Pneumology - Original Articles
Early Access
https://doi.org/10.4081/monaldi.2026.3911

Pneumonia due to respiratory syncytial virus does not cause long-lasting disorders in respiratory gas transport after clinical resolution in adults. Comparison vs. SARS-CoV-2 pneumonia

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 9 March 2026
174
Views
88
Downloads
RSV pneumonia, SARS-CoV-2 pneumonia, lung function, long-lasting sequelae, blood gas transport, single-breath simultaneous DLNO and DLCO diffusing capacity

Authors

Roberto W. Dal Negro
National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology – CESFAR, Verona, Italy.
Paola Turco
National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology – CESFAR, Verona, Italy.
Massimiliano Povero
m.povero@adreshe.com
AdRes Health Economics and Outcomes Research, Turin, Italy.

Long-term consequences of viral pneumonia on lung function depend on virus-specific tissue injury. Persistent impairment of alveolar-blood gas transport has been described after SARS-CoV-2 pneumonia but has not been investigated following respiratory syncytial virus (RSV) pneumonia. Possible long-term effects of these two viral infections were never compared after their clinical resolution in terms of lung physiology. The aim of this paper was to compare long-term sequelae of RSV and SARS-CoV-2 pneumonia on lung function and blood gas transport. Adults (>18 years) with previous RSV or SARS-CoV-2 pneumonia were investigated after complete computed tomography scan resolution. Collected variables included demographics, body mass index, hemoglobin, SpO₂, modified British Medical Research Council dyspnea score, spirometry, diffusing capacity [diffusing capacity for carbon oxide (DLCO), carbon monoxide transfer coefficient (KCO)], single-breath diffusing capacity for nitric oxide (DLNO) and DLCO, DLNO/DLCO ratio, and lung capillary blood volume (Vc). 38 post-SARS-CoV-2 and 37 post-RSV patients were studied. Groups were comparable and showed similar spirometric values. Compared with RSV, SARS-CoV-2 patients had significantly lower SpO₂, DLCO, and KCO (p<0.01). Vc was markedly reduced (p<0.001), with a corresponding increase in the DLNO/DLCO ratio (p<0.001). Only post-RSV patients were dyspnea-free. In conclusion, viral pneumonia may cause long-lasting lung function impairment depending on virus-specific tissue damage. Unlike RSV, SARS-CoV-2 pneumonia induces a persistent reduction of lung Vc, leading to impaired gas exchange despite radiological resolution.

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Widmer K, Zhu Y, Williams JV, et al. Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis 2012;206:56-62.
Wright AL, Taussig LM, Ray CG, et al. The Tucson Children’s Respiratory Study. II. Lower respiratory tract illness in the first year of life. Am J Epidemiol 1989;129:1232-46.
Pickles RJ, De Vincenzo JP. Respiratory syncytial virus (RSV) and its propensity for causing bronchiolitis. J Pathol 2015;235:266-76.
van den Borst B, Peters JB, Brink M, et al. Comprehensive health assessment three months after recovery from acute COVID-19. Clin Infect Dis 2020;73:e1089-98.
Psarras S, Papadopoulos NG, Johnston SI. Athogenesis of respiratory syncytial virus bronchiolitis-related wheezing. Paediatr Respir Rev 2004;5:S179-84.
Lukacs NW, Smit J, Lindell D, Schaller M. Respiratory syncytial virus-induced pulmonary disease and exacerbation of allergic asthma. Contrib Microbiol 2007;14:68-82.
Jartti T, Gern JE. Role of viral infections in the development and exacerbation of asthma in children. J Allergy Clin Immunol 2017;140:895-06.
Bellan M, Soddu D, Balbo PE, et al. Respiratory and psychosocial sequelae among patients with COVID-19 four months after hospital discharge. JAMA Netw Open 2021;4:e2036142.
Limkar AR, Percopo CM, Redes JL, et al. Persistent airway hyperresponsiveness following recovery from infection with pneumonia virus of mice. Viruses 2021;13:728.
Falsey AR. Respiratory syncytial virus infection in adults. Semin Respir Crit Care Med 2007;28:171-81.
Dal Negro RW, Turco P, Povero M. Long-lasting dyspnoea in patients otherwise clinically and radiologically recovered from COVID pneumonia: a probe for checking persisting disorders in capillary lung volume as a cause. Multidiscip Respir Med 2022;17:875.
Pini L, Giordani J, Levi G, et al. Long-term alveolar-capillary diffusion impairments after severe SARS-CoV-2 pneumonia. Ann Med 2025;57:2483383.
Zavorsky JS, Barisone G, Gille T, et al. Enhanced detection of patients with previous COVID-19: Superiority of the double diffusion technique. BMJ Open Respir Res 2025;12:e002561.
Branche AR, Falsey AR. Respiratory syncytial virus infection in older adults: an under-recognized problem. Drugs Aging 2015;32:261-9.
Estofolete CF, Banho CA, Verro AT, et al. Clinical characterization of respiratory syncytial virus infection in adults: a neglected disease? Viruses 2023;15:1848.
Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnoea. Chest 1988;93:580-6.
Roughton FJ, Forster RE. Relative importance of diffusion and chemicalreaction in determining rate of exchange of gases in the human lung. J Appl Physiol 1957;11:290-302.
Graham BL, Brusasco V, Burgos F, et al. ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J 2017;49:1600016.
Zavorsky GS, Hsia CCW, Hughes MB, et al. Standardisation and application of the single-breath determination of nitric oxide uptake in the lung. Eur Respir J 2017;49:1600962.
Dal Negro RW, Turco P, Povero M. Persistent reduction of lung capillary blood volume as the major “deep lung” disorder underlying respiratory long-COVID syndrome. Am J Med Public Health 2024;5:1059.
Shi T, McAllister DA, O’Brien KL, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet 2017;390:946-58.
Falsey AR, Patricia A, Hennessey RN, et al. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med 2005;352:1749-59.
Nair H, Simoes EA, Rudan I, et al. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet 2013;381:1380-90.
Sweetman LL, Ng YT, Butler IJ, Bodensteiner JB. Neurologic complications associated with respiratory syncytial virus. Pediatr Neurol 2005;32:307-10.
van Drunen Littel-van den Hurk S, Watkiss ER. Pathogenesis of respiratory syncytial virus. Curr Opin Virol 2012;2:300-5.
Dowell SF, Anderson LJ, Gary HE Jr, et al. Respiratory syncytial virus is an important cause of community-acquired lower respiratory infection among hospitalized adults. J Infect Dis 1996;174:456-62.
Matricardi PM, Dal Negro RW, Nisini R. The first, comprehensive immunological model of COVID-19: implications for prevention, diagnosis, and public health measures. Pediatr Allergy Immunol 2020;31:454-70.
Chu H, Chan JFW, Wang Y, et al. Comparative replication and immune activation profiles of SARS-CoV-2 and SARS-CoV in human lungs: an ex vivo study with implications for the pathogenesis of COVID-19. Clin Infect Dis 2020;ciaa410.
Iba T, Connors JM, Levy JH. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Inflamm Res 2020;69:1181-9.
Wu X, Xiang M, Jing H, et al. Damage to endothelial barriers and its contribution to long COVID. Angiogenesis 2024;27:5-22.
Morris SB, Ocadiz-Ruiz R, Asai N, et al. Long-term alterations in lung epithelial cells after EL-RSV infection exacerbate allergic responses through IL-1β-induced pathways. Mucosal Immunol 2024;17:1072-88.
Osiaevi I, Schulze A, Evers G, et al. Persistent capillary rarefication in long COVID syndrome. Angiogenesis 2023;26:53-61.
Rovas A, Osiaevi I, Buscher K, et al. Microvascular dysfunction in COVID-19: the MYSTIC study. Angiogenesis 2021;24:145-57.
Smadja DM, Mentzer SJ, Fontenay M, et al. COVID-19 is a systemic vascular hemopathy: insight for mechanistic and clinical aspects. Angiogenesis 2021;24:755-88.
Fabbri L, Moss S, Khan FA, et al. Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: a systematic review and meta-analysis. Thorax 2023;78:191-201.

Ethics Approval

The study was approved by the CASFAR Ethical Committee during the session of September 18, 2023 (N. 04/CES/2023).

How to Cite



“Pneumonia Due to Respiratory Syncytial Virus Does Not Cause Long-Lasting Disorders in Respiratory Gas Transport After Clinical Resolution in Adults. Comparison Vs. SARS-CoV-2 Pneumonia”. 2026. Monaldi Archives for Chest Disease, March. https://doi.org/10.4081/monaldi.2026.3911.
Copyright (c) 2026 The Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.