COVID-19 potentially causes long-term deterioration of lung function: a systematic review and meta-analysis

  • Yudha Nur Patria Department of Physiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
  • Rahmaningsih Mara Sabirin Department of Physiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Keywords: COVID-19, FEV1, pulmonary function test, SARS-CoV-2, spirometry


BACKGROUND The COVID-19 is an emerging disease that commonly involves respiratory complaints, including acute respiratory distress syndrome. The effect of COVID-19 on pulmonary function is still unclear and only based on sporadic reports with a small sample size. This study aimed to compile evidence on the pulmonary function of patients who have recovered from COVID-19.

METHODS Literature searching was conducted in PubMed, Embase, Google Scholar, Scopus, Web of Sciences, and CINAHL. Any types of studies published before June 26, 2020 and reported lung function tests of post-COVID-19 patients were included. Articles reporting data from early hospitalization were excluded. The risk of bias was measured using tools developed by the Joanna Briggs Institute. Meta-analysis was done using a meta statistical package in R and presented in the random effects model.

RESULTS 378 recovered COVID-19 patients in 7 studies were included. The lung function measurement periods were varied, ranging from 14 days after hospitalization to 10 weeks after receiving rehabilitation. Meta-analyses found that the pooled mean of diffusion capacity of carbon monoxide in recovered COVID-19 patients was lower than 80% predicted, whereas the other parameters were normal. The forced vital capacity and total lung capacity showing restrictive lung disorders were significantly lower in the severe COVID-19 survivors.

CONCLUSIONS COVID-19 has a negative impact on lung function for at least several weeks in the recovery period. Diffusion and restrictive problems could be the main long-term consequences of COVID-19.


Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus cisease 2019 in China. N Engl J Med. 2020;382:1708-20.

Elezkurtaj S, Greuel S, Ihlow J, Michaelis EG, Bischoff P, Kunze CA, et al. Causes of death and comorbidities in hospitalized patients with COVID-19. Sci Rep. 2021;11(1):4263.

Scialo F, Daniele A, Amato F, Pastore L, Matera MG, Cazzola M, et al. ACE2: the major cell entry receptor for SARS-CoV-2. Lung. 2020;198(6):867-77.

Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: a review. Clin Immunol. 2020;215:108427.

Zou JN, Sun L, Wang BR, Zou Y, Xu S, Ding YJ, et al. The characteristics and evolution of pulmonary fibrosis in COVID-19 patients as assessed by AI-assisted chest HRCT. PLoS One. 2021;16(3):e0248957.

Zhao YM, Shang YM, Song WB, Li QQ, Xie H, Xu QF, et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine. 2020;25:100463.

Ahmed H, Patel K, Greenwood DC, Halpin S, Lewthwaite P, Salawu A, et al. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: a systematic review and meta-analysis. J Rehabil Med. 2020;52(5):jrm00063.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis; 2020. Available from:

Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Chapter 3: Systematic reviews of effectiveness. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis; 2020. Available from:

World Health Organization (WHO). Living guidance for clinical management of COVID-19 [Internet]. World Health Organization (WHO); 2021. Available from:

Schwarzer G. meta: an R package for meta-analysis. R News. 2007;7:40-5.

Balduzzi S, Rücker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health. 2019;22(4):153-60.

Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y. Respiratory rehabilitation in elderly patients with COVID-19: a randomized controlled study. Complement Ther Clin Pract. 2020;39:101166.

Huang Y, Tan C, Wu J, Chen M, Wang Z, Luo L, et al. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir Res. 2020;21(1):163.

Li X, Wang C, Kou S, Luo P, Zhao M, Yu K. Lung ventilation function characteristics of survivors from severe COVID-19: a prospective study. Crit Care. 2020;24(1):300.

Lv D, Chen X, Wang X, Mao L, Sun J, Wu G, et al. Pulmonary function of patients with 2019 novel coronavirus induced pneumonia: a retrospective cohort study. Ann Palliat Med. 2020;9(5):3447-52.

Mo X, Jian W, Su Z, Chen M, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020;55(6):2001217.

You J, Zhang L, Ti MN, Zhang J, Hu F, Chen L, et al. Anormal pulmonary function and residual CT abnormalities in rehabilitating COVID-19 patients after discharge. J Infect. 2020;81(2):e150-2.

Zha L, Shen Y, Pan L, Han M, Yang G, Teng X, et al. Follow-up study on pulmonary function and radiological changes in critically ill patients with COVID-19. J Infect. 2021;82(1):159-98.

Lutfi MF. The physiological basis and clinical significance of lung volume measurements. Multidiscip Respir Med. 2017;12:3.

Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26(5):948-68.

Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631-7.

Mason RJ. Pathogenesis of COVID-19 from a cell biology perspective. Eur Respir J. 2020;55(4):2000607.

Lorenzo B. COVID-19, type II alveolar cells and surfactant. J Med Clin Res Rev. 2020;4(4):1-3.

Koumbourlis AC, Motoyama EK. Lung mechanics in COVID-19 resemble respiratory distress syndrome, not acute respiratory distress syndrome: could surfactant be a treatment? Am J Respir Crit Care Med. 2020;202(4):624-6.

Hall JE, Hall ME. Guyton and Hall textbook of medical physiology. Elsevier; 2020.

Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-2.

Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers D, Kant KM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis. Thromb Res. 2020;191:148-50.

Xie J, Covassin N, Fan Z, Singh P, Gao W, Li G, et al. Association between hypoxemia and mortality in patients with COVID-19. Mayo Clin Proc. 2020;95(6):1138-47.

Ngai JC, Ko FW, Ng SS, To KW, Tong M, Hui DS. The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology. 2010;15(3):543-50.

Zhang P, Li J, Liu H, Han N, Ju J, Kou Y, et al. Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study. Bone Res. 2020;8:8.

Das KM, Lee EY, Singh R, Enani MA, Al Dossari K, Van Gorkom K, et al. Follow-up chest radiographic findings in patients with MERS-CoV after recovery. Indian J Radiol Imaging. 2017;27(3):342-9.

How to Cite
Patria YN, Sabirin RM. COVID-19 potentially causes long-term deterioration of lung function: a systematic review and meta-analysis. Med J Indones [Internet]. 2021Dec.30 [cited 2024Mar.3];30(4):279-89. Available from:
Clinical Research