{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:58:36Z","timestamp":1791485916902,"version":"4.3.4"},"reference-count":34,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T00:00:00Z","timestamp":1620950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Three to four months after hospitalisation for COVID-19 pneumonia, the most frequently described alteration in respiratory function tests (RFTs) is decreased carbon monoxide transfer capacity (DLCO). Methods: This is a prospective cohort study that included patients hospitalised because of SARS-CoV-2 pneumonia, three months after their discharge. A clinical evaluation, analytical parameters, chest X-ray, six-minute walk test, spirometry and DLCO\u2013DLNO analysis were performed. Demographic variables, comorbidities, and variables related to the severity of the admission were recorded. Results: Two hundred patients completed the study; 59.5% men, age 62 years, 15.5% admitted to the intensive care unit. The most frequent functional alteration, in 27% of patients, was in the DLCO\u2013DLNO combination. This alteration was associated with age, male sex, degree of dyspnoea, poorer perception of health, and limited ability for physical effort. These patients also presented higher levels of D-Dimer and more residual radiological alterations. In 42% of the patients with diffusion alterations, only reduced DLNO was presented, along with lower D-Dimer levels and less capillary volume involvement. The severity of the process was associated with the reduction in DLCO\u2013DLNO. Conclusions: The most sensitive RFT for the detection of the sequelae of COVID-19 pneumonia was the combined measurement of DLCO\u2013DLNO and this factor was related to patient health status and their capacity for physical exertion. In 40% of these cases, there was only a reduction in DLNO, a finding that may indicate less pulmonary vascular involvement.<\/jats:p>","DOI":"10.3390\/jcm10102119","type":"journal-article","created":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T10:54:22Z","timestamp":1620989662000},"page":"2119","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Alterations in Respiratory Function Test Three Months after Hospitalisation for COVID-19 Pneumonia: Value of Determining Nitric Oxide Diffusion"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9088-3713","authenticated-orcid":false,"given":"Marta","family":"N\u00fa\u00f1ez-Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"Service of Pneumology, University Hospital Complex of Vigo, NeumoVigo I+i. Institute of Health Research South Galicia (IISGS), 36213 Vigo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5626-7810","authenticated-orcid":false,"given":"Cristina","family":"Ramos-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Service of Pneumology, University Hospital Complex of Vigo, NeumoVigo I+i. Institute of Health Research South Galicia (IISGS), 36213 Vigo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7227-2238","authenticated-orcid":false,"given":"Francisco","family":"Garc\u00eda-R\u00edo","sequence":"additional","affiliation":[{"name":"Service of Pneumology La Paz-IdiPAZ University Hospital, 28046 Madrid, Spain"},{"name":"CIBER Respiratory Diseases (CIBERES), 28046 Madrid, Spain"},{"name":"Department of Medicine, University Aut\u00f3noma de Madrid, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Torres-Dur\u00e1n","sequence":"additional","affiliation":[{"name":"Service of Pneumology, University Hospital Complex of Vigo, NeumoVigo I+i. Institute of Health Research South Galicia (IISGS), 36213 Vigo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s","family":"Nodar-Germi\u00f1as","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Service of Internal Medicine, University Hospital Complex of Vigo, 36213 Vigo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amara","family":"Tilve-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Service of Radiodiagnosis, University Hospital Complex of Vigo, 36213 Vigo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Rodr\u00edguez-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Service of Radiodiagnosis, University Hospital Complex of Vigo, 36213 Vigo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7024-1657","authenticated-orcid":false,"given":"Diana","family":"Valverde-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Genetics and Immunology, University of Vigo, 36310 Vigo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9927-7453","authenticated-orcid":false,"given":"Alberto","family":"Ruano-Ravi\u00f1a","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15704 Santiago de Compostela, Spain"},{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 15704 Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7407-5249","authenticated-orcid":false,"given":"Alberto","family":"Fern\u00e1ndez-Villar","sequence":"additional","affiliation":[{"name":"Service of Pneumology, University Hospital Complex of Vigo, NeumoVigo I+i. 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J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1136\/thoraxjnl-2020-216308","article-title":"A prospective study of 12-week respira-tory outcomes in COVID-19-related hospitalisations","volume":"76","author":"Shah","year":"2020","journal-title":"Thorax"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"106197","DOI":"10.1016\/j.rmed.2020.106197","article-title":"Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae","volume":"174","author":"Daher","year":"2020","journal-title":"Respir. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100463","DOI":"10.1016\/j.eclinm.2020.100463","article-title":"Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recov-ery","volume":"25","author":"Zhao","year":"2020","journal-title":"EClinicalMedicine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2003690","DOI":"10.1183\/13993003.03690-2020","article-title":"Pulmonary function and radiological features four months after COVID-19: First results from the national prospective observational Swiss COVID-19 lung study","volume":"57","author":"Guler","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e2036142","DOI":"10.1001\/jamanetworkopen.2020.36142","article-title":"Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge","volume":"4","author":"Bellan","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2004015","DOI":"10.1183\/13993003.04015-2020","article-title":"Medium-term impact of COVID-19 on pulmonary function, functional capacity and quality of life","volume":"2021","author":"Anastasio","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sibila, O., Albacar, N., Perea, L., Faner, R., Torralba, Y., Hernandez-Gonzalez, F., Mois\u00e9s, J., Sanchez-Ruano, N., Sequeira-Aymar, E., and Badia, J.R. (2021). Lung Function sequelae in COVID-19 Patients 3 Months After Hospital Discharge. Arch. Bronconeumol.","DOI":"10.1016\/j.arbres.2021.01.036"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez, J., Ben\u00edtez, I.D., Carmona, P., Santisteve, S., Monge, A., Moncus\u00ed-Moix, A., Gort-Paniello, C., Pinilla, L., Carratal\u00e1, A., and Zuil, M. (2021). Pulmonary Function and Radiologic Features in Survivors of Critical COVID-19. Chest.","DOI":"10.1016\/j.chest.2021.02.062"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2001217","DOI":"10.1183\/13993003.01217-2020","article-title":"Abnormal pulmonary function in COVID-19 patients at time of hospital discharge","volume":"55","author":"Mo","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2001832","DOI":"10.1183\/13993003.01832-2020","article-title":"Abnormal carbon monoxide diffusion capacity in COVID-19 patients at time of hospital discharge","volume":"56","author":"Nusair","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2002194","DOI":"10.1183\/13993003.02194-2020","article-title":"Impaired pulmonary function in discharged patients with COVID-19: More work ahead","volume":"56","author":"Chen","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.acra.2020.07.019","article-title":"Assessment of Small Pulmonary Blood Vessels in COVID-19 Patients Using HRCT","volume":"27","author":"Lins","year":"2020","journal-title":"Acad. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e0266","DOI":"10.1097\/CCE.0000000000000266","article-title":"Spectrum of Vascular Involvement in Coronavirus Disease 2019 Pneumonia-Findings on CT Perfusion","volume":"2","author":"Ghariq","year":"2020","journal-title":"Crit. Care Explor."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2003263","DOI":"10.1183\/13993003.03263-2020","article-title":"Caution in interpretation of abnormal carbon monoxide diffusion capacity in COVID-19 patients","volume":"57","author":"Chapman","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e14748","DOI":"10.14814\/phy2.14748","article-title":"Lung diffusing capacity for nitric oxide and carbon monoxide following mild-to-severe COVID-19","volume":"9","author":"Barisione","year":"2021","journal-title":"Physiol. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.resp.2016.11.008","article-title":"Can the measurement of pulmonary diffusing capacity for nitric oxide replace the measure-ment of pulmonary diffusing capacity for carbon monoxide?","volume":"241","author":"Zavorsky","year":"2017","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e14149","DOI":"10.14814\/phy2.14149","article-title":"Value of lung diffusing capacity for nitric oxide in systemic sclerosis","volume":"7","author":"Barisione","year":"2019","journal-title":"Physiol. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1152\/japplphysiol.00964.2015","article-title":"Lung diffusing capacity for nitric oxide as a marker of fibrotic changes in idiopathic interstitial pneumonias","volume":"120","author":"Barisione","year":"2016","journal-title":"J. Appl. Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1600962","DOI":"10.1183\/13993003.00962-2016","article-title":"Standardisation and application of the single-breath determination of nitric oxide uptake in the lung","volume":"49","author":"Zavorsky","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"704","DOI":"10.2105\/AJPH.80.6.704","article-title":"Spanish version of the Nottingham Health Profile: Translation and preliminary validity","volume":"80","author":"Alonso","year":"1990","journal-title":"Am. J. Public Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1164\/rccm.201908-1590ST","article-title":"Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement","volume":"200","author":"Graham","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1183\/09031936.00080312","article-title":"Mul-ti-ethnic reference values for spirometry for the 3\u201395-yr age range: The global lung function 2012 equations","volume":"40","author":"Quanjer","year":"2012","journal-title":"Eur. J. Resp."},{"key":"ref_25","first-page":"131","article-title":"A theoretical and experimental analysis of anomalies in the estimation of pulmonary diffusing capacity by the single breath method","volume":"46","author":"Jones","year":"1961","journal-title":"Q. J. Exp. Physiol. Cogn. Med. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resp.2016.03.003","article-title":"In vivo estimates of NO and CO conductance for haemo-globin and for lung transfer in humans","volume":"228","author":"Martinot","year":"2016","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002). ATS statement: Guidelines for the six-minute walk test. Am. J. Respir. Crit. Care Med., 166, 111\u2013117.","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"L277","DOI":"10.1152\/ajplung.00195.2020","article-title":"Novel insights on the pulmonary vascular consequences of COVID-19","volume":"319","author":"Potus","year":"2020","journal-title":"Am. J. Physiol. Cell. Mol. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chun, H.J., Coutavas, E., Pine, A., Lee, A.I., Yu, V., Shallow, M., Giovacchini, C.X., Mathews, A., Stephenson, B., and Que, L.G. (2021). Immuno-fibrotic drivers of impaired lung function in post-COVID-19 syndrome. MedRxiv.","DOI":"10.1101\/2021.01.31.21250870"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"L12","DOI":"10.1152\/ajplung.00304.2020","article-title":"Hyperoxia and modulation of pulmonary vascular and immune responses in COVID-19","volume":"320","author":"Hanidziar","year":"2021","journal-title":"Am. J. Physiol. Cell. Mol. Physiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"454","DOI":"10.3389\/fmed.2020.00454","article-title":"Safety and Efficacy of Chest Physiotherapy in Patients with COVID-19: A Critical Review","volume":"7","author":"Abdullahi","year":"2020","journal-title":"Front. Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Van den Borst, B., Peters, J.B., Brink, M., Schoon, Y., Bleeker-Rovers, C.P., Schers, H., van Hees, H.W.H., van Helvoort, H., van den Boogaard, M., and van der Hoeven, H. (2020). Comprehensive health assessment three months after recovery from acute COVID-19. Clin. Infect. Dis., ciaa1750.","DOI":"10.1093\/cid\/ciaa1750"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/S0140-6736(20)32656-8","article-title":"6-month consequences of COVID-19 in patients discharged from hospital: A cohort study","volume":"397","author":"Huang","year":"2021","journal-title":"Lancet"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1136\/thx.2004.030205","article-title":"Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors","volume":"60","author":"Hui","year":"2005","journal-title":"Thorax"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/10\/2119\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:00:39Z","timestamp":1760162439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/10\/2119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,14]]},"references-count":34,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["jcm10102119"],"URL":"https:\/\/doi.org\/10.3390\/jcm10102119","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,14]]}}}