https://doi.org/10.15218/ejnm.2025.05 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article Evaluation of Pulmonary Function Test in Post-COVID-19 Patients ABSTRACT Background and Objectives: SARS-CoV-2 emerged, leading to a global pandemic with significant morbidity and mortality. Lung injury is prevalent, raising concerns about long-term complications. Current data indicate persistent pulmonary function issues, particularly diffusion capacity, in survivors. Critical care needs and risk factors for poor outcomes are identified, but the full impact of post-COVID syndromes remains inadequately defined. Further research is essential to understand the long-term consequences of COVID-19. This study aims to evaluate pulmonary function tests in post- COVID-19 patients. Methods: A quantitative study was conducted on 74 post-COVID-19 patients in Erbil, Iraq, evaluating demographic and clinical characteristics. Data were collected via question- naires and analyzed using SPSS, ensuring participant confidentiality and voluntary partici- pation throughout the research process. Results: The study analyzed 74 post-COVID-19 patients, revealing demographics such as 55.4% aged 54-69 and a male predominance (63.5%). Common symptoms included cough (66.2%) and shortness of breath (73%). Half had high systolic blood pressure, and signifi- cant associations were found between severity and factors like age, SPO2, and pulmonary function tests. Conclusion: Spirometry patterns significantly correlate with the severity of post-COVID-19 symptoms, suggesting their value as prognostic markers. However, the study found no significant link between spirometry patterns and comorbidities, indicating a need for fur- ther research to explore these relationships and their implications for patient manage- ment. Keywords: Pulmonary Function Test; Spirometry Patterns; Post-COVID-19; SARS-CoV-2. Hemin Khalid Saber; Department of Medicine, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq. Baghawan Ahmed Osthman; Department of Medicine, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq. Dara Abdulla Al-Banna; Department of Nursing, Faculty of Nursing, Tishk International University, Erbil, Kurdistan Region, Iraq. (Correspondence: dara.albanna@hmu.edu.krd) 37 Received: 15/02/2025 Accepted: 14/03/2025 Published: 30/05/2025 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:(Correspondence:%20dara.albanna@hmu.edu.krd) mailto:(Correspondence:%20dara.albanna@hmu.edu.krd)?subject=(Correspondence:%20dara.albanna@hmu.edu.krd) mailto:(Correspondence:%20dara.albanna@hmu.edu.krd)?subject=(Correspondence:%20dara.albanna@hmu.edu.krd) mailto:jawdat.baker@hmu.edu.krd?subject=jawdat.baker@hmu.edu.krd%20%20%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.05 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article In late 2019, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China, and has since spread globally, infecting more than 200 million people. The clinical course of infection appears to be extreme- ly variable, from asymptomatic to severe pneumonia with multiorgan failure requir- ing critical care. More than 1,122,036 peo- ple are known to have died following infec- tion, but data on morbidity in survivors are scarce. Lung injury is a predominant fea- ture of acute SARS-CoV-2 infection, and understanding the longer-term implica- tions is critical given the number of affect- ed patients. There is currently little known about the post-infectious long-term com- plications from the severe acute respirato- ry syndrome coronavirus two (SARS-CoV- 2), with much extrapolated from severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) pandemics during the 2003 and 2012, re- spectively (Zhao. et al, 2020; Ngia, et al., 2010).The extrapolated data has shown that there are long-term reductions in pul- monary function, as measured by Pulmo- nary Function Testing (PFT), most signifi- cantly for Diffusion Capacity for Carbon Monoxide (DLCO) for up to two years after infection (Hui. et al., 2005; Ong. et al., 2004; Park, Jun, and Kim, 2018) [3,4,5,6,7]. Approximately 1 in 7 hospital- ized patients with COVID-19 in the United Kingdom required critical care admission, the majority for management of ARDS (Drake. et al., 2021). The onset of COVID- ARDS in the second week post-symptom- onset (at declining viral loads) and re- sponse to immunomodulation suggests pathogenic immune dysregulation. Given the unprecedented scale of the COVID-19 pandemic, even a low event rate may have a significant population-level impact (morbidity, late mortality). Most descriptions of post-COVID syndromes stipulate symptom duration for > 3 months (Munblit, O’Hara, Akrami, Perego, Olliaro, Needham, 2022). Clinically significant ILD refers to > 10% lung parenchymal changes on chest Computed Tomography (CT). A consensus definition and the true burden of Post-Covid19-ILD have not yet been determined. PC-ILD should be considered in patients with persistent respiratory symptoms (e.g., cough and dyspnea) 3 months post-COVID-19 symptom-onset, and patients with > 10% CT changes should be monitored. Accumulating data suggests that while the majority of scans show improvement, at 12 months the prevalence of (non-progressive) fibrosis is  ~ 10% in hospitalized patients, particularly in severe disease and older age (Ong. et al., 2004). Several clinical features and comorbidities are associated with a poor prognosis and a higher risk of mortality from COVID-19. These include pre-existing health problems such as hypertension, diabetes, cardiovascular disease, obesity, cancer, chronic kidney, liver, and lung diseases, and older age, male sex, smoking, and race (Richardson. et al., 2020; Docherty. et al., 1985; Sze. et al., 2020; Sanchez-Ramirez and Mackey, 2020). Whether these risk factors are also predictors of longer-term outcomes from COVID-19 is currently unclear.The most common radiological pattern of acute infection with SARS-CoV-2 is of bilateral ground-glass opacification with or without consolidation in a subpleural distribution, and a radiological and histological pattern of organizing pneumonia pattern is described in many cases (Zhao, Zhong, Xie, Yu, and Liu, 2020). Radiological findings alter as the disease progresses, but persistent computed tomographic (CT) imaging abnormalities beyond Day 14 of symptoms and up to Day 37 have been reported (Pan. et al., 2020; Wang. 38 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.05 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article obtained permission from the Scientific and Ethical Committees at the College of Medicine, Hawler Medical University. on 4th June 2022. The other official permis- sion from the Erbil Directorate of Health and the administrative units of the teach- ing hospitals was obtained. This study in- cludes 74 patients. A sample of post-COVID -19 patients was recruited in this study based on a convenience (purposeful) sam- pling technique, according to the inclusion and exclusion criteria. Ages more than 18 years, both genders, with good communi- cation were included. This study was car- ried out from November 2022 to April 2023. The duration of the data collection was around four months. A questionnaire was designed, and it consisted of two main parts. Part one included Demographic and Clinical Characteristics. Part two included laboratory and non-laboratory investiga- tions of SBP, DBP, SPO2, PR, Temp, PMH, CRP, D. Dimer, LDH, WBCs, Pulmonary Function Tests, Forced Vital Capacity, and the ratio of FEV1/FVC. The data was col- lected through a direct interview method (face-to-face) with the patients. Informal oral consent was obtained from each par- ticipant. The researchers promised to keep the participant’s information confidential and use this data for this study only, then explained the purpose of this study to each participant. In addition to the above, the researchers told each participant that this is voluntary work, and they could leave at any time even if the process is not com- pleted. The data was analyzed through sta- tistical software (Statistical Package for Sci- ence Service-SPSS V.26) which includes de- scriptive statistical analysis as frequency and percentage and inferential statistical analysis including Pearson Correlation, Chi- square, and Fisher’s Exact tests. The P- value is considered significant if it is less than or equal to 0.05. et al., 2020). However, no data exist as to the natural history of inflammatory infil- trates during recovery from SARS-CoV-2 or the utility of any treatment in patients with persistent inflammatory Interstitial Lung Disease (ILD) following infection with coro- navirus. However, corticosteroids are the mainstay of treatment for organizing pneu- monia of other causes (Cordier, 2000), and when used acutely in the management of acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 they have been associated with a reduction in mor- tality (Horby. et al., 2020; Sterne. et al., 2020). Whether PC-ILD should be divided into binary “inflammatory” and “fibrotic” categories based on radiological patterns remains controversial, given the ambiguity of some features (e.g., irregular lines), ab- sence of histological correlates, uncertain course, and likelihood of reversibility. Per- sistent ground-glass changes may indicate fine/immature fibrosis rather than inflam- mation, and fibrotic-like changes may be capable of regression and remodeling, al- beit at a slower rate. Idiopathic pulmonary fibrosis (IPF) is the archetypal fibrotic ILD (f -ILD), but most existing ILD syndromes are thought to reside on an overlapping fibro- inflammatory spectrum, e.g., hypersensi- tivity pneumonitis, an exaggerated aeroan- tigen-induced immune response, and rheu- matic-associated ILD. This arbitrary stratifi- cation into predominant fibrotic or inflam- matory phenotypes may have therapeutic and prognostic implications (although tar- geted treatments may be used concurrent- ly), with potential extrapolation to PC-IL (Mehta, Ivan, Rosas, and Singer, 2022). A quantitative, descriptive study design was conducted on post-COVID-19 patients at the medical wards in Rizgary and Hawler Teaching Hospitals in Erbil City in the Kur- distan Region of Iraq. The researchers 39 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.05 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article Table 1 shows the demographic and clinical characteristics of the post-COVID-19 pa- tients. Regarding the age group, more than half of the study sample in the age group between 54-69 years old (55.4%) and oth- ers are between 22-37 and 38-53 years old (17.6% and 27% respectively). About 63.5% were male and 36.5% female. Regarding the symptoms, 66.2% had a cough, 32.4% had a fever, and 73% had a shortness of Concerning blood pressure, half of the pa- tients have high systolic blood pressure (50%) and only 35.1% have high diastolic blood pressure. About 81.1% of COVID-19 patients suffer from hypoxemia. The high- est percentage of the study samples have tachycardia (64.9%) with normal body tem- perature (40.5%) and only 28.4% have hy- pothermia. breathing. Concerning the past medical history, the highest percentage have other diseases (37.8%), while 6.8% of the partici- pants have COPD and only 2.7% have Asth- ma, the rest of them have no past medical history (52.7%). About 66.2% were non- smokers, the smokers were 10.8% and ex- smokers 21.6% with only one case of pas- sive smoker. The highest percentage of the study sam- ple have high CRP (77%), high D. Dimer (62.2%), normal LDH (48.6%), normal WBC (66.2%), low Forced Expiratory Volume in one second (58.1%), low Forced Vital Ca- pacity (63.5%), more than normal ratio of FEV1/FVC (98.6%), with normal pattern (71.6%). 40 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 1: Demographic and Clinical Characteristics Demographic and Clinical Characteristics F. (%) Age Groups (years) 22-37 13 (17.6) 38-53 20 (27) 54-69 41 (55.4) Sex Male 47 (63.5) Female 27 (36.5) Cough No 25 (33.8) Yes 49 (66.2) Fever No 50 (67.6) Yes 24 (32.4) Shortness of Breath No 20 (27) Yes 54 (73) Others No 13 (17.6) Yes 61 (82.4) Past Medical History None 39 (52.7) Asthma 2 (2.7) COPD 5 (6.8) Others 28 (37.8) Smoking No Smoker 49 (66.2) Smoker 8 (10.8) Ex-Smoker 16 (21.6) Passive-Smoker 1 (1.4) RESULTS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.05 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article 41 moderate and severe (28.4% and 25.7% respectively). Regarding the severity, the highest percentage was mild (43.2%) followed by Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2: Laboratory and non-laboratory investigations of post-COVID-19 patients Laboratory and Non-laboratory Investigations F. (%) SBP Low Systolic Blood Pressure 4 (5.4) Normal Systolic Blood Pressure 33 (44.6) High Systolic Blood Pressure 37 (50) DBP Low Diastolic Blood Pressure 4 (5.4) Normal Diastolic Blood Pressure 44 (59.5) High Diastolic Blood Pressure 26 (35.1) SPO2 Hypoxemia 60 (81.1) Normal SPO2 14 (18.9) PR Bradycardia 0 (0) Normal pulse rate 26 (35.1) Tachycardia 48 (64.9) Temp Hypothermia 21 (28.4) Normal body temperature 30 (40.5) Hyperthermia 23 (31.1) CRP Normal CRP 17 (23) High CRP 57 (77) D. Dimer Normal D dimer 28 (37.8) High D dimer 46 (62.2) LDH Low LDH 22 (29.7) Normal LDH 36 (48.6) High LDH 16 (21.6) WBC Leukopenia 20 (27) Normal WBC 49 (66.2) Leukocytosis 5 (6.8) Forced Expiratory Volume in one second Low FEV1 43 (58.1) Normal FEV1 30 (40.5) High FEV1 1 (1.4) Forced Vital Capacity Low FVC 47 (63.5) Normal FVC 24 (32.4) High FVC 3 (4.1) FEV1/FVC Airflow Limitation 1 (1.4) Normal FEV1/FVC 0 (0) More than Normal 73 (98.6) Pattern Normal 53 (71.6) Obstructive 3 (4.1) Restrictive 18 (24.3) Table 3: Severity Severity F. (%) Mild 32 (43.2) Moderate 21 (28.4) Severe 19 (25.7) Critical 2 (2.7) Total 74 (100) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.05 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article Concerning the association between inves- tigations and severity, there is a significant association between SPO2, PR, D. Dimer, WBC, Pulmonary Function Tests, and Forced Vital Capacity with the severity (P- value ≤ 0.05). The other associations are non-significant (P-value > 0.05). 42 Concerning the association between demographic and clinical characteristics with the severity, there is a very highly significant association between age groups and SOB with the severity (P-value < 0.001). The other associations are non- significant (P-value > 0.05). Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 4. Association between Demographic and Clinical Characteristics with Severity Demographic and Clinical Characteristics Severity P-value Mild Moderate Severe Critical F. (%) F. (%) F. (%) F. (%) Age Groups (years) 22-37 10 (76.9) 2 (15.4) 1 (7.7) 0 (0) < 0.001 VHS 38-53 15 (75) 2 (10) 3 (15) 0 (0) 54-69 7 (17.1) 17 (41.5) 15 (36.6) 2 (4.9) Sex Male 19 (40.4) 16 (34) 11 (23.4) 1 (2.1) 0.550 NS Female 13 (48.1) 5 (18.5) 8 (29.6) 1 (3.7) Cough No 14 (56) 6 (24) 4 (16) 1 (4) 0.349 NS Yes 18 (36.7) 15 (30.6) 15 (30.6) 1 (2) Fever No 21 (42) 17 (34) 12 (24) 0 (0) 0.107 NS Yes 11 (45.8) 4 (16.7) 7 (29.2) 2 (8.3) SOB No 15 (75) 2 (10) 1 (5) 2 (10) < 0.001 VHS Yes 17 (31.5) 19 (35.2) 18 (33.3) 0 (0) others No 9 (69.2) 3 (23.1) 1 (7.7) 0 (0) 0.169 NS Yes 23 (37.7) 18 (29.5) 18 (29.5) 2 (3.3) PMH None 20 (51.3) 9 (23.1) 9 (23.1) 1 (2.6) 0.620 NS Asthma 1 (50) 1 (50) 0 (0) 0 (0) COPD 2 (40) 3 (60) 0 (0) 0 (0) Others 9 (32.1) 8 (28.6) 10 (35.7) 1 (3.6) Smoking No Smoker 23 (46.9) 12 (24.5) 14 (28.6) 0 (0) 0.149 NS Smoker 5 (62.5) 2 (25) 0 (0) 1 (12. 5) Ex-Smoker 3 (18.8) 7 (43.8) 5 (31.3) 1 (6.3) Passive- Smoker 1 (100) 0 (0) 0 (0) 0 (0) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.05 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article 43 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 5: Association between investigations with the severity Investigations Severity P– value Mild Moderate Severe Critical F. (%) F. (%) F. (%) F. (%) SBP Low Systolic Blood Pressure 0 (0) 2 (50) 2 (50) 0 (0) 0.148 NS Normal Systolic Blood Pressure 20 (60.6) 6 (18.2) 6 (18.2) 1 (3) High Systolic Blood Pressure 12 (32.4) 13 (35.1) 11 (29.7) 1 (2.7) DBP Low Diastolic Blood Pressure 1 (25) 1 (25) 2 (50) 0 (0) 0.348 NS Normal Diastolic Blood Pressure 24 (54.5) 11 (25) 8 (18.2) 1 (2.3) High Diastolic Blood Pressure 7 (26.9) 9 (34.6) 9 (34.6) 1 (3.8) SPO2 Hypoxemia 18 (30) 21 (35) 19 (31.7) 2 (3.3) < 0.001 VHS Normal SPO2 14 (100) 0 (0) 0 (0) 0 (0) PR Bradycardia 0 (0) 0 (0) 0 (0) 0 (0) 0.002 HS Normal pulse rate 18 (69.2) 7 (26.9) 1 (3.8) 0 (0) Tachycardia 14 (29.2) 14 (29.2) 18 (37.5) 2 (4.2) Temp Hypothermia 8 (38.1) 6 (28.6) 6 (28.6) 1 (4.8) 0.306 NS Normal body temperature 17 (56.7) 9 (30) 4 (13.3) 0 (0) Hyperthermia 7 (30.4) 6 (26.1) 9 (39.1) 1 (4.3) CRP Normal CRP 10 (58.8) 5 (29.4) 2 (11.8) 0 (0) 0.320 NS High CRP 22 (38.6) 16 (28.1) 17 (29.8) 2 (3.5) D. Dimer Normal D dimer 19 (67.9) 3 (10.7) 4 (14.3) 2 (7.1) 0.001 VHS High D dimer 13 (28.3) 18 (39.1) 15 (32.6) 0 (0) LDH Low LDH 10 (45.5) 6 (27.3) 6 (27.3) 0 (0) 0.271 NS Normal LDH 16 (44.4) 11 (30.6) 9 (25) 0 (0) High LDH 6 (37.5) 4 (25) 4 (25) 2 (12.5) WBC Leukopenia 8 (40) 7 (35) 5 (25) 0 (0) 0.010 S Normal WBC 24 (49) 14 (28.6) 10 (20.4) 1 (2) Leukocytosis 0 (0) 0 (0) 4 (80) 1 (20) Pulmonary Function Low FEV1 7 (16.3) 15 (34.9) 19 (44.2) 2 (4.7) < 0.001 VHS Normal FEV1 24 (80) 6 (20) 0 (0) 0 (0) High FEV1 1 (100) 0 (0) 0 (0) 0 (0) Forced Vital Capacity Low FVC 10 (21.3) 16 (34) 19 (40.4) 2 (4.3) < 0.001 VHS Normal FVC 20 (83.3) 4 (16.7) 0 (0) 0 (0) High FVC 2 (66.7) 1 (33.3) 0 (0) 0 (0) FEV1FVC Airflow Limitation 1 (100) 0 (0) 0 (0) 0 (0) 0.722 NS Normal FEV1/FVC 0 (0) 0 (0) 0 (0) 0 (0) More than Normal 31 (42.5) 21 (28.8) 19 (26) 2 (2.7) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.05 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article pattern, all of the associations are non-significant (P -value > 0.05). Concerning the association between demographic and clinical characteristics and the spirometry 44 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 6: Association between Demographic and Clinical Characteristics and the Spirometry Pattern Demographic and Clinical Characteristics Spirometry Pattern P-value Normal Obstructive Restrictive F. (%) F. (%) F. (%) Age Groups (years) 22-37 11 (84.6) 0 (0) 2 (15.4) 0.367 NS 38-53 16 (80) 0 (0) 4 (20) 54-69 26 (63.4) 3 (7.3) 12 (29.3) Sex Male 34 (72.3) 3 (6.4) 10 (21.3) 0.329 NS Female 19 (70.4) 0 (0) 8 (29.6) Cough No 17 (68) 1 (4) 7 (28) 0.870 NS Yes 36 (73.5) 2 (4.1) 11 (22.4) Fever No 39 (78) 2 (4) 9 (18) 0.182 NS Yes 14 (58.3) 1 (4.2) 9 (37.5) SOB No 15 (75) 1 (5) 4 (20) 0.854 NS Yes 38 (70.4) 2 (3.7) 14 (25.9) Pregnancy No 53 (71.6) 3 (4.1) 18 (24.3) Constant Yes 0 (0) 0 (0) 0 (0) SBP Low Systolic Blood Pressure 3 (75) 0 (0) 1 (25) 0.775 NS Normal Systolic Blood Pressure 25 (75.8) 2 (6.1) 6 (18.2) High Systolic Blood Pressure 25 (67.6) 1 (2.7) 11 (29.7) DBP Low Diastolic Blood Pressure 3 (75) 0 (0) 1 (25) 0.987 NS Normal Diastolic Blood Pressure 32 (72.7) 2 (4.5) 10 (22.7) High Diastolic Blood Pressure 18 (69.2) 1 (3.8) 7 (26.9) SPO2 Hypoxemia 41 (68.3) 3 (5) 16 (26.7) 0.388 NS Normal SPO2 12 (85.7) 0 (0) 2 (14.3) Temp Hypothermia 15 (71.4) 2 (9.5) 4 (19) 0.371 NS Normal body temperature 23 (76.7) 1 (3.3) 6 (20) Hyperthermia 15 (65.2) 0 (0) 8 (34.8) PMH None 29 (74.4) 0 (0) 10 (25.6) 0.244 NS Asthma 2 (100) 0 (0) 0 (0) COPD 4 (80) 1 (20) 0 (0) Others 18 (64.3) 2 (7.1) 8 (28.6) CRP Normal CRP 16 (94.1) 0 (0) 1 (5.9) 0.069 NS High CRP 37 (64.9) 3 (5.3) 17 (29.8) D. dimer Normal D dimer 19 (67.9) 1 (3.6) 8 (28.6) 0.799 NS High D dimer 34 (73.9) 2 (4.3) 10 (21.7) Smoking No Smoker 35 (71.4) 2 (4.1) 12 (24.5) 0.860 NS Smoker 5 (62.5) 1 (12.5) 2 (25) Ex-Smoker 12 (75) 0 (0) 4 (25) Passive-Smoker 1 (100) 0 (0) 0 (0) NS* Non-Significant https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.05 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article significant association between Spirometry Pattern and the severity (P-value < 0.001). between Spirometry Pattern and the comorbidities (P-value 0.244). from acute infection, a phenomenon re- ported in several studies (Carfì et al., 2020; Huang et al., 2021). Comparing these find- ings with existing literature, several simi- larities and differences emerge. For in- stance, while our study reports a high prevalence of cough and shortness of breath, Huang et al. (2021) found a similar pattern of respiratory symptoms in their cohort of post-COVID-19 patients. Howev- er, the prevalence of fever in our study ap- pears lower than reported by Carfì et al. (2020), suggesting potential variations in symptom presentation across different pa- tient populations or study methodologies. Elevated blood pressure, hypoxemia, tach- ycardia, and abnormal biomarker levels x Concerning the association between Spirometry Pattern with the severity, there is a very highly Regarding the association between the Spirometry Pattern and the Comorbidities, there is a non- significant association The age distribution in this study demon- strates a predominance of patients be- tween 54-69 years old, comprising 55.4% of the sample, which aligns with previous research indicating a higher susceptibility to severe COVID-19 outcomes among older individuals (Rothan and Byrareddy, 2020). Additionally, a higher proportion of males (63.5%) compared to females (36.5%) was observed, consistent with prior observa- tions of COVID-19's disproportionate im- pact on males (Jin et al., 2020). Sympto- matology among post-COVID-19 patients reveals a significant prevalence of cough (66.2%), fever (32.4%), and shortness of breath (73%), reflecting the persistence of respiratory symptoms even after recovery 45 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 7: Association between Spirometry Pattern and Severity Severity Spirometry Pattern P-value Normal Obstructive Restrictive F. (%) F. (%) F. (%) Mild 28 (87.5) 2 (6.3) 2 (6.3) < 0.001 VHS* Moderate 19 (90.5) 0 (0) 2 (9.5) Severe 6 (31.6) 1 (5.3) 12 (63.2) Critical 0 (0) 0 (0) 2 (100) VHS* Very Highly Significant Table 8: Association between the Spirometry Pattern and Comorbidities PMH Spirometry Pattern P-value Normal Obstructive Restrictive F. (%) F. (%) F. (%) None 29 (74.4) 0 (0) 10 (25.6) 0.244 NS Asthma 2 (100) 0 (0) 0 (0) COPD 4 (80) 1 (20) 0 (0) Others 18 (64.3) 2 (7.1) 8 (28.6) NS* Non-Significant DISCUSSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.05 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article (Williamson et al., 2020), the association between symptoms like cough and fever with severity may vary depending on fac- tors like disease prevalence, population demographics, and study design. The asso- ciation between investigative parameters and the severity of post-COVID-19 symp- toms. Parameters such as SPO2, pulse rate (PR), D. Dimer, white blood cell count (WBC), and pulmonary function tests (FEV1 and FVC) demonstrate a significant associ- ation with severity (P-value ≤ 0.05). This suggests that abnormalities in these pa- rameters may serve as valuable indicators of disease severity and could aid in risk stratification and clinical decision-making. A significant association between spirome- try patterns and the severity of post-COVID -19 symptoms. Notably, a very highly sig- nificant association (P-value < 0.001) was observed, indicating that the type of spi- rometry pattern exhibited by patients is strongly correlated with the severity of their symptoms. Specifically, patients with mild or moderate symptoms predominant- ly displayed normal or obstructive spirom- etry patterns, while those with severe or critical symptoms were more likely to ex- hibit restrictive patterns. This suggests that spirometry patterns could serve as valua- ble indicators of disease severity in post- COVID-19 patients, aiding clinicians in risk stratification and prognostication. A non- significant association (P-value 0.244) be- tween spirometry patterns and comorbidi- ties among post-COVID-19 patients. De- spite trends indicating that patients with comorbidities such as asthma and COPD tend to exhibit obstructive spirometry patterns, while those with other comorbid- ities display varied patterns, the lack of sta- tistical significance suggests that spirome- try patterns may not be strongly influ- enced by comorbidities alone in this co- hort. Further research is warranted to elu- cidate the interplay between comorbidities (e.g., CRP, D. Dimer) indicate persistent systemic inflammation and cardiovascular involvement in post-COVID-19 patients (Nalbandian et al., 2021; Libby et al., 2021). Pulmonary function tests reveal a high prevalence of airflow limitation and restric- tive patterns, indicative of lingering respir- atory impairments post-recovery (George et al., 2020). When compared with similar investigations, our findings corroborate the persistence of cardiovascular and respira- tory sequelae post-COVID-19. For instance, Nalbandian et al. (2021) reported a similar- ly high prevalence of abnormal cardiac bi- omarkers and pulmonary dysfunction in their study cohort. However, differences in the prevalence of specific abnormalities may reflect variations in patient de- mographics, disease severity, or follow-up duration across studies. The distribution of severity among post-COVID-19 patients, with mild cases being the most prevalent (43.2%), followed by moderate (28.4%) and severe (25.7%) cases. This distribution un- derscores the heterogeneity in symptom presentation and the need for tailored management strategies based on the se- verity of symptoms. the association be- tween demographic/clinical characteristics and the severity of post-COVID-19 symp- toms. Notably, age groups and shortness of breath (SOB) exhibit a highly significant association with severity (P-value < 0.001), suggesting that older age and the presence of SOB may predispose individuals to more severe outcomes. Other associations, such as sex, cough, fever, past medical history, and smoking status, appear non- significant, indicating that these factors may not independently predict the severity of post-COVID-19 symptoms in this cohort. Comparing these findings with existing lit- erature can provide further insights. For instance, while age has consistently been identified as a significant predictor of COVID-19 severity in numerous studies 46 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.05 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article [4] Docherty AB, Harrison EM, Green CA, Hard- wick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisa- tion Protocol: prospective observational cohort study. bmj. 2020 May 22;369. https://doi.org/10.1136/bmj.m1985. [5] Drake TM, Riad AM, Fairfield CJ, Egan C, Knight SR, Pius R, et al. Characterisation of in -hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study. 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Presenting characteristics, comorbidities, and outcomes among 5700 patients 48 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/