Potential Need for Pulmonary Rehabilitation Six Months After Hospital Discharge to Home Following COVID-19 Infection

Rationale: Individuals recovering from COVID-19 may have prolonged symptoms and functional limitations well after the acute illness has subsided. Pulmonary rehabilitation, with its interdisciplinary, holistic approach to individuals with complex and systematic manifestations from chronic respiratory disease may be a platform to provide comprehensive healthcare to these patients. Methods: We did a structured telephone interview and review of medical records from a random sample of patients discharged home from our hospital approximately five months after a COVID-19 hospitalization this spring. This was a hypothesis-generating study. Data categories included: 1) Demographics;2) Acute disease severity markers;3) Dyspnea (Modified MRC);4) A structured review of systems (ROS);and 5) Generic heath status (Medical Outcomes Study Short Form -12, Version 1). The SF-12 has 8 domains and physical and mental composite scores (PCS and MCS, respectively). Results: In our sample of 26 patients, 65% were male, age (mean ± SD) was 60 ± 16 years, hospital length of stay was 5.6 ± 3.5 days, interval from discharge to telephone contact was 154 ± 34 days, 85% had pneumonia, and 42% required > 4 L/min supplemental oxygen. The most common positive ROS categories were: (% for each) dyspnea (50), cognitive impairment (38), fatigue (27), and sleepiness (24). The MRC (range, 0-4 with higher scores indicating more dyspnea) was 0.87 ± 1.00, corresponding to breathlessness hurrying or walking up a slight hill;27% were MRC2 or higher. SF-12 Composite and its 8 domain scores for the sample are given in Table 1. Comparative reference values for these variables from a large sample are provided. Conclusions: Patients discharged from the hospital following COVID-19 infection approximately five months earlier had, on average, mild-to-moderate MRC dyspnea and mild-to-moderate impairments in general health status. It is uncertain whether these abnormalities are residual effects of the remote COVID -19 infection or represent unrelated medical or mental problems. Limitations of our study include its small size and potential selection bias from evaluating those discharged directly to home from the hospital. Based on these observations, pulmonary rehabilitation would not be uniformly indicated months after hospital discharge for COVID-19. However, in view of the considerable variability in dyspnea and health status, the intervention would be reasonable in selected patients with more substantial limitations.