Respiratory Muscle Performance Screening for Infectious Disease Management Following COVID-19: A Highly Pressurized Situation

Am J Med. 2020 Sep;133(9):1025-1032. doi: 10.1016/j.amjmed.2020.04.003. Epub 2020 Apr 25.


The 2019-2020 coronavirus pandemic elucidated how a single highly infectious virus can overburden health care systems of even highly economically developed nations. A leading contributor to these concerning outcomes is a lack of available intensive care unit (ICU) beds and mechanical ventilation support. Poorer health is associated with a higher risk for severe respiratory complications from the coronavirus. We hypothesize that impaired respiratory muscle performance is an underappreciated factor contributing to poor outcomes unfolding during the coronavirus pandemic. Although impaired respiratory muscle performance is considered to be rare, it is more frequently encountered in patients with poorer health, in particular obesity. However, measures of respiratory muscle performance are not routinely performed in clinical practice, including those with symptoms such as dyspnea. The purpose of this article is to discuss the potential role of respiratory muscle performance from the perspective of the coronavirus pandemic. We also provide a theoretical patient management model to screen for impaired respiratory muscle performance and intervention, if identified, with the goal of unburdening health care systems during future pandemic crises.

Keywords: Exercise training; Mechanical ventilation; Muscle force production; Pandemic; Rehabilitation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections* / physiopathology
  • Coronavirus Infections* / rehabilitation
  • Coronavirus Infections* / therapy
  • Humans
  • Musculoskeletal Physiological Phenomena*
  • Pandemics*
  • Physical Functional Performance
  • Pneumonia, Viral* / physiopathology
  • Pneumonia, Viral* / rehabilitation
  • Pneumonia, Viral* / therapy
  • Respiration, Artificial / methods
  • Respiratory Muscles / physiopathology*
  • SARS-CoV-2