Characteristics and risk factors for post-COVID breathlessness after hospitalisation for COVID-19

PHOSP-COVID Collaborative Group, Luke Daines, Bang Zheng, Omer Elneima, Ewen M Harrison, Nazir I Lone, John R. Hurst, Jeremy S Brown, Elizabeth Sapey, James D. Chalmers, Jennifer K Quint, Paul E. Pfeffer, Salman Siddiqui, Samantha Walker, Krisnah Poinasamy, Hamish McAuley, Marco Sereno, Aarti Shikotra, Amisha Singapuri, Annemarie B DochertyMichael Marks, Mark Toshner, Luke S Howard, Alex Horsley, Gisli Jenkins, Joanna C Porter, Ling-Pei Ho, Betty Raman, Louise V Wain, Christopher E Brightling, Rachael A Evans, Liam G Heaney, Anthony De Soyza, Aziz Sheikh*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Persistence of respiratory symptoms—particularly breathlessness—after acute COVID-19 infection has emerged as a significant clinical problem. We aimed to characterise and identify risk factors for patients with persistent breathlessness following COVID-19 hospitalisation.

PHOSP-COVID is a multi-centre prospective cohort study of UK adults hospitalised for COVID-19. Clinical data were collected during hospitalisation and at a follow-up visit. Breathlessness was measured by a numeric rating scale of 0-10. We defined post-COVID breathlessness as an increase in score of 1 or more compared to the pre-COVID-19 level. Multivariable logistic regression was used to identify risk factors, and to develop a prediction model for post-COVID breathlessness.

We included 1,226 participants (37% female, median age 59 years, 22% mechanically ventilated). At a median five months after discharge, 50% reported post-COVID breathlessness. Risk factors for post-COVID breathlessness were socio-economic deprivation (adjusted odds ratio, 1.67; 95% confidence interval, 1.14–2.44), pre-existing depression/anxiety (1.58; 1.06–2.35), female sex (1.56; 1.21–2.00) and admission duration (1.01; 1.00–1.02). Black ethnicity (0.56; 0.35–0.89) and older age groups (0.31; 0.14–0.66) were less likely to report post-COVID breathlessness. Post-COVID breathlessness was associated with worse performance on the shuttle walk test and forced vital capacity, but not with obstructive airflow limitation. The prediction model had fair discrimination (concordance-statistic 0.66; 0.63–0.69), and good calibration (calibration slope 1.00; 0.80–1.21).

Post-COVID breathlessness was commonly reported in this national cohort of patients hospitalised for COVID-19 and is likely to be a multifactorial problem with physical and emotional components.
Original languageEnglish
JournalERJ Open Research
Early online date22 Dec 2022
Publication statusE-pub ahead of print - 22 Dec 2022


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