Persistent breathlessness >28 days after acute COVID-19 infection has been identified as a highly debilitating post-COVID symptom. However, the prevalence, risk factors, mechanisms, and treatments for post-COVID breathlessness remain poorly understood. We systematically searched PubMed and Embase for relevant studies published from January 1, 2020 to November 1, 2021 (PROSPERO registration number: CRD42021285733) and included 119 eligible papers. Random-effects meta-analysis of 43,437 COVID-19 patients reported in 102 papers found an overall prevalence of post-COVID breathlessness of 26% (95% CI: 23-29) when measuring the presence/absence of the symptom, and 41% (95% CI: 34-48) when using MRC/modified MRC dyspnoea scale. The pooled prevalence decreased significantly from 1-6 months to 7-12 months post-infection. Post-COVID breathlessness was more common in those with severe/critical acute infection, those who were hospitalised, females, and less likely to be reported by patients in Asia than in Europe or North America. Multiple pathophysiologic mechanisms have been proposed (including deconditioning, restrictive/obstructive airflow limitation, systemic inflammation, impaired mental health), but the body of evidence remains inconclusive. Seven cohort studies and one randomised controlled trial suggested rehabilitation exercises may reduce post-COVID breathlessness. There is an urgent need for mechanistic research and development of interventions for the prevention and treatment of post-COVID breathlessness.

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Zheng, B., Daines, L., Han, Q., Hurst, J., Pfeffer, P., Shankar-Hari, M., Elneima, O., Walker, S., Brown, J., Siddiqui, S., Quint, J., Brightling, C., Evans, R., Wain, L., Heaney, L. & Sheikh, A. 2022, 'Prevalence, risk factors, and treatments for post-COVID breathlessness:a systematic review and meta-analysis', European Respiratory Review, 31, article no: 220071 . https://doi.org/10.1183/16000617.0071-2022

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Last updated: 29 August 2023
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