Long-term impact of COVID-19 hospitalisation among individuals with pre-existing airway diseases in the UK: a multicentre, longitudinal cohort study - PHOSP-COVID

Omer Elneima; John R Hurst; Carlos Echevarria; Jennifer K Quint; Samantha Walker; Salman Siddiqui; Petr Novotny; Paul E Pfeffer; Jeremy S Brown; Manu Shankar-Hari; Hamish J C McAuley; Olivia C Leavy; Aarti Shikotra; Amisha Singapuri; Marco Sereno; Matthew Richardson; Ruth M Saunders; Victoria C Harris; Linzy Houchen-Wolloff; Neil J Greening; Ewen M Harrison; Annemarie B Docherty; Nazir I Lone; James D Chalmers; Ling-Pei Ho; Alex Horsley; Michael Marks; Krisnah Poinasamy; Betty Raman; Rachael A Evans; Louise V Wain; Aziz Sheikh; Chris E Brightling; Anthony De Soyza; Liam G Heaney

doi:10.1183/23120541.00982-2023

Long-term impact of COVID-19 hospitalisation among individuals with pre-existing airway diseases in the UK: a multicentre, longitudinal cohort study - PHOSP-COVID

ERJ Open Res. 2024 Jul 15;10(4):00982-2023. doi: 10.1183/23120541.00982-2023. eCollection 2024 Jul.

Authors

Omer Elneima¹, John R Hurst^{2

3}, Carlos Echevarria^{4

5}, Jennifer K Quint⁶, Samantha Walker⁷, Salman Siddiqui⁸, Petr Novotny¹, Paul E Pfeffer^{9

10}, Jeremy S Brown², Manu Shankar-Hari¹¹, Hamish J C McAuley¹, Olivia C Leavy^{1

12}, Aarti Shikotra¹, Amisha Singapuri¹, Marco Sereno¹, Matthew Richardson¹, Ruth M Saunders¹, Victoria C Harris¹, Linzy Houchen-Wolloff^{1

13}, Neil J Greening¹, Ewen M Harrison¹⁴, Annemarie B Docherty¹⁴, Nazir I Lone¹⁴, James D Chalmers¹⁵, Ling-Pei Ho^{16

17}, Alex Horsley^{18

19}, Michael Marks^{20

21}, Krisnah Poinasamy⁷, Betty Raman^{17

22}, Rachael A Evans¹, Louise V Wain^{1

11}, Aziz Sheikh¹⁴, Chris E Brightling^{1

23}, Anthony De Soyza^{4

24

23}, Liam G Heaney^{25

26

23}

Affiliations

¹ The Institute for Lung Health, NIHR Leicester Biomedical Research Centre - Respiratory, University of Leicester, Leicester, UK.
² UCL Respiratory, Department of Medicine, University College London, London, UK.
³ Royal Free London NHS Foundation Trust, London, UK.
⁴ Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
⁵ Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
⁶ School of Public Health, Imperial College London, London, UK.
⁷ Asthma+Lung UK, London, UK.
⁸ National Heart and Lung Institute, Imperial College London, London, UK.
⁹ Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.
¹⁰ Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
¹¹ Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.
¹² Department of Population Health Sciences, University of Leicester, Leicester, UK.
¹³ Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK.
¹⁴ Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK.
¹⁵ University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
¹⁶ MRC Translational Discovery Immunology Unit, University of Oxford, Oxford, UK.
¹⁷ NIHR Oxford BRC, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
¹⁸ Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
¹⁹ Manchester University NHS Foundation Trust, Manchester, UK.
²⁰ Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
²¹ Hospital for Tropical Diseases, University College London Hospital, London, UK.
²² Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
²³ Joint senior authors.
²⁴ Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
²⁵ Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, UK.
²⁶ Belfast Health and Social Care Trust, Belfast, UK.

Abstract

Background: The long-term outcomes of COVID-19 hospitalisation in individuals with pre-existing airway diseases are unknown.

Methods: Adult participants hospitalised for confirmed or clinically suspected COVID-19 and discharged between 5 March 2020 and 31 March 2021 were recruited to the Post-hospitalisation COVID-19 (PHOSP-COVID) study. Participants attended research visits at 5 months and 1 year post discharge. Clinical characteristics, perceived recovery, burden of symptoms and health-related quality of life (HRQoL) of individuals with pre-existing airway disease (i.e., asthma, COPD or bronchiectasis) were compared to the non-airways group.

Results: A total of 615 out of 2697 (22.8%) participants had a history of pre-existing airway diseases (72.0% diagnosed with asthma, 22.9% COPD and 5.1% bronchiectasis). At 1 year, the airways group participants were less likely to feel fully recovered (20.4% versus 33.2%, p<0.001), had higher burden of anxiety (29.1% versus 22.0%, p=0.002), depression (31.2% versus 24.7%, p=0.006), higher percentage of impaired mobility using short physical performance battery ≤10 (57.4% versus 45.2%, p<0.001) and 27% had a new disability (assessed by the Washington Group Short Set on Functioning) versus 16.6%, p=0.014. HRQoL assessed using EQ-5D-5L Utility Index was lower in the airways group (mean±SD 0.64±0.27 versus 0.73±0.25, p<0.001). Burden of breathlessness, fatigue and cough measured using a study-specific tool was higher in the airways group.

Conclusion: Individuals with pre-existing airway diseases hospitalised due to COVID-19 were less likely to feel fully recovered, had lower physiological performance measurements, more burden of symptoms and reduced HRQoL up to 1 year post-hospital discharge.