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Pathophysiology of pulmonary function anomalies in COVID-19 survivors

Pierantonio Laveneziana, Lucile Sesé, Thomas Gille
Breathe 2021 17: 210065; DOI: 10.1183/20734735.0065-2021
Pierantonio Laveneziana
1Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire APHP-Sorbonne Université, sites Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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  • For correspondence: pierantonio.laveneziana@aphp.fr
Lucile Sesé
3Université Sorbonne Paris Nord (USPN), INSERM, UMR 1272 “Hypoxia & the Lung”, UFR SMBH Léonard de Vinci, Bobigny, France
4Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaire Paris-Seine-Saint-Denis (HUPSSD), Hôpital Avicenne, Service de Physiologie et Explorations Fonctionnelles du Département Médico-Universitaire NARVAL, Bobigny, France
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Thomas Gille
3Université Sorbonne Paris Nord (USPN), INSERM, UMR 1272 “Hypoxia & the Lung”, UFR SMBH Léonard de Vinci, Bobigny, France
4Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaire Paris-Seine-Saint-Denis (HUPSSD), Hôpital Avicenne, Service de Physiologie et Explorations Fonctionnelles du Département Médico-Universitaire NARVAL, Bobigny, France
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    Figure 1

    Overview of the most common pulmonary pathology findings observed in post-mortem patients affected by various degrees of severity of COVID-19. See the text for more details and explanations.

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    Figure 2

    Factors contributing to lung transfer (or diffusing) capacity for carbon monoxide ( TLCO or DLCO). See the text for more details and explanations.

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    Figure 3

    Algorithm allowing physiologists and clinicians to unravel mechanisms of a decreased TLCO (or DLCO). If TLCO (or DLCO) is reduced, the next step is to check whether the VA is preserved or reduced. If  VA is diminished, the next step is to check whether the VA/TLC ratio is low (<80%) due to ventilation maldistribution secondary to an obstructive ventilatory defect or is preserved (≥80%) due to restrictive ventilatory defect, associated or not with impaired pulmonary gas exchange. If  VA is preserved, please follow the arrows in the algorithm to get some explanations and to see whether the KCO is reduced and if there are pulmonary gas exchange anomalies associated with this. “Coronavirus diseases” appears in red, as potential mechanisms explaining the TLCO (or DLCO) anomalies observed in coronavirus diseases such as COVID-19 (caused by SARS-CoV-2), severe acute respiratory syndrome (SARS; caused by SARS-CoV-1) and Middle East respiratory syndrome (MERS; caused by MERS-CoV) are yet not fully understood. See the text for more details and explanations. IPF: idiopathic pulmonary fibrosis; ILD: interstitial lung disease.

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Vol 17 Issue 3 Table of Contents
Breathe: 17 (3)
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Pathophysiology of pulmonary function anomalies in COVID-19 survivors
Pierantonio Laveneziana, Lucile Sesé, Thomas Gille
Breathe Sep 2021, 17 (3) 210065; DOI: 10.1183/20734735.0065-2021

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Pathophysiology of pulmonary function anomalies in COVID-19 survivors
Pierantonio Laveneziana, Lucile Sesé, Thomas Gille
Breathe Sep 2021, 17 (3) 210065; DOI: 10.1183/20734735.0065-2021
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  • Article
    • Abstract
    • Abstract
    • Introduction
    • Physiology and pathophysiology of abnormal pulmonary function variables as observed in COVID-19 survivors
    • Abnormal respiratory function in COVID-19 patients
    • Potential hypotheses on altered TLCO or DLCO in COVID-19 survivors
    • Specific features of respiratory dysfunction in COVID-19 compared with other viral pneumonias (SARS, MERS, and influenza A H1N1)
    • Future directions, perspectives and conclusions
    • Footnotes
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  • Mechanisms of lung disease
  • Respiratory infections and tuberculosis
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