Pulmonary Evaluation in Children with Post-COVID-19 Condition Respiratory Symptoms: A Prospective Cohort Study

Einat Shmueli*, Ophir Bar-On, Ben Amir, Meir Mei-Zahav, Patrick Stafler, Hagit Levine, Guy Steuer, Benjamin Rothschild, Lior Tsviban, Nofar Amitai, Miri Dotan, Gabriel Chodick, Dario Prais, Liat Ashkenazi-Hoffnung

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Studies on post-COVID-19 condition (PCC) in adults have shown deterioration in pulmonary function tests (PFTs), mainly a diffusion limitation. Among the pediatric population, data are scarce. Aim: To characterize PFTs in children with PCC, including changes over time. Methods: A prospective longitudinal study of children with defined PCC and respiratory complaints who were referred to a designated multidisciplinary clinic from 11/2020 to 12/2022. Results: Altogether, 184 children with a mean age of 12.4 years (SD 4.06) were included. A mild obstructive pattern was demonstrated in 19/170 (11%) at presentation, as indicated by spirometry and/or positive exercise challenge test and/or reversibility post bronchodilators, only three had a previous diagnosis of asthma. Lung volumes and diffusion were normal in all but one patient (1/134, 0.7%). Exhaled nitric oxide levels were elevated in 32/144 (22%). A total of 33 children who had repeated PFTs had normal or near-normal PFTs on follow-up testing, including seven (21.2%) who had mild obstructive PFTs at presentation. Multivariate analysis identified older age [OR 1.36 (95% CI:1.07–1.75)], specific imaging findings (prominent bronchovascular markings (OR 43.28 (95% CI: 4.50–416.49)), and hyperinflation (OR 28.42, 95% CI: 2.18–370.84)] as significant predictors of an obstructive pattern on PFTs. Conclusions: In children with PCC and respiratory symptoms, the most common impairment was a mild obstructive pattern; most were without a history of asthma. Improvement was witnessed in long-term follow-up. In contrast to the adult population, no diffusion limitation was found. Empirical periodic inhaler therapy may be considered in children with factors associated with PFT abnormalities.

Original languageEnglish
Article number6891
JournalJournal of Clinical Medicine
Issue number21
StatePublished - Nov 2023


  • SARS-CoV-2
  • long COVID
  • lung clearance index
  • post-COVID-19 condition
  • pulmonary function tests


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