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COVID-19 primarily affects the respiratory system. We aimed to evaluate how pulmonary outcomes develop after COVID-19 by assessing participants from the first pandemic wave prospectively 3 and 12 months following hospital discharge. Pulmonary outcomes included self-reported dyspnoea assessed with the modified Medical Research Council dyspnoea scale, 6-min walk distance (6MWD), spirometry, diffusing capacity of the lung for carbon monoxide ( D LCO ), body plethysmography and chest computed tomography (CT). Chest CT was repeated at 12 months in participants with pathological findings at 3 months. The World Health Organization (WHO) ordinal scale for clinical improvement defined disease severity in the acute phase. Of 262 included COVID-19 patients, 245 (94%) and 222 (90%) participants attended the 3- and 12-month follow-up, respectively. Self-reported dyspnoea and 6MWD remained unchanged between the two time points, while D LCO and total lung capacity improved (0.28 mmol·min -1 ·kPa -1 , 95% CI 0.12-0.44, and 0.13 L, 95% CI 0.02-0.24, respectively). The prevalence of fibrotic-like findings on chest CT at 3 and 12 months in those with follow-up chest CT was unaltered. Those with more severe disease had worse dyspnoea, D LCO and total lung capacity values than those with mild disease. There was an overall positive development of pulmonary outcomes from 3 to 12 months after hospital discharge. The discrepancy between the unaltered prevalence of self-reported dyspnoea and the improvement in pulmonary function underscores the complexity of dyspnoea as a prominent factor of long-COVID. The lack of increase in fibrotic-like findings from 3 to 12 months suggests that SARS-CoV-2 does not induce a progressive fibrotic process in the lungs., Competing Interests: Conflict of interest: T.V. Lerum has nothing to disclose. Conflict of interest: C. Meltzer has nothing to disclose. Conflict of interest: J.R. Rodriguez has nothing to disclose. Conflict of interest: T.M. Aaløkken has nothing to disclose. Conflict of interest: E. Brønstad has nothing to disclose. Conflict of interest: B.B. Aarli reports personal fees for lectures and advisory board work from AstraZeneca, personal fees for lectures from GlaxoSmithKline, Novartis, Boehringer Ingelheim and Chiesi Pharma, outside the submitted work. Conflict of interest: K.M. Aarberg-Lund has nothing to disclose. Conflict of interest: M.T. Durheim reports grants to his institution and personal fees from Boehringer Ingelheim and Roche, and personal fees from AstraZeneca, outside the submitted work. Conflict of interest: H. Ashraf reports grants from Boehringer Ingelheim, during the conduct of the study. Conflict of interest: G. Einvik reports grants from Boehringer Ingelheim, during the conduct of the study; and personal fees for consultancy from AstraZeneca AB, outside the submitted work. Conflicts of interest: O.H. Skjønsberg has nothing to disclose. Conflict of interest: K. Stavem reports fees from UCB Pharma and MSD, outside the submitted work., (Copyright ©The authors 2023.)

The long-term pulmonary outcomes of coronavirus disease 2019 (COVID-19) are unknown. We aimed to describe self-reported dyspnoea, quality of life, pulmonary function and chest computed tomography (CT) findings 3 months following hospital admission for COVID-19. We hypothesised outcomes to be inferior for patients admitted to intensive care units (ICUs), compared with non-ICU patients.Discharged COVID-19 patients from six Norwegian hospitals were enrolled consecutively in a prospective cohort study. The current report describes the first 103 participants, including 15 ICU patients. The modified Medical Research Council (mMRC) dyspnoea scale, the EuroQol Group's questionnaire, spirometry, diffusing capacity of the lung for carbon monoxide ( D LCO ), 6-min walk test, pulse oximetry and low-dose CT scan were performed 3 months after discharge.mMRC score was >0 in 54% and >1 in 19% of the participants. The median (25th-75th percentile) forced vital capacity and forced expiratory volume in 1 s were 94% (76-121%) and 92% (84-106%) of predicted, respectively. D LCO was below the lower limit of normal in 24% of participants. Ground-glass opacities (GGO) with >10% distribution in at least one of four pulmonary zones were present in 25% of participants, while 19% had parenchymal bands on chest CT. ICU survivors had similar dyspnoea scores and pulmonary function as non-ICU patients, but higher prevalence of GGO (adjusted OR 4.2, 95% CI 1.1-15.6) and lower performance in usual activities.3 months after admission for COVID-19, one-fourth of the participants had chest CT opacities and reduced diffusing capacity. Admission to ICU was associated with pathological CT findings. This was not reflected in increased dyspnoea or impaired lung function., Competing Interests: Conflict of interest: T.V. Lerum has nothing to disclose. Conflict of interest: T.M. Aaløkken has nothing to disclose. Conflict of interest: E. Brønstad has nothing to disclose. Conflict of interest: B. Aarli reports personal fees for lectures and advisory board work from AstraZeneca, personal fees for lectures from GlaxoSmithKline, Novartis, Boehringer Ingelheim and Chiesi Pharma, outside the submitted work. Conflict of interest: E. Ikdahl has nothing to disclose. Conflict of interest: K.M.A. Lund has nothing to disclose. Conflict of interest: M.T. Durheim reports grants and personal fees from Boehringer Ingelheim, personal fees from Roche and AstraZeneca, outside the submitted work. Conflict of interest: J.R. Rodriguez has nothing to disclose. Conflict of interest: C. Meltzer has nothing to disclose. Conflict of interest: K. Tonby has nothing to disclose. Conflict of interest: K. Stavem has nothing to disclose. Conflict of interest: O.H. Skjønsberg has nothing to disclose. Conflict of interest: H. Ashraf reports grants from Boehringer Ingelheim, during the conduct of the study. Conflict of interest: G. Einvik reports grants from Boehringer Ingelheim, during the conduct of the study; personal fees for consultancy from AstraZeneca AB, outside the submitted work., (Copyright ©ERS 2021.)