Chest
Volume 128, Issue 4, October 2005, Pages 2247-2261
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Clinical Investigations
The 1-Year Impact of Severe Acute Respiratory Syndrome on Pulmonary Function, Exercise Capacity, and Quality of Life in a Cohort of Survivors

https://doi.org/10.1378/chest.128.4.2247Get rights and content

Objective

To examine pulmonary function, exercise capacity, and health-related quality of life (HRQoL) among severe acute respiratory syndrome (SARS) survivors.

Methods

We evaluated survivors with confirmed SARS at the Prince of Wales Hospital, Hong Kong, at 3, 6, and 12 months after symptom onset. Our assessment included: lung volume (total lung capacity [TLC], vital capacity, residual volume, functional residual capacity), spirometry (FVC, FEV1), diffusing capacity of the lung for carbon monoxide (Dlco), inspiratory and expiratory respiratory muscle strength, 6-min walk distance (6MWD), chest radiographs (CXRs), and HRQoL by Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire.

Results

Ninety-seven patients completed the serial assessments. There were 39 male and 58 female patients, and 63 patients (70%) were health-care workers (mean age, 36.9 years [SD, 9.5 years]; body mass index, 23.7 kg/m2 [SD, 4.0 kg/m2]). At 1 year, 27 patients (27.8%) had abnormal CXR findings. Four patients (4.1%), 5 patients (5.2%), and 23 patients (23.7%) had FVC, TLC, and Dlco values < 80% of predicted values, respectively. The 6MWD at 12 months was 511.0 m (SD, 89.8 m), which was higher than at 3 months (mean difference, 47.0 m; 95% confidence interval [CI], 31.8 to 62.1 m; p < 0.01) but not different from 6 months (mean difference, 9.7 m; 95% CI, − 4.4 to 23.8 m; p = 0.18). The 6MWD was lower than that for normal control subjects of the same age groups, and there was impairment of HRQoL at 12 months. Patients who required ICU admission (n = 31) showed higher CXR scores (1.6 [SD, 3.1]; vs 0.4 [SD, 1.1]; p = 0.04) and lower percentage of predicted FVC, TLC, and Dlco than those who did not, but there were no differences in 6MWD and health status.

Conclusion

Significant impairment in Dlco was noted in 23.7% of survivors 1 year after illness onset. Exercise capacity and health status of SARS survivors were remarkably lower than those of a normal population.

Keywords

severe acute respiratory syndrome
lung function
functional capacity
quality of life

Abbreviations

ANOVA
analysis of variance
BMI
body mass index
BOOP
bronchiolitis obliterans organizing pneumonia
BP
bodily pain
CI
confidence interval
CPET
cardiopulmonary exercise testing
CRP
C-reactive protein
CXR
chest radiograph
Dlco
diffusing capacity of the lung for carbon dioxide
FEF25–75
forced expiratory flow, midexpiratory phase
FRC
functional residual capacity
GH
general health
HCW
health-care worker
HK
Hong Kong
HRCT
high-resolution CT
HRQoL
health-related quality of life
IQR
interquartile range
Kco
diffusing capacity of the lung for carbon dioxide adjusted for alveolar volume
LDH
lactate dehydrogenase
LOS
length of stay
MH
mental health
Pemax
maximum static expiratory pressure
Pimax
maximum static inspiratory pressure
PF
physical functioning
RE
role limitation due to emotional problems
RP
role limitation due to physical problems
RV
residual volume
SARS
severe acute respiratory syndrome
SF
social functioning
SF-36
Medical Outcomes Study 36-Item Short-Form General Health Survey
TLC
total lung capacity
Va
alveolar volume
VC
vital capacity
VT
vitality
6MWD
6-min walk distance
6MWT
6-min walk test

Cited by (0)

Funding was provided by the Research Fund for the Control of Infectious Diseases (Health, Welfare and Food Bureau, Hong Kong Special Administrative Region).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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