{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T21:07:54Z","timestamp":1768338474733,"version":"3.49.0"},"reference-count":25,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T00:00:00Z","timestamp":1657670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CONSORZIO FUTURO IN RICERCA","award":["ROMA\\01"],"award-info":[{"award-number":["ROMA\\01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>SARS-CoV-2 may lead to a large spectrum of respiratory manifestations, including pulmonary sequelae. We conducted a single-center longitudinal study of survivors from severe COVID-19 cases who underwent a chest CT during hospitalization (CTH). Three months after being discharged, these patients were evaluated by a clinical examination, pulmonary function tests and a chest-CT scan (CTFU). Sixty-two patients were enrolled. At follow-up, 27% complained of exertional dyspnoea and 12% of cough. Dyspnoeic patients had a lower forced expiratory flow (FEF)25\u201375 (p = 0.015), while a CT scan (p = 0.016 showed that patients with cough had a higher extent of bronchiectasis. Lung volumes and diffusion of carbon monoxide (DLCO) at follow-up were lower in patients who had been invasively ventilated, which correlated inversely with the length of hospitalization and ground-glass extension at CTH. At follow-up, 14.5% of patients had a complete radiological resolution, while 85.5% presented persistence of ground-glass opacities, and 46.7% showed fibrotic-like alterations. Residual ground-glass at CTFU was related to the length of hospitalization (r = 0.48; p = 0.0002) and to the need for mechanical ventilation or high flow oxygen (p = 0.01) during the acute phase. In conclusion, although patients at three months from discharge showed functional impairment and radiological abnormalities, which correlated with a prolonged hospital stay and need for mechanical ventilation, the persistence of respiratory symptoms was related not to parenchymal but rather to airway sequelae.<\/jats:p>","DOI":"10.3390\/jcm11144046","type":"journal-article","created":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T22:06:00Z","timestamp":1657749960000},"page":"4046","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Multidimensional 3-Month Follow-Up of Severe COVID-19: Airways beyond the Parenchyma in Symptomatic Patients"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1796-8478","authenticated-orcid":false,"given":"Matteo","family":"Bonato","sequence":"first","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"},{"name":"Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piera","family":"Peditto","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Landini","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"},{"name":"Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, \u201cSapienza\u201d Rome University, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"Fraccaro","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cosimo","family":"Catino","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Cuzzola","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Malacchini","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Savoia","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Roma","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Salasnich","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Turrin","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Zampieri","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Zanardi","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabiola","family":"Zeraj","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcello","family":"Rattazzi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Peta","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiology, Intensive Care, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8923-7511","authenticated-orcid":false,"given":"Simonetta","family":"Baraldo","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Saetta","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Fusaro","sequence":"additional","affiliation":[{"name":"Department of Radiology, Oderzo City Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31046 Oderzo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Morana","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7037-7511","authenticated-orcid":false,"given":"Micaela","family":"Romagnoli","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Ca\u2019 Foncello Hospital, Azienda Unit\u00e0 Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.clinimag.2020.11.021","article-title":"Diagnostic accuracy of CT and radiographic findings for novel coronavirus 2019 pneumonia: Systematic review and meta-analysis","volume":"72","author":"Garg","year":"2021","journal-title":"Clin. Imaging"},{"key":"ref_2","first-page":"383","article-title":"Analysis of thin-section CT in patients with coronavirus disease (COVID-19) after hospital discharge","volume":"28","author":"Wei","year":"2020","journal-title":"J. X-ray Sci. Technol."},{"key":"ref_3","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 recovery","volume":"25","author":"Zhao","year":"2020","journal-title":"EClinicalMedicine"},{"key":"ref_4","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"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1378\/chest.128.4.2247","article-title":"The 1-year impact of severe acute respiratory syndrome on pulmonary function, exercise capacity, and quality of life in a cohort of survivors","volume":"128","author":"Hui","year":"2005","journal-title":"Chest"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"342","DOI":"10.4103\/ijri.IJRI_469_16","article-title":"Follow-up chest radiographic findings in patients with MERS-CoV after recovery","volume":"27","author":"Das","year":"2017","journal-title":"Indian J. Radiol. Imaging"},{"key":"ref_7","unstructured":"(2022, May 22). Available online: https:\/\/www.aifa.gov.it\/aggiornamento-sui-farmaci-utilizzabili-per-il-trattamento-della-malattia-covid19."},{"key":"ref_8","unstructured":"(2022, May 22). Available online: https:\/\/www.flipsnack.com\/SIAARTI\/siaarti_raccomandazioni_per_la_gestione_del_paziente_criti\/full-view.html."},{"key":"ref_9","first-page":"2101499","article-title":"ERS\/ATS technical standard on interpretive strategies for routine lung function tests","volume":"23","author":"Stanojevic","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5178","DOI":"10.1007\/s00330-020-07623-w","article-title":"Clinical and chest CT features as a predictive tool for COVID-19 clinical progress: Introducing a novel semi-quantitative scoring system","volume":"31","author":"Salahshour","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.jpeds.2004.02.038","article-title":"High-resolution computed tomography in young patients with cystic fibrosis: Distribution of abnormalities and correlation with pulmonary function tests","volume":"145","author":"Brody","year":"2004","journal-title":"J. Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1148\/radiol.2462070712","article-title":"Fleischner Society: Glossary of terms for thoracic imaging","volume":"246","author":"Hansell","year":"2008","journal-title":"Radiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"106383","DOI":"10.1016\/j.rmed.2021.106383","article-title":"Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae","volume":"181","author":"Froidure","year":"2021","journal-title":"Respir. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/S2213-2600(21)00174-0","article-title":"3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: A prospective study","volume":"9","author":"Wu","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"823600","DOI":"10.3389\/fmed.2021.823600","article-title":"Characteristics and Prognostic Factors of Pulmonary Fibrosis after COVID-19 Pneumonia","volume":"8","author":"Cocconcelli","year":"2022","journal-title":"Front. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4427","DOI":"10.1007\/s00330-022-08580-2","article-title":"Air trapping in COVID-19 patients following hospital discharge: Retrospective evaluation with paired inspiratory\/expiratory thin-section CT","volume":"32","author":"Franquet","year":"2022","journal-title":"Eur. Radiol."},{"key":"ref_17","first-page":"1299","article-title":"Inspiratory and Expiratory Chest High-resolution CT: Small-airway Disease Evaluation in Patients with COVID-19","volume":"17","author":"Huang","year":"2021","journal-title":"Curr. Med. Imaging"},{"key":"ref_18","first-page":"1753466621995043","article-title":"Impact of bronchiectasis on susceptibility to and severity of COVID-19: A nationwide cohort study","volume":"15","author":"Choi","year":"2021","journal-title":"Adv. Respir. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Baratella, E., Ruaro, B., Marrocchio, C., Starvaggi, N., Salton, F., Giudici, F., Quaia, E., Confalonieri, M., and Cova, M.A. (2021). Interstitial Lung Disease at High Resolution CT after SARS-CoV-2-Related Acute Respiratory Distress Syndrome According to Pulmonary Segmental Anatomy. J. Clin. Med., 10.","DOI":"10.3390\/jcm10173985"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2003481","DOI":"10.1183\/13993003.03481-2020","article-title":"Cardiopulmonary recovery after COVID-19: An observational prospective multicentre trial","volume":"57","author":"Sonnweber","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_21","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_22","doi-asserted-by":"crossref","first-page":"2003690","DOI":"10.1183\/13993003.03690-2020","article-title":"Pulmonary function and radiological features 4 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_23","first-page":"103590","article-title":"Post COVID-19 pulmonary fibrosis; A meta-analysis study","volume":"77","author":"Kakamad","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1148\/radiol.2021212350","article-title":"Residual Lung Lesions at 1-year CT after COVID-19","volume":"302","author":"Yu","year":"2022","journal-title":"Radiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"224","DOI":"10.4103\/jpgm.jpgm_550_21","article-title":"Sequelae of COVID-19 pneumonia: Is it correct to label everything as post-COVID lung fibrosis?","volume":"67","author":"Garg","year":"2021","journal-title":"J. Postgrad. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/14\/4046\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:49:23Z","timestamp":1760140163000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/14\/4046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,13]]},"references-count":25,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["jcm11144046"],"URL":"https:\/\/doi.org\/10.3390\/jcm11144046","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,13]]}}}