Pakistan Journal of Chest Medicine

Clinical Outcomes and Risk Factors of Post-COVID Pulmonary Fibrosis in Hospitalized Patients

Akbar Gohar Abro — 2026-06-02

Background: Post-COVID pulmonary fibrosis is an important long-term respiratory complication among patients recovering from moderate-to-severe COVID-19, particularly those requiring hospitalization. Persistent fibrotic changes may lead to chronic dyspnea, impaired pulmonary function, oxygen dependency, and reduced quality of life. Identification of high-risk patients is essential for timely follow-up and intervention.

Objective: To evaluate the clinical outcomes and risk factors associated with post-COVID pulmonary fibrosis among hospitalized patients.

Methodology: This retrospective observational study was conducted at the Department of Medicine, Liaquat University of Medical & Health Sciences, Jamshoro, from August 2024 to July 2025. A total of 212 adult patients previously hospitalized with RT-PCR-confirmed COVID-19 infection were included through consecutive non-probability sampling. Patients with follow-up high-resolution computed tomography chest performed at least 12 weeks after recovery were included. Patients with pre-existing interstitial lung disease, pulmonary fibrosis, active pulmonary tuberculosis, connective tissue disease-related lung involvement, lung malignancy, or incomplete records were excluded. Data were analyzed using SPSS version 26.0.

Results: Post-COVID pulmonary fibrosis was identified in 49 patients, giving a prevalence of 23.1%. Patients with fibrosis were significantly older than those without fibrosis (59.8 ± 12.6 vs 50.7 ± 13.2 years, p=0.0003). Smoking history, obesity, diabetes mellitus, prolonged hospital stay, ICU admission, oxygen requirement, mechanical ventilation, and raised inflammatory markers were significantly associated with fibrosis. Fibrotic patients also had higher rates of persistent dyspnea, chronic cough, oxygen dependency, pulmonary function abnormalities, and rehospitalization. Multivariable regression identified advanced age, smoking history, ICU admission, and mechanical ventilation as independent predictors.

Conclusion: Post-COVID pulmonary fibrosis affected nearly one-quarter of hospitalized COVID-19 survivors and was associated with severe acute illness and poorer respiratory outcomes.

Evaluation of Health-Related Quality of Life Among Patients with Respiratory Diseases in a Tertiary Care Teaching Hospital

Nadeem Shah — 2026-06-02

Background: Respiratory diseases have been considered as an important source of morbidity and mortality globally and have considerable implications for the physical, psychological, and social well-being of the patients. There is scant literature on the HRQoL of respiratory disease patients in Pakistan. The objective of this study was to determine HRQoL of the patients with respiratory diseases in Pakistan.

Methods: Cross-sectional research was carried out at the Department of Pulmonology, Lady Reading Hospital, Peshawar from January 2024 to June 2024. The sample size consisted of 180 patients aged 18 years and older suffering from pulmonary diseases like COPD, asthma, tuberculosis, pneumonia, bronchiectasis, and interstitial lung diseases by non-probability consecutive sampling technique. Information was gathered by employing a well-structured questionnaire involving sociodemographic and clinical factors along with the assessment of HRQoL by utilizing EuroQol EQ-5D. All data were processed utilizing SPSS software version 26. Descriptive analysis, chi-square test, independent t-test, and ANOVA were utilized, and p-value <0.05 was taken as significant.

Results: The predominant demographic profile among the sample included middle-aged respondents (39.4%), males (58.3%), married individuals (80.5%), and those from lower socioeconomic status (55.6%). The most prevalent diseases among the patients suffering from respiratory diseases were chronic obstructive pulmonary diseases (COPD) (28.8%), tuberculosis (21.1%), and asthma (17.7%). The aspect of pain or discomfort was identified as the most affected HRQoL domain among 52.2% respondents, whereas 18.8% experienced serious problems. The association between HRQoL and age (p=0.001), smoking (p=0.002), and disease type (p=0.001). It is important to note that in general, 62% of participants have poor HRQoL while only 38% have good HRQoL.

Conclusion: Respiratory diseases lower the quality of life especially among elderly people, smokers, and those with chronic respiratory diseases. A comprehensive approach to managing respiratory diseases should be adopted, and it includes early detection, quitting smoking, pulmonary rehabilitation, and psychological counseling.

Drug Resistance Patterns of Bacterial Pathogens in Adult Pneumonia Patients in a Tertiary Care Hospital

Hifsa Zia — 2026-06-02

Background
Pneumonia remains one of the leading causes of morbidity and mortality around the world, with a disproportionate burden in low- and middle-income countries such as Pakistan. Antimicrobial resistance (AMR), especially multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria, is becoming more common. This presents a serious obstacle to efficient therapeutic therapy and worsens patient consequences.

Objective
To determine the bacteriological profile, antimicrobial resistance patterns, and distribution of MDR and XDR pathogens among adult pneumonia patients, as well as to evaluate their clinical characteristics.

Methodology
In the present cross-sectional study, 385 respiratory specimens were collected from adult patients with pneumonia. Pathogens were isolated and identified using gram staining and culture by using different media such as MacConkey, blood agar, and chocolate agar. Biochemical tests were performed such catalase and coagulase for Staphylococcus spp, Oxidase test for P. aeruginosa and Indole, citrate Urease and TSI.

Results
In the present study, 146 (37.9%) pneumonia patients needed intensive care management. The most affected age group was old age people (> 60) accounted for 169 (43.9%). Klebsiella pneumoniae 126 (32.7%) being the most commonly isolated pathogen, followed by Pseudomonas aeruginosa 104 (27%) and Acinetobacter baumannii 61 (15%). Biofilm formation was observed in 182 (47.3%) of the 385 bacterial isolates that were isolated from pneumonia patients.

Conclusion

Present study show that the most common etiological agents were Gram-negative organisms, specifically Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. These organisms also showed alarmingly high resistance rates to commonly prescribed antibiotics, such as ?-lactams, tetracyclines, fluoroquinolones, and third-generation cephalosporins.

Menstrual Cycle-Related Changes in Spirometric Lung Function Among Young Women With and Without Asthma: A Prospective Comparative Study

Tahira Bibi — 2026-06-02

Background: Bronchial asthma is a prevalent chronic respiratory disease with significant sex disparities that emerge during reproductive years, suggesting a role for ovarian hormones in disease expression. The influence of menstrual cycle-related hormonal fluctuations on pulmonary function remains incompletely understood, with inconsistent findings across previous studies.

Objective: To compare spirometric lung function parameters across different phases of the menstrual cycle among young women with well-controlled asthma and healthy non-asthmatic women, and to determine whether the magnitude and pattern of menstrual cycle-related changes differ between the two groups.

Methodology: This prospective longitudinal comparative study was conducted from January to December 2025. A total of 140 young women (70 asthmatics and 70 age- and BMI-matched non-asthmatics) were enrolled. Spirometric assessment including FEV?, FVC, FEV?/FVC ratio, PEFR, and mid-expiratory flow rates (FEF?????, FEF??, FEF??) was performed during three menstrual cycle phases: menstrual (Days 1-3), follicular (Days 7-10), and luteal (Days 20-23). Within-group variations were analyzed using repeated measures ANOVA, while between-group comparisons were performed using independent t-tests.

Results: Asthmatic women demonstrated significantly lower spirometric parameters across all phases compared to non-asthmatics (p < 0.001 for FEV?, FEV?/FVC, PEFR, and mid-expiratory flows). In asthmatic women, FEV? and mid-expiratory flow rates were lowest during menstrual phase and highest during luteal phase, while FVC and PEFR showed the opposite pattern. Non-asthmatics exhibited similar but smaller magnitude changes. Asthmatics demonstrated substantially greater percentage changes from menstrual to luteal phase for expiratory flow parameters (FEV?: +5.6% vs. +2.4%; FEF?????: +9.5% vs. +4.3%). However, within-group variations did not reach statistical significance (p > 0.05) in either group.

Conclusion: Asthmatic women exhibit greater menstrual cycle-related variation in lung function compared to non-asthmatics, with lowest values during menstrual phase, supporting the concept of perimenstrual asthma. These findings have important clinical implications for monitoring and managing asthma in reproductive-aged women.

Clinical Presentation, Disease Severity, and Pregnancy Outcomes among Women with Active Tuberculosis: A Comparative Cohort Study

Aliya Ishaque — 2026-06-02

Background: Tuberculosis (TB) during pregnancy continues to pose a significant maternal and public health challenge, especially in high-burden regions. Physiological and immunological changes associated with pregnancy can modify TB presentation and increase disease severity.

Objective: To compare the clinical presentation, disease severity, laboratory and radiological findings, and pregnancy outcomes among pregnant and non-pregnant women with active TB.

Methodology: This prospective comparative cohort study cohort study was conducted from January 2024 to June 2025. A total of 190 women with active TB were enrolled, including 60 pregnant and 130 non-pregnant women matched by age and admission period. We prospectively collected demographic, clinical, laboratory, radiological, treatment, and outcome data. Categorical variables were analyzed using the chi-square or Fisher’s exact test, while continuous variables were compared using the independent-samples t-test or Mann-Whitney U test, as appropriate.

Results: Pregnant women had significantly higher frequencies of fever (71.7% vs. 35.4%, p<0.001), dyspnoea (43.3% vs. 19.2%, p=0.001), and neurological symptoms (33.3% vs. 13.1%, p=0.003). ICU admission was also significantly more frequent among pregnant women (18.3% vs. 3.0%, p<0.001). TB-related mortality was higher among pregnant women (11.6% vs. 3.8%), although the difference was not statistically significant (p=0.065). Among pregnant women, spontaneous abortion occurred in 33.3%, stillbirth in 5.0%, preterm birth in 20.0%, and low birth weight in 15.0%.

Conclusion: Active TB during pregnancy is associated with more severe clinical manifestations and adverse maternal and pregnancy outcomes. In high-burden settings, early diagnosis, prompt treatment, and integrated maternal and fetal monitoring are essential.

Blood Coagulability and Inflammatory and Hematological Profiles Across Different Clinical States of Chronic Obstructive Pulmonary Disease: A Comparative Cross-Sectional Study

Naseem Shah — 2026-06-02

Background: Chronic Obstructive Pulmonary Disease (COPD) involves persistent inflammation and vascular alterations that promote a prothrombotic state. Acute exacerbations and disease progression further activate clotting pathways, elevating thrombosis risk. The associations among coagulation parameters, inflammatory markers, haematological indices, and arterial blood gas values across COPD stages remain incompletely elucidated.

Objective: To evaluate coagulation status and related inflammatory and hematological markers in patients with stable COPD, hospitalized COPD, critically ill COPD, and healthy controls.

Methodology: This prospective, comparative, cross-sectional study was conducted at Benazir Bhutto Hospital, Rawalpindi, and Muslim Youth University, Islamabad from January 2024 to September 2025. A total of 108 participants were enrolled and assigned equally to four groups: stable COPD outpatients, hospitalized COPD patients, intensive care unit (ICU) COPD patients, and healthy controls. Laboratory assessments included D-dimer, C-reactive protein (CRP), hematocrit, red cell distribution width (RDW), platelet count, mean platelet volume (MPV), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), prothrombin time (PT), activated partial thromboplastin time (aPTT), and arterial blood gas analysis.

Results: D-dimer, CRP, MPV, PLR, and NLR differed significantly among groups (p ? 0.002), with the highest levels observed in critically ill patients. PT, aPTT, hematocrit, and platelet count showed no significant variation among groups. PaCO? demonstrated positive correlations with D-dimer, CRP, RDW, and MPV.

Conclusion: Advanced stages of COPD are associated with heightened coagulation activity and inflammation. The observed relationship between D-dimer and PaCO? highlights the clinical utility of these markers for risk assessment.

Association Between Left Ventricular Diastolic Dysfunction and Chronic Obstructive Pulmonary Disease Severity: A Cross-Sectional Study

Laiba Akbar — 2026-06-02

Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by cardiovascular comorbidities, notably left ventricular diastolic dysfunction (LVDD). Due to overlapping symptoms between LVDD and COPD-related dyspnea, cardiac involvement may go undetected. The association between COPD severity and LVDD has not been fully elucidated.

Objective: To determine the prevalence of LVDD and assess its association with the severity of COPD in affected patients.

Methodology: This cross-sectional analytical study was conducted in Peshawar, from September 2024 to August 2025. A total of 394 clinically stable COPD patients were consecutively recruited. COPD diagnosis was confirmed using post-bronchodilator spirometry in accordance with GOLD criteria. Transthoracic echocardiography assessed left ventricular systolic and diastolic function, regional contractility, and right ventricular systolic pressure.

Results: The mean age of participants was 61.4 ± 8.2 years, with 84.5% being male. LVDD was identified in 246 patients (62.4%). Among those with LVDD, 189 (76.8%) exhibited grade 1 and 57 (23.2%) exhibited grade 2 dysfunction; no cases of grade 3 or 4 dysfunction were observed. LVDD was present in 55.8% of GOLD 2, 68.4% of GOLD 3, and 63.2% of GOLD 4 patients. There was no significant association between GOLD severity and LVDD (p=0.208). Older age was significantly associated with LVDD (p=0.002). FVC was significantly lower among patients with segmental contractility abnormalities (p=0.002), but was not associated with LVDD.

Conclusion: LVDD was prevalent among patients with COPD, primarily as mild dysfunction, but was not significantly associated with spirometric measures of COPD severity. Age demonstrated a significant association with LVDD, underscoring the importance of cardiovascular assessment in this population.