. 1

Mean (SE) increase from baseline of FEV1 after salbutamol 400 μg in the entire group (105 subjects), in 76 patients with a basal FEV1 <90% predicted, in 88 subjects without concomitant obstructive lung diseases (No OLD), and in 48 previously healthy asymptomatic non-smokers (Healthy NS). *P < 0.05, **P < 0.01, ***P < 0.001 vs pre salbutamol.

Fig. 2

Mean (SE) increase from baseline of FEV1 after salbutamol 400 μg in the entire group (105 subjects), in 14 patients with preexisting COPD and in 3 asthmatic subjects. ***P < 0.001 vs pre salbutamol.

Fig. 3

Mean (SE) increase from baseline of FEV1 after salbutamol 400 μg in the subgroups divided according to the body mass index (BMI) values (BMI <30: 57 subjects; BMI 30.00–34.99: 24 subjects; BMI 35.01–39.99: 18 subjects; BMI ≥40: 6 subjects). *P < 0.05, **P < 0.01 vs pre salbutamol.

Fig. 4

Mean (SE) increase from baseline of FEV1 and FVC after salbutamol 400 μg in the group of 80 patients who did not undergo mechanical ventilation (MV) and in that of 25 subjects who had undergone MV. *P < 0.05, **P < 0.01 vs pre salbutamol.

Fig. 5

Mean (SE) increase from baseline of FVC after salbutamol 400 μg in the entire group (105 subjects), in 88 subjects without concomitant obstructive lung diseases (No OLD), in 15 COPD patients and in 3 asthma subjects. *P 

Fig. 6

– Correlation between the changes of FEV1 and those of FVC after salbutamol 400 μg in the entire group, in subjects without concomitant obstructive lung diseases (No OLD), in COPD and in asthma.