Unless poorly-controlled or immune suppressed, patients with pre-existing respiratory disease (PwPRD) are not at increased risk for severe SARS-CoV-2 disease or mortality. As opposed to acute disease outcomes, there are no data on medium-term outcome in this population.We describe 3-month clinical, functional and radiological outcome after severe COVID-19 in PwPRD.

Methods
Prospective cohort of adults returning 3 months after severe COVID-19 admission (i.e. WHO score >5) between 03/2020-03/2022. We collected standardized data on symptoms, functionality and chest CT.

Results
At 3 months, 202 severe COVID-19 patients returned (median age 61, 70% male, BMI 28.8 kg/m2, no significant difference across 4 waves), 24 (12%) of whom were PwPRD: 14 asthma, 5 ILD, 4 COPD and 1 lung cancer. Besides more comorbidities in PwPRD, baseline characteristics and disease severity were similar. 84% reported persistent symptoms, most commonly fatigue and dyspnea (50% each). PwPRD experienced significantly more severe dyspnea and chest pain. None of the PwPRD resumed work vs 42% of the others. A significantly higher proportion of PwPRD had FEV1 and TLC z-score <-1.64: 91% vs 62%, and 38% vs 17% respectively. We noted no difference in DLCO (49% z-score<-1.64) and 6MWD (55% <80%pred). CT abnormalities were common and did not differ between groups.

Conclusion
At 3 months following severe COVID-19, PwPRD experienced more respiratory symptoms, impacting daily life. Although a higher proportion of them had impaired FEV1 and TLC, likely reflecting their underlying lung disease rather than COVID-sequelae, we observed no significant differences in functional and radiological recovery.