Journal of Cardio-Thoracic Medicine

Journal of Cardio-Thoracic Medicine

Pulmonary Complications and Systemic Abnormalities in Post-COVID-19 Patients: A 3-Month

Document Type : Original Article

Authors
Farzaneh Akbari 1
Zahra Javid Arabshahi 2
Sepideh Hejazi 2
Fariba Rezaeetalab 2
Arezoo Faridzadeh 3
Elham Shaarbaf Eidaghi 4
Mahnaz Mozdourian 2
1 Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
4 Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/jctm.2026.92983.1521
Abstract
Introduction: The coronavirus disease 2019(COVID-19) pandemic has had significant acute and long-term health impacts. Persistent pulmonary and systemic complications after recovery remain inadequately studied. This cohort study aimed to assess chronic respiratory and systemic abnormalities in patients three months post-COVID-19 recovery.
Methods: We evaluated 100 patients more than three months after recovery. Assessments included spirometry, high-resolution computed tomography (HRCT), arterial blood gas (ABG) analysis, and laboratory tests of inflammatory and hematologic parameters. Patients with preexisting lung disease or those to perform spirometry were excluded. Data were analyzed using SPSS version 27.
Results: The cohort consisted of 100 patients (mean age 49.8 ± 15.1 years; 50 males, 50 females). While clinical symptoms significantly decreased after three months, cough and dyspnea persisted in a notable proportion. Of the patients, 59.8% were managed as outpatients, 18.5% were hospitalized in general wards, and 21.7% required intensive care unit (ICU) admission. Spirometry revealed ongoing pulmonary dysfunction across obstructive, restrictive, and mixed patterns, with significantly reduced predicted forced expiratory volume in 1 second (FEV₁) and Forced Vital Capacity (FVC). The FEV₁/FVC ratio was notably decreased in obstructive and mixed groups, indicating persistent airflow limitation. Lung Computed Tomography (CT) scan showed significant resolution of ground-glass opacities (80.9% to 18.8%) and consolidation (19.1% to 3.5%). However, fibrotic-like changes, including septal thickening, persisted or slightly increased (21.3% to 32.9%). Other structural abnormalities were uncommon and largely unchanged.
Conclusion: Most patients showed symptomatic improvement by three months, but a significant subset continued to exhibit respiratory dysfunction and structural lung alterations. These findings highlight the importance of long-term clinical and radiological monitoring of post-COVID-19 patients and suggest broader implications for managing post-viral respiratory sequelae.
Keywords
COVID-19
Post-COVID-19
Follow up
Pulmonary
Respiratory Function Tests
  1. WHO. WHO COVID-19 dashboard. 2025; Available from: https://covid19.who.int/.
  2. CDC, Long COVID Basics. 2025. Available from: https://www.cdc.gov/long-covid/about/index.html
  3. Chemaitelly H, Nagelkerke N, Ayoub HH, Coyle P, Tang P, Yassine HM, et al. Duration of immune protection of SARS-CoV-2 natural infection against reinfection. Journal of Travel Medicine. 2022 Dec;29(8):taac109.
  4. Jacobs JJ. Persistent SARS-2 infections contribute to long COVID-19. Medical hypotheses. 2021 Apr 1;149:110538.
  5. Moghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH, et al. The impact of vaccination on coronavirus disease 2019 (COVID-19) outbreaks in the United States. Clinical Infectious Diseases. 2021 Dec 15;73(12):2257-64.
  6. Dorri M, Bazargany MH, Khodaparast Z, Bahrami S, Alan MS, Rahimi F, et al. Psychological problems and reduced health-related quality of life in the COVID-19 survivors. Journal of affective disorders reports. 2021 Dec 1;6:100248.
  7. Lupu L, Palmer A, Huber-Lang M. Inflammation, thrombosis, and destruction: the three-headed cerberus of trauma-and SARS-CoV-2-induced ARDS. Frontiers in immunology. 2020 Sep 25;11:584514.
  8. Bösmüller H, Matter M, Fend F, Tzankov A. The pulmonary pathology of COVID-19. Virchows Archiv. 2021 Jan;478(1):137-50.
  9. D'Cruz RF, Waller MD, Perrin F, Periselneris J, Norton S, Smith LJ, et al. Chest radiography is a poor predictor of respiratory symptoms and functional impairment in survivors of severe COVID-19 pneumonia. ERJ open research. 2021 Feb 8;7(1).
  10. Desai AD, Lavelle M, Boursiquot BC, Wan EY. Long-term complications of COVID-19. American Journal of Physiology-Cell Physiology. 2022 Jan 1;322(1):C1-1.
  11. Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. Jama. 2020 Aug 11;324(6):603-5.
  12. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet. 2023 Jun 17;401(10393):e21-33.
  13. Davis HE, Assaf GS, McCorkell L, Wei H, Low RJ, Re'em Y, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. 2021 Aug 1;38.
  14. Mandal S, Barnett J, Brill SE, Brown JS, Denneny EK, Hare SS, et al. ‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax. 2021 Apr 1;76(4):396-8.
  15. Fumagalli A, Misuraca C, Bianchi A, Borsa N, Limonta S, Maggiolini S, et al. Long-term changes in pulmonary function among patients surviving to COVID-19 pneumonia. Infection. 2022 Aug;50(4):1019-22.
  16. Guler SA, Ebner L, Aubry-Beigelman C, Bridevaux PO, Brutsche M, Clarenbach C, et al. Pulmonary function and radiological features 4 months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study. European respiratory journal. 2021 Apr 29;57(4).
  17. Bellan M, Soddu D, Balbo PE, Baricich A, Zeppegno P, Avanzi GC, et al. Respiratory and psychophysical sequelae among patients with COVID-19 four months after hospital discharge. JAMA network open. 2021 Jan 27;4(1):e2036142.
  18. Mo X, Jian W, Su Z, Chen MU, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. European Respiratory Journal. 2020 Jun 18;55(6).
  19. Frija-Masson J, Debray MP, Gilbert M, Lescure FX, Travert F, Borie R, et al. Functional characteristics of patients with SARS-CoV-2 pneumonia at 30 days post-infection. European Respiratory Journal. 2020 Aug 6;56(2).
  20. Anastasio F, Barbuto S, Scarnecchia E, Cosma P, Fugagnoli A, Rossi G, et al. Medium-term impact of COVID-19 on pulmonary function, functional capacity and quality of life. European Respiratory Journal. 2021 Sep 16;58(3).
  21. Myall KJ, Mukherjee B, Castanheira AM, Lam JL, Benedetti G, Mak SM, et al. Persistent post–COVID-19 interstitial lung disease. An observational study of corticosteroid treatment. Annals of the American Thoracic Society. 2021 May;18(5):799-806.
  22. Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month follow-up chest CT findings after severe COVID-19 pneumonia. Radiology. 2021 Apr;299(1):E177-86.
  23. Wu X, Liu X, Zhou Y, Yu H, Li R, Zhan Q, et al. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. The Lancet Respiratory Medicine. 2021 Jul 1;9(7):747-54.
  24. Wanner N, Andrieux G, Badia-i-Mompel P, Edler C, Pfefferle S, Lindenmeyer MT, et al. Molecular consequences of SARS-CoV-2 liver tropism. Nature Metabolism. 2022 Mar;4(3):310-9.
  25. Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. European radiology. 2020 Dec;30(12):6808-17.
  26. Fogarty H, Townsend L, Morrin H, Ahmad A, Comerford C, Karampini E, et al. Persistent endotheliopathy in the pathogenesis of long COVID syndrome. Journal of thrombosis and haemostasis. 2021 Oct;19(10):2546-53.
Journal of Cardio-Thoracic Medicine
Volume 14, Issue 1
Winter 2026
Pages 1646-1655