Fatigue and exercise intolerance after survived COVID-19-infection might be related toweakness of the respiratory muscles. The aim of the project is to measure respiratorymuscle function and strength in our respiratory physiology laboratory in patients whowere not hospitalized during the acute COVID-19-infection but still complain of differentpersistent symptoms including exertional dyspnea and fatigue.
Since the beginning of the COVID pandemic, more and more recovered patients have a number
of persistent symptoms including exertional dyspnea and fatigue even months after
recovering from acute coronavirus disease 2019 (COVID-19). These symptoms often cannot be
explained because routine clinical diagnoses, including extensive cardiac and pulmonary
examinations, do not reveal any relevant abnormalities.
In our previous study (Regmi et al) with 50 patients formerly hospitalized due to acute
COVID-19 infection, it was shown that diaphragm muscle weakness contributes to persistent
exertional dyspnea about one year after hospitalization for COVID-19, regardless of
mechanical ventilation. Additionally, the severity of exertional dyspnea correlated with
the extent of diaphragmatic weakness.
Since laboratory findings, pulmonary function tests and cardiological routine
examinations did not reveal any significant impairments, this was the first time that a
potential pathophysiological correlate is objectively associated with dyspnea in long
COVID-19 syndrome. The results of our study were clinically relevant because the
persistent symptom burden in patients after surviving COVID-19 infection remains very
high. In addition diaphragm training presents itself as a potential therapeutic target,
since in other diseases such as COPD, such training has been shown to improve the
symptoms. Therefore, the investigators believe that the results provide important
perspectives, both for the pathophysiological understanding and for the potential
treatment of persistent exertional dyspnea in patients.
However, a considerable gap exists here: a significant number of patients who suffer from
an acute COVID-19 infection but do not have a severe course during the initial infection,
so that hospitalization is not necessary, still complain of different persistent
symptoms. Here, too, despite an extensive cardiopulmonary work-up, there is a lack of a
sufficient explanation of the lasting complaints. It is precisely in these patients that
a possible role of diaphragmatic weakness on the symptoms is yet to be investigated using
already established gold standard techniques.
Diagnostic Test: Comprehensive assessment of respiratory muscle function.
Comprehensive assessment of respiratory muscle function to the point of its invasive
assessment with recordings of twitch transdiaphragmatic pressure in response to magnetic
phrenic nerve stimulation and stimulation of the lower thoracic nerve roots.
Inclusion Criteria:
- Patients with COVID-19 infection without hospitalization during the acute infection
(n=25)
- Patients aged at least 18 years, who are mentally and physically able to consent and
participate into the study
Exclusion Criteria:
- Clinically pre-established cardiovascular disease or other pulmonary diseases which
might lead to exertional dyspnea (systolic heart failure, COPD).
- Body-mass-index (BMI) >40
- Expected absence of active participation of the patient in study-related
measurements
- Alcohol or drug abuse
- Metal implant in the body that is not MRI compatible (NON MRI compatible pacemaker,
implantable defibrillator, cervical implants, e.g. brain pacemakers etc.)
- Slipped disc
- Epilepsy
- Bound to a wheel chair
Jens Spiesshoefer
Aachen, NRW, Germany
Investigator: Jens Spiesshoefer
jspiesshoefe@ukaachen.de
Jens Spiesshoefer, MD
+4924180 - 37065
mdreher@ukaachen.de
Michael Dreher, Professor
+4924180 - 88763
jspiesshoefe@ukaachen.de