Scientific Letter
Bronchodilator Response as a Possible Predictor of Lung Function Improvement After Pulmonary Rehabilitation in Post-COVID-19 Patients
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Pericàs, Héctor Peroni, Enric Barbeta, Albert Gabarrús, Antoni Torres" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Catia" "apellidos" => "Cillóniz" ] 1 => array:2 [ "nombre" => "Juan M." 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[ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "The Role of Blood Gas Analysis in the Post-Acute Phase of COVID-19 Pneumonia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "513" "paginaFinal" => "516" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Dina Visca, Giovanni Battista Migliori, Anh-Tuan Dinh-Xuan, Rosella Centis, Stefano Belli, Michele Vitacca, Maria Aliani, Elisabetta Zampogna, Davide Feci, Patrizia Pignatti, Martina Zappa, Laura Saderi, Giovanni Sotgiu, Antonio Spanevello" "autores" => array:14 [ 0 => array:2 [ "nombre" => "Dina" "apellidos" => "Visca" ] 1 => array:2 [ "nombre" => "Giovanni Battista" "apellidos" => "Migliori" ] 2 => array:2 [ "nombre" => "Anh-Tuan" "apellidos" => "Dinh-Xuan" ] 3 => array:2 [ "nombre" => "Rosella" "apellidos" => "Centis" ] 4 => array:2 [ "nombre" => "Stefano" "apellidos" => "Belli" ] 5 => array:2 [ "nombre" => "Michele" "apellidos" => "Vitacca" ] 6 => array:2 [ "nombre" => "Maria" "apellidos" => "Aliani" ] 7 => array:2 [ "nombre" => "Elisabetta" "apellidos" => "Zampogna" ] 8 => array:2 [ "nombre" => "Davide" "apellidos" => "Feci" ] 9 => array:2 [ "nombre" => "Patrizia" "apellidos" => "Pignatti" ] 10 => array:2 [ "nombre" => "Martina" "apellidos" => "Zappa" ] 11 => array:2 [ "nombre" => "Laura" "apellidos" => "Saderi" ] 12 => array:2 [ "nombre" => "Giovanni" "apellidos" => "Sotgiu" ] 13 => array:2 [ "nombre" => "Antonio" "apellidos" => "Spanevello" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028962100185X?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000006/v2_202212170815/S030028962100185X/v2_202212170815/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Bronchodilator Response as a Possible Predictor of Lung Function Improvement After Pulmonary Rehabilitation in Post-COVID-19 Patients" "tieneTextoCompleto" => true "saludo" => "To the Director," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "517" "paginaFinal" => "519" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mauro Maniscalco, Salvatore Fuschillo, Pasquale Ambrosino, Silvestro Ennio D’Anna, Maria Sofia Accardo, Maria Gabriella Matera, Mario Cazzola" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Mauro" "apellidos" => "Maniscalco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Salvatore" "apellidos" => "Fuschillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Pasquale" "apellidos" => "Ambrosino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Silvestro Ennio" "apellidos" => "D’Anna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Maria Sofia" "apellidos" => "Accardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Maria Gabriella" "apellidos" => "Matera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:4 [ "nombre" => "Mario" "apellidos" => "Cazzola" "email" => array:1 [ 0 => "mario.cazzola@uniroma2.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unit of Pharmacology, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3329 "Ancho" => 3175 "Tamanyo" => 718205 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mean (SE) increase from baseline of FEV<span class="elsevierStyleInf">1</span> after salbutamol 400<span class="elsevierStyleHsp" style=""></span>μg in the entire group, in subjects without concomitant obstructive lung diseases (no OLD), and in COPD patients (A), and mean (SE) pre-salbutamol test in the entire group, in no OLD subjects, in COPD patients and in asthmatics before (pre) and after (post) rehabilitation (B). Correlation between improvements in FEV<span class="elsevierStyleInf">1</span> induced by salbutamol before starting the rehabilitation program and the improvements in parameter measured at the end of rehabilitation in different groups (C). *<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05, **<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01, ***<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 vs pre-salbutamol (A) and vs pre-rehabilitation (B).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In a preliminary study, we showed that many COVID-19 pneumonia patients when discharged from the acute care setting respond significantly to inhaled short-acting β<span class="elsevierStyleInf">2</span>-agonists (SABAs). Such response is observed in patients without an obstructive pattern <a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> but also in those experiencing lung interstitial impairment which represents a characteristic feature of COVID-19 patients.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Therefore, we investigated whether the bronchial response to SABAs may serve as functional predictor of lung function improvement induced by pulmonary rehabilitation (PR).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Within 48<span class="elsevierStyleHsp" style=""></span>h of admission to the Pulmonary Rehabilitation Unit of Istituti Clinici Scientifici Maugeri of Telese Terme, Italy, consecutive post-COVID-19 patients discharged from an acute care setting were screened for eligibility (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Bronchial response to inhaled salbutamol 400<span class="elsevierStyleHsp" style=""></span>μg was assessed according to the American Thoracic Society/European Respiratory Society (ATS/ESR) Task Force<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> using automated equipment (Vyasis FlowScreen II Spirometer, Milan, Italy). Then, all included patients underwent a 5-week PR program with daily sessions (6 sessions/week). The program consisted of 30 sessions following the official ATS/ERS statement on PR.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> All exercises were performed at moderate to high intensity to obtain an overload stimulus. Based on dyspnea and fatigue symptom scores, the training intensity was progressively increased. At the end of the RP program, lung functional tests were repeated, including assessment of bronchial response to salbutamol.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The study was approved with reference number ICS 11/20 and all patients provided written informed consent.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Data were expressed as mean and 95% confidence interval (CI) (standard errors have been reported in figures). Analysis of spirometric data before and after PR was performed using the Student's <span class="elsevierStyleItalic">t</span> test for paired variables. Furthermore, a Pearson correlation analysis was performed to determine if there were significant correlations between the improvements in FEV<span class="elsevierStyleInf">1</span> and FVC induced by salbutamol before and after PR. We used the Chan's interpretation of the <span class="elsevierStyleItalic">r</span> values<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> to name the strength of the linear relationship between the two variables. A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 was considered as being of significance for all tests.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Among the 84 patients in whom reversibility tests could be performed, 14 had concomitant obstructive lung disease (OLD), 12 suffering from chronic obstructive pulmonary disease (COPD) and 2 from asthma (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Forty-nine and 52 patients, respectively, had FEV<span class="elsevierStyleInf">1</span> and FVC values lower than 80% of predicted values.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Before PR, mean improvement in FEV<span class="elsevierStyleInf">1</span> induced by salbutamol for all patients was 48.0<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 20.4–75.6<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). FEV<span class="elsevierStyleInf">1</span> increased by 90.8<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 37.7–144.0<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) and 325.0<span class="elsevierStyleHsp" style=""></span>mL in COPD and asthmatic subjects, respectively, but excluding the subjects with OLD, FEV<span class="elsevierStyleInf">1</span> improvement was 32.7<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 3.6–61.9<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">After PR, FEV<span class="elsevierStyleInf">1</span> increased by 260.5<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 190.2–330.8<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) in the entire population (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), while the number of patients with FEV<span class="elsevierStyleInf">1</span> and FVC values below 80% of predicted decreased from 34 to 30 patients. However, FEV<span class="elsevierStyleInf">1</span> and FVC values decreased more than 5% predicted in 5 patients. In subjects without OLD, COPD and asthmatics FEV<span class="elsevierStyleInf">1</span> increased by 288.6<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 210.12–367.0<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), 67.5<span class="elsevierStyleHsp" style=""></span>mL (95% CI: −87.4–222.4<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.358), and 435.0<span class="elsevierStyleHsp" style=""></span>mL, respectively.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Changes in FEV<span class="elsevierStyleInf">1</span> induced by salbutamol before rehabilitation significantly correlated with the improvement in FEV<span class="elsevierStyleInf">1</span> observed after PR in the entire group (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.22; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) and in patients without OLD (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.25; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05), but not in COPD patients (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.42; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.176) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p><p id="par0050" class="elsevierStylePara elsevierViewall">In patients who required mechanical ventilation during hospitalization for COVID-19 pneumonia, the mean salbutamol induced increase in FEV<span class="elsevierStyleInf">1</span> was 82.4<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 43.6–121.1<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) and 347.6<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 187.3–508.0<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) before and after rehabilitation, respectively. In patients who did not require mechanical ventilation the mean FEV<span class="elsevierStyleInf">1</span> change induced by salbutamol was 39.2<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 6.1–72.4<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) and 238.4<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 159.0–317.7<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) before and after rehabilitation, respectively.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In non-ventilated subjects a significant and direct correlation between salbutamol induced changes in FEV<span class="elsevierStyleInf">1</span> before and after rehabilitation (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.27; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) was observed. In contrast, a non-significant correlation was found in patients who had been mechanically ventilated (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.17; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.513) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p><p id="par0060" class="elsevierStylePara elsevierViewall">Before rehabilitation, salbutamol improved FVC by an average of 71.8<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 31.7–111.9<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), 57.0<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 15.0–99.0<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01), 125.0<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 16.8–266.8<span class="elsevierStyleHsp" style=""></span>mL; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.078) and 270.0<span class="elsevierStyleHsp" style=""></span>mL (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.226) in the entire population, in patients without OLD, in COPD and asthmatic patients, respectively. The mean value of FVC before salbutamol increased substantially after PR (entire sample: 387.5<span class="elsevierStyleHsp" style=""></span>mL, 95% CI: 298.1–476.9<span class="elsevierStyleHsp" style=""></span>mL, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001; no OLD subjects: 429.0<span class="elsevierStyleHsp" style=""></span>mL, 95% CI: 334.6–523.4<span class="elsevierStyleHsp" style=""></span>mL, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001; COPD patients: 102.5<span class="elsevierStyleHsp" style=""></span>mL, 95% CI: −160.7–365.7<span class="elsevierStyleHsp" style=""></span>mL, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.410; asthma patients: 645.0<span class="elsevierStyleHsp" style=""></span>mL).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Only when OLD patients were excluded from the Pearson correlation analysis, the rehabilitation-induced improvement in FVC correlated with salbutamol-induced increase in FVC at admission (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.26, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 vs. <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.735).</p><p id="par0070" class="elsevierStylePara elsevierViewall">In patients who had been mechanically ventilated, the mean FVC improvement after salbutamol was 129.4<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 50.9–207.9<span class="elsevierStyleHsp" style=""></span>mL, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) and 13.6<span class="elsevierStyleHsp" style=""></span>mL (95% CI: −43.0–70.1<span class="elsevierStyleHsp" style=""></span>mL, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.619) before and after rehabilitation, respectively. In patients who were not mechanically ventilated, these changes were 54.8<span class="elsevierStyleHsp" style=""></span>mL (95% CI: 7.9–101.8<span class="elsevierStyleHsp" style=""></span>mL, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) and 32.4<span class="elsevierStyleHsp" style=""></span>mL (95% CI: −3.1–67.9<span class="elsevierStyleHsp" style=""></span>mL, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.072), respectively.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Our results consistently show that PR in post COVID-19 patients may result in a substantial improvement in lung function, with the normalization of lung functional parameters in a high percentage of cases that are without pre-existing OLD. In fact, 31 of our 84 patients had FEV<span class="elsevierStyleInf">1</span> greater than 90% predicted at the end of the PR program and in other 22 subjects, FEV<span class="elsevierStyleInf">1</span> was between 80.0 and 89.9% predicted.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the COPD population, the Pearson correlation coefficient was higher, indicating a fair association between the salbutamol-induced improvements in FEV<span class="elsevierStyleInf">1</span> before and after PR. However, the reliability of the linear model also depends on how many observed data-points are in the sample. In our COPD patients, the <span class="elsevierStyleItalic">P</span> value was 0.176 (not statistically significant), which reflected the very small sample size (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12). It will therefore be essential to conduct a specific study on a larger population of COPD patients.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the absence of a control group, it is hard to determine how much of the improvement was the consequence of rehabilitation rather than the spontaneous recovery of lung function. Unfortunately, the challenges posed by the pandemic did not allow us to enroll a control group. COVID-19 is in fact an obstacle to the use of the standard diagnostic criterion, namely spirometry, which is considered a procedure that generates aerosols and which can therefore increase the risk that someone who is an asymptomatic carrier of the virus can easily spread it in an outpatient setting.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The significant PR-induced improvement in lung function in mechanically ventilated patients, none of whom had pre-existing chronic OLD, is noteworthy. The reasons for this improvement are not univocal. The greater severity of the disease, on the one hand, and the effects of mechanical ventilation on the trophism of the respiratory muscles, on the other hand, may have contributed to the observed differences.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion, our results suggest that the reversibility test with SABAs may be a predictor of the functional improvements induced by rehabilitation in post COVID-19 patients. Larger controlled studies are needed to confirm our preliminary findings.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contributions</span><p id="par0100" class="elsevierStylePara elsevierViewall">M. Maniscalco: Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Writing – review and editing. S. Fuschillo: Investigation. P. Ambrosino: Data curation, Investigation, Methodology, Writing – review and editing. S.E. D’Anna: Investigation. M.S. Accardo: Investigation. M.G. Matera: Formal analysis, Validation, Writing – review and editing. M. Cazzola: Conceptualization, Formal analysis, Validation, Writing – original draft, Writing – review and editing. All Authors read and approved the final version of the manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding sources</span><p id="par0105" class="elsevierStylePara elsevierViewall">No funding or economic support were received for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interests</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding sources" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interests" ] 3 => array:2 [ "identificador" => "xack642533" "titulo" => "Acknowledgments" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3329 "Ancho" => 3175 "Tamanyo" => 718205 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mean (SE) increase from baseline of FEV<span class="elsevierStyleInf">1</span> after salbutamol 400<span class="elsevierStyleHsp" style=""></span>μg in the entire group, in subjects without concomitant obstructive lung diseases (no OLD), and in COPD patients (A), and mean (SE) pre-salbutamol test in the entire group, in no OLD subjects, in COPD patients and in asthmatics before (pre) and after (post) rehabilitation (B). Correlation between improvements in FEV<span class="elsevierStyleInf">1</span> induced by salbutamol before starting the rehabilitation program and the improvements in parameter measured at the end of rehabilitation in different groups (C). *<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05, **<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01, ***<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 vs pre-salbutamol (A) and vs pre-rehabilitation (B).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">N</span>: number; FEV<span class="elsevierStyleInf">1</span>: forced expiratory volume in 1 second; FVC: forced vital capacity; OLD: obstructive lung disease; COPD: chronic obstructive pulmonary disease; F<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>females; WHO: world health organization of COVID-19 severity classification.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Entire group<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>84 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No OLD<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>70 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">COPD<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Asthmatic<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ventilated<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>24 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 F \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smokers (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ex-smokers (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WHO classification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Length of stay for hospitalized patients (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEV<span class="elsevierStyleInf">1</span> (L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEV<span class="elsevierStyleInf">1</span>% predicted \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FVC (L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FVC % predicted \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEV<span class="elsevierStyleInf">1</span>/FVC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients’ characteristics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bronchodilator reversibility testing in post-COVID-19 patients undergoing pulmonary rehabilitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Maniscalco" 1 => "P. Ambrosino" 2 => "S. Fuschillo" 3 => "S. Stufano" 4 => "A. Sanduzzi" 5 => "M.G. Matera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2021.106401" "Revista" => array:5 [ "tituloSerie" => "Respir Med" "fecha" => "2021" "volumen" => "182" "paginaInicial" => "106401" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33873099" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional impairment during post-acute COVID-19 phase: preliminary finding in 56 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Zampogna" 1 => "G.B. Migliori" 2 => "R. Centis" 3 => "F. Cherubino" 4 => "C. Facchetti" 5 => "D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 4 | 18 |
| 2024 October | 92 | 25 | 117 |
| 2024 September | 120 | 19 | 139 |
| 2024 August | 138 | 38 | 176 |
| 2024 July | 171 | 24 | 195 |
| 2024 June | 132 | 31 | 163 |
| 2024 May | 139 | 37 | 176 |
| 2024 April | 85 | 22 | 107 |
| 2024 March | 82 | 22 | 104 |
| 2024 February | 85 | 26 | 111 |
| 2024 January | 127 | 37 | 164 |
| 2023 December | 132 | 24 | 156 |
| 2023 November | 224 | 36 | 260 |
| 2023 October | 175 | 43 | 218 |
| 2023 September | 149 | 45 | 194 |
| 2023 August | 111 | 48 | 159 |
| 2023 July | 877 | 40 | 917 |
| 2023 June | 91 | 23 | 114 |
| 2023 May | 118 | 33 | 151 |
| 2023 April | 132 | 65 | 197 |
| 2023 March | 137 | 81 | 218 |
| 2023 February | 104 | 35 | 139 |
| 2023 January | 143 | 42 | 185 |
| 2022 December | 148 | 60 | 208 |
| 2022 November | 149 | 47 | 196 |
| 2022 October | 149 | 54 | 203 |
| 2022 September | 139 | 39 | 178 |
| 2022 August | 146 | 53 | 199 |
| 2022 July | 210 | 76 | 286 |
| 2022 June | 217 | 69 | 286 |
| 2022 May | 28 | 2 | 30 |
| 2022 April | 43 | 11 | 54 |
| 2022 March | 40 | 2 | 42 |
| 2022 February | 37 | 2 | 39 |
| 2022 January | 28 | 1 | 29 |
| 2021 December | 19 | 5 | 24 |
| 2021 November | 7 | 0 | 7 |
| 2021 October | 2 | 2 | 4 |
| 2021 August | 1 | 0 | 1 |
| 2021 July | 7 | 2 | 9 |
| 2021 June | 1 | 6 | 7 |
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