Objective: To examine pulmonary function, exercise capacity, and health-related quality of life (HRQoL) among severe acute respiratory syndrome (SARS) survivors. Methods: We evaluated survivors with confirmed SARS at the Prince of Wales Hospital, Hong Kong, at 3, 6, and 12 months after symptom onset. Our assessment included: lung volume (total lung capacity [TLC], vital capacity, residual volume, functional residual capacity), spirometry (FVC, FEV 1 ), diffusing capacity of the lung for carbon monoxide (DLCO), inspiratory and expiratory respiratory muscle strength, 6-min walk distance (6MWD), chest radiographs (CXRs), and HRQoL by Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire. Results: Ninety-seven patients completed the serial assessments. There were 39 male and 58 female patients, and 63 patients (70%) were health-care workers (mean age, 36.9 years [SD, 9.5 years]; body mass index, 23.7 kg/m 2 [SD, 4.0 kg/m 2 ]). At 1 year, 27 patients (27.8%) had abnormal CXR findings. Four patients (4.1%), 5 patients (5.2%), and 23 patients (23.7%) had FVC, TLC, and DLCO values < 80% of predicted values, respectively. The 6MWD at 12 months was 511.0 m (SD, 89.8 m), which was higher than at 3 months (mean difference, 47.0 m; 95% confidence interval [CI], 31.8 to 62.1 m; p < 0.01) but not different from 6 months (mean difference, 9.7 m; 95% CI, ؊ 4.4 to 23.8 m; p ‫؍‬ 0.18). The 6MWD was lower than that for normal control subjects of the same age groups, and there was impairment of HRQoL at 12 months. Patients who required ICU admission (n ‫؍‬ 31) showed higher CXR scores (1.6 [SD, 3.1]; vs 0.4 [SD, 1.1]; p ‫؍‬ 0.04) and lower percentage of predicted FVC, TLC, and DLCO than those who did not, but there were no differences in 6MWD and health status. Conclusion: Significant impairment in DLCO was noted in 23.7% of survivors 1 year after illness onset. Exercise capacity and health status of SARS survivors were remarkably lower than those of a normal population. (CHEST 2005; 128:2247-2261) Key words: severe acute respiratory syndrome; lung function; functional capacity; quality of life Abbreviations: ANOVA ϭ analysis of variance; BMI ϭ body mass index; BOOP ϭ bronchiolitis obliterans organizing pneumonia; BP ϭ bodily pain; CI ϭ confidence interval; CPET ϭ cardiopulmonary exercise testing; CRP ϭ C-reactive protein; CXR ϭ chest radiograph; Dlco ϭ diffusing capacity of the lung for carbon dioxide; FEF 25-75 ϭ forced expiratory flow, midexpiratory phase; FRC ϭ functional residual capacity; GH ϭ general health; HCW ϭ health-care worker; HK ϭ Hong Kong; HRCT ϭ high-resolution CT; HRQoL ϭ health-related quality of life; IQR ϭ interquartile range; Kco ϭ diffusing capacity of the lung for carbon dioxide adjusted for alveolar volume; LDH ϭ lactate dehydrogenase; LOS ϭ length of stay; MH ϭ mental health; Pemax ϭ maximum static expiratory pressure; Pimax ϭ maximum static inspiratory pressure; PF ϭ physical functioning; RE ϭ role limitation due to emotional problems; RP ϭ role limitation due to physical problems; RV ϭ residual volume; SARS ϭ severe acute respiratory syndrome; SF ϭ social functioning; SF-36 ϭ Medical Outcomes Study 36-Item Short-Form General Health Survey; TLC ϭ total lung capacity; Va ϭ alveolar volume; VC ϭ vital capacity; VT ϭ vitality; 6MWD ϭ 6-min walk distance; 6MWT ϭ 6-min walk test T he emergence of severe acute respiratory syndrome (SARS) in Southern China in November 2002, followed by the global outbreak in 2003, caught the medical profession by surprise. 1-3 Studies on SARS-coronavirus viral loads have shown that peak viral levels were reached at the second week of illness when patients were receiving hospital care, and thus health-care workers (HCWs) were particularly prone to infection while caring for their patients. 4, 5 The morbidity of SARS is highlighted by the observation that even when there was only 10% of total lung field involved by consolidation, 50% of patients would require supplemental oxygen in order
Output: The 1-Year Impact of Severe Acute Respiratory Syndrome on Pulmonary Function, Exercise Capacity, and Quality of Life in a Cohort of Survivors* *From the Center for Emerging Infectious Diseases (Drs and Tam), and Diagnostic Radiology and Organ Imaging