Persistent exertional dyspnea following mild COVID-19: potential association with diaphragm impairment 🚨Mild COVID, ‘normal’ lungs & heart, still breathless 2 years later? Your diaphragm may be the missing piece! #LongC0VID ➡️Interesting small German study of 25 non-hospitalized outpatients with persistent exertional dyspnoea a median of 24 months after mild COVID-19, ➡️Routine cardiopulmonary work-up (lung function, echocardiography, 6-minute walk test, bloods) showed no clear group-level explanation for the breathlessness, ➡️Non-volitional diaphragm strength (twitch transdiaphragmatic pressure (TwPdi) after cervical magnetic phrenic-nerve stimulation) was significantly lower than in matched pre-pandemic controls (median 14.2 vs 21.4 cmH₂O, p=0.02) with 52% of patients falling below the lower limit of normal, ➡️Diaphragm thickness on ultrasound was also reduced at both functional residual capacity (FRC) and total lung capacity (TLC), ➡️TwPdi declined stepwise with worsening dyspnoea severity and correlated strongly and inversely with post-walk mBorg score (r = −0.67), ➡️Fatigue scores were tightly linked to dyspnoea severity, ➡️56% of patients had already had two SARSCoV2 infections and 96% had received ≥2 mRNA vaccine doses, but these factors were not analysed separately. ‼️So, mild COVID-19 can leave the diaphragm measurably weaker and thinner two years later, producing real, progressive breathlessness that ordinary heart and lung tests completely miss. ‼️For the large group of people whose post-COVID breathlessness remains unexplained after standard tests, this identifies a concrete, potentially treatable target (respiratory-muscle weakness). Prior work by the same group has already shown that inspiratory muscle training can improve diaphragm function and reduce dyspnoea in hospitalised longC0VID patients. The authors advocate the same approach may be a plausible alternative for this milder phenotype. Clinically it argues for adding simple respiratory-muscle assessment (or at least considering targeted training) when routine cardiopulmonary evaluation is unrevealing.🤔 #AvoidSars2 #AvoidReinfections 🙏I would greatly appreciate @RobWust take and comments on this study! frontiersin.org/journals/phy…