One-fourth of COVID-19 patients have an impaired pulmonary function after 12 months of disease onset

PLoS One. 2023 Sep 11;18(9):e0290893. doi: 10.1371/journal.pone.0290893. eCollection 2023.


Background: There is increasing data that show a persistently impaired pulmonary function upon recovery after severe infection. Little is known however about the extent, recovery and determinants of pulmonary impairment across the full spectrum of COVID-19 severity over time.

Methods: In a well characterized, prospective cohort of both hospitalised and non-hospitalised individuals with SARS-CoV-2 infection, the RECoVERED study, pulmonary function (diffusing capacity for carbon monoxide (DLCO)) and spirometry) was measured until one year after disease onset. Additionally, data on sociodemographics, clinical characteristics, symptoms, and health-related quality of life (HRQL) were collected. Pulmonary function and these determinants were modelled over time using mixed-effect linear regression. Determinants of pulmonary function impairment at 12 months after disease onset were identified using logistic regression.

Findings: Between May 2020 and December 2021, 301 of 349 participants underwent at least one pulmonary function test. After one year of follow-up, 25% of the participants had an impaired pulmonary function which translates in 11%, 22%, and 48% of the participants with mild, moderate and severe/critical COVID-19. Improvement in DLCO among the participants continued over the period across one, six and twelve months. Being older, having more than three comorbidities (p<0·001) and initial severe/critical disease (p<0·001) were associated with slower improvement of pulmonary function over time, adjusted for age and sex. HRQL improved over time and at 12 months was comparable to individuals without impaired pulmonary function.

Interpretation: The prevalence of impaired pulmonary function after twelve months of follow-up, was still significant among those with initially moderate or severe/critical COVID-19. Pulmonary function increased over time in most of the severity groups. These data imply that guidelines regarding revalidation after COVID-19 should target individuals with moderate and severe/critical disease severities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19* / complications
  • Carbon Monoxide
  • Humans
  • Prospective Studies
  • Quality of Life*
  • SARS-CoV-2


  • Carbon Monoxide

Grants and funding

MdJ received support for conducting this study by the Netherlands Organization for Health Research and Development (ZonMw) [10150062010002] [] and MP received additional funding from the Public Health Service of Amsterdam [R&D]. Funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.