Do not forget the lungs: preliminary feasibility study on I/E mode physiotherapy for people recovering from COVID-19

Abstract

Early chest physiotherapy is recommended for patients with post-COVID syndrome to improve dyspnea, relieve anxiety, minimize disability, preserve lung function and improve Quality of Life. However, there is still no consensus on the best treatments to manage respiratory symptoms. We aimed to test a method based on a guided in/expiratory (I/E) modulation to treat the lung inhomogeneity. Twenty patients with post-COVID syndrome and mild-to-moderate obstructive syndrome performed 3 15-min sessions/day using the I/E mode of the T-PEP®4 device (Medical Products Research Srl, Legnano, Milan, Italy), for 15 consecutive days. Lung function parameters, dyspnea, and Quality of Life scores, as well as exercise capacity were assessed before and after treatment. All patients concluded the treatment and showed significant improvements in symptoms (chest pain during deep inspiration, chest tightness, inability to yawn, fatigue during activities of daily living [ADL], desaturation ≥4% during ADL) and in health status (BCSS -1.75, P=0.0003; CAT -5.2, P=0.0001). Lung function (FVC +10.9%, P=0.0002; FEV<inf>1</inf> +8%, P=0.0001) and respiratory muscle strength (MIP +13.8%, P<0.0001; SNIP +13.6%, P=0.0122; MEP +7.6%, P=0.0045) improved. Exercise capacity also improved (6MWT +14.2%, P=0.005). At the end of treatment, only 2 patients reported symptoms and ADL-induced desaturation, while 14 still had fatigue during ADL. This study shows that chest physiotherapy using an I/E device to actively recruit peripheral lungs in COVID-19 patients early after hospital discharge improved lung function tests as well as respiratory muscle strength, exercise capacity and Quality of Life.