Pulmonary Recovery 12 Months after Non-Severe and Severe COVID-19: The Prospective Swiss COVID-19 Lung Study

Respiration. 2023;102(2):120-133. doi: 10.1159/000528611. Epub 2022 Dec 23.


Background: Lung function impairment persists in some patients for months after acute coronavirus disease 2019 (COVID-19). Long-term lung function, radiological features, and their association remain to be clarified.

Objectives: We aimed to prospectively investigate lung function and radiological abnormalities over 12 months after severe and non-severe COVID-19.

Methods: 584 patients were included in the Swiss COVID-19 lung study. We assessed lung function at 3, 6, and 12 months after acute COVID-19 and compared chest computed tomography (CT) imaging to lung functional abnormalities.

Results: At 12 months, diffusion capacity for carbon monoxide (DLCOcorr) was lower after severe COVID-19 compared to non-severe COVID-19 (74.9% vs. 85.2% predicted, p < 0.001). Similarly, minimal oxygen saturation on 6-min walk test and total lung capacity were lower after severe COVID-19 (89.6% vs. 92.2%, p = 0.004, respectively, 88.2% vs. 95.1% predicted, p = 0.011). The difference for forced vital capacity (91.6% vs. 96.3% predicted, p = 0.082) was not statistically significant. Between 3 and 12 months, lung function improved in both groups and differences in DLCO between non-severe and severe COVID-19 patients decreased. In patients with chest CT scans at 12 months, we observed a correlation between radiological abnormalities and reduced lung function. While the overall extent of radiological abnormalities diminished over time, the frequency of mosaic attenuation and curvilinear patterns increased.

Conclusions: In this prospective cohort study, patients who had severe COVID-19 had diminished lung function over the first year compared to those after non-severe COVID-19, albeit with a greater extent of recovery in the severe disease group.

Keywords: COVID-19 sequelae; Long COVID; SARS-CoV-2; SARS-CoV-2 lung functional sequelae; SARS-CoV-2 radiological sequelae.

MeSH terms

  • COVID-19*
  • Humans
  • Lung / diagnostic imaging
  • Prospective Studies
  • Respiratory Insufficiency*
  • Switzerland / epidemiology

Grant support

Lungenliga Bern (to MFC), Johanna Dürmüller Foundation (to MFC), Bern Center for Precision Medicine (BCPM) (to MFC), the Federal Office of Public Health (FOPH) of the Federal Council of Switzerland (to MFC), Ligue Pulmonaire Vaudoise (to CvG), Fondation Placide Nicod (to CvG), and Fondation Yuchum (to CvG) contributed to the funding of this study but had no role in its design, conduct, or analysis.