Coronavirus Disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), emerged as a global pandemic and has had profound effects on public health worldwide. Although the majority of patients recover from the acute phase of infection, increasing evidence indicates that a considerable proportion continue to experience persistent symptoms and functional impairments for weeks or months after recovery. This condition, commonly referred to as post-COVID syndrome or long COVID, has become an important healthcare concern due to its impact on physical, psychological, and social well-being [1-3]. Residual pulmonary symptoms such as breathlessness, persistent cough, chest tightness, sputum production, wheezing, and exercise intolerance have been frequently reported among COVID-19 survivors. These symptoms may occur irrespective of the severity of the initial infection, although they are generally more common among individuals who experienced moderate to severe disease, required hospitalization, or received intensive care support. Persistent respiratory symptoms can limit daily activities, reduce work productivity, and adversely affect overall health status [4-6]. Quality of life (QoL) has emerged as an important outcome measure in the assessment of post-COVID recovery. Beyond physical symptoms, many survivors experience fatigue, anxiety, depression, sleep disturbances, cognitive difficulties, and social limitations, all of which contribute to reduced quality of life. Evaluation of quality of life provides a comprehensive understanding of the long-term burden of COVID-19 and helps identify individuals who may benefit from rehabilitation and supportive interventions [7, 8]. Community-based follow-up studies are particularly valuable because they capture the experiences of individuals recovering in real-world settings rather than only those attending healthcare facilities. Such studies help determine the true prevalence of persistent symptoms, assess their impact on daily living, and guide the development of effective public health strategies for long-term care and rehabilitation [9]. Several studies conducted worldwide have demonstrated varying rates of post-COVID symptoms, with fatigue and breathlessness being among the most commonly reported complaints. However, data regarding the persistence of pulmonary symptoms and their influence on quality of life in community populations remain limited, especially in developing countries. Understanding these long-term consequences is essential for planning healthcare services and improving patient outcomes [10, 11]. Therefore, the present study was undertaken to evaluate residual pulmonary symptoms and assess their impact on quality of life among individuals who had recovered from COVID-19 infection in the general population through a community-based follow-up approach. The study also aimed to identify factors associated with persistent symptoms and reduced quality of life following recovery from COVID-19.

Study Design and Study Population: This community-based follow-up study was conducted in the Department of Pulmonology, Sri Lakshmi Narayana Institute of Medical Sciences, Osudu, Villianur Commune, Puducherry, between February 2022 and January 2023. A total of 40 individuals with a previous laboratory-confirmed diagnosis of COVID-19 were enrolled in the study after obtaining written informed consent. Ethical approval was obtained from the Institutional Ethics Committee before commencement of the study. Participants were recruited from the community and followed up at least three months after recovery from acute COVID-19 infection. Baseline demographic characteristics, comorbidities, COVID-19 vaccination status, severity of initial illness, hospitalization history, oxygen requirement, and duration since recovery were recorded. Methods: All participants underwent a detailed clinical evaluation using a structured questionnaire designed to assess residual pulmonary symptoms. Symptoms evaluated included breathlessness, persistent cough, chest tightness, wheezing, sputum production, fatigue on exertion, and exercise intolerance. Quality of life was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, which evaluates four domains: physical health, psychological well-being, social relationships, and environmental health. Pulmonary symptom severity was graded according to symptom frequency and impact on daily activities. Participants were categorized according to the severity of their initial COVID-19 infection as mild, moderate, or severe based on available clinical records. Associations between residual symptoms, disease severity, demographic factors, and quality-of-life scores were analyzed. Inclusion Criteria: 1. Individuals aged 18 years and above. 2. Previous laboratory-confirmed COVID-19 infection by RT-PCR 3. At least three months elapsed since recovery from acute COVID-19 infection. 4. Individuals residing within the study area and available for follow-up assessment. 5. Participants willing to provide written informed consent. Exclusion Criteria: 1. Individuals with active COVID-19 infection at the time of assessment. 2. Patients with pre-existing chronic respiratory diseases such as severe COPD, bronchial asthma, interstitial lung disease. 3. Individuals with severe cardiac disease causing breathlessness unrelated to COVID-19. 4. Patients with cognitive impairment preventing completion of questionnaires. 5. Individuals unwilling to participate or unable to provide informed consent. 6. Incomplete clinical records or loss to follow-up. Statistical Analysis: Data were entered into Microsoft Excel and analyzed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were presented as frequencies and percentages. The Student’s t-test and one-way ANOVA were used to compare continuous variables between groups. The Chi-square test or Fisher’s exact test was used to assess associations between categorical variables such as residual symptoms and severity of initial COVID-19 illness. Correlation analysis was performed between pulmonary symptom burden and quality-of-life scores. A p-value <0.05 was considered statistically significant.

A total of 40 post-COVID individuals were included in the study and completed the follow-up assessment. Demographic characteristics, residual pulmonary symptoms, and quality-of-life outcomes were analyzed. Table 1. Demographic and Clinical Characteristics of Study Participants Variable Number (%) Male 22 (55.0%) Female 18 (45.0%) Mean Age (Years) 44.8 ± 13.5 Mild COVID-19 18 (45.0%) Moderate COVID-19 15 (37.5%) Severe COVID-19 7 (17.5%) Hospitalized During Acute Illness 14 (35.0%) Required Oxygen Therapy 8 (20.0%) Presence of Comorbidities 16 (40.0%) The mean age of participants was 44.8 ± 13.5 years, with males accounting for 55.0% of the study population. Table 2. Prevalence of Residual Pulmonary Symptoms Symptom Number (%) Breathlessness 16 (40.0%) Persistent Cough 11 (27.5%) Chest Discomfort 7 (17.5%) Wheezing 5 (12.5%) Sputum Production 6 (15.0%) Fatigue on Exertion 20 (50.0%) Exercise Intolerance 14 (35.0%) Any Residual Pulmonary Symptom 26 (65.0%) A total of 26 participants (65.0%) reported at least one persistent pulmonary symptom during follow-up. Fatigue on exertion and breathlessness were the most common complaints. Table 3: Association between Initial COVID-19 Severity and Residual Symptoms Initial Disease Severity Participants (n) Residual Symptoms Present Percentage Mild 18 8 44.4% Moderate 15 12 80.0% Severe 7 6 85.7% Residual symptoms were significantly more common among participants who had experienced moderate-to-severe COVID-19 infection compared with those with mild disease (p < 0.05). Table 4: WHOQOL-BREF Domain Scores Domain Symptomatic Participants (n=26) Asymptomatic Participants (n=14) p-value Physical Health 60.8 ± 8.4 78.6 ± 7.1 <0.001 Psychological Health 65.4 ± 7.9 79.2 ± 6.8 <0.001 Social Relationships 72.1 ± 6.7 80.4 ± 5.9 0.002 Environmental Health 74.3 ± 5.8 81.5 ± 5.6 0.004 Participants with persistent pulmonary symptoms demonstrated significantly lower quality-of-life scores across all domains. Table 5. Overall Quality-of-Life Scores Group Mean QoL Score Symptomatic Participants 68.4 ± 8.6 Asymptomatic Participants 81.2 ± 7.4 p-value <0.001 The mean overall quality-of-life score was significantly lower among participants experiencing residual symptoms compared with asymptomatic individuals.

The COVID-19 pandemic has resulted in a large population of survivors who continue to experience persistent symptoms long after recovery from the acute infection. Increasing evidence suggests that post-COVID syndrome, particularly residual respiratory manifestations, can significantly affect physical functioning and overall quality of life. The present community-based follow-up study evaluated residual pulmonary symptoms and their impact on quality of life among individuals who had recovered from COVID-19 infection [11, 12]. In the present study, 65.0% of participants reported at least one residual pulmonary symptom during follow-up. This finding is consistent with previous studies that have documented persistent respiratory complaints among COVID-19 survivors several months after recovery. The persistence of symptoms may be attributed to residual pulmonary inflammation, impaired lung function, airway hyperreactivity, alveolar damage, or post-infectious fibrotic changes. These long-term consequences emphasize that recovery from acute infection does not necessarily indicate complete restoration of respiratory health [13-15]. In the previous study reported that among the reported symptoms, fatigue on exertion (50.0%) and breathlessness (40.0%) were the most common. Persistent fatigue has emerged as one of the hallmark features of post-COVID syndrome and may result from ongoing inflammatory responses, reduced physical conditioning, and multisystem involvement. Breathlessness remains a significant concern among recovered patients and may reflect residual pulmonary impairment, reduced diffusion capacity, or cardiovascular deconditioning. Persistent cough and exercise intolerance were also frequently observed, highlighting the prolonged respiratory burden associated with COVID-19 [16]. In this study demonstrated a strong association between the severity of the initial COVID-19 infection and the occurrence of residual symptoms. Participants who experienced moderate-to-severe disease showed significantly higher rates of persistent pulmonary complaints compared with those who had mild illness. This observation is supported by previous reports indicating that severe acute infection may result in greater lung injury, prolonged inflammatory responses, and delayed functional recovery. Patients requiring hospitalization and oxygen therapy were particularly vulnerable to persistent respiratory sequelae [17, 18]. In the previous study reported the prevalence of persistent symptoms was observed to decline gradually with increasing duration since recovery. Participants assessed within three to six months after infection reported a higher frequency of symptoms compared with those evaluated later. This trend suggests progressive improvement over time; however, a substantial proportion of individuals continued to experience symptoms even after several months, indicating the need for long-term monitoring and rehabilitation services [19]. In the previous study reported that community-based follow-up proved valuable in identifying individuals experiencing ongoing health problems after COVID-19 recovery. Unlike hospital-based studies that may focus predominantly on severe cases, community-based assessment provides a broader understanding of the long-term consequences of COVID-19 across the general population. Such approaches facilitate early recognition of persistent symptoms and enable timely intervention through pulmonary rehabilitation, counseling, and supportive care [20]. In this present study has certain limitations. The sample size was relatively small, and follow-up was conducted within a single geographical region. Objective pulmonary function tests and radiological assessments were not performed for all participants, limiting the ability to correlate symptoms with physiological abnormalities. Larger multicenter studies incorporating pulmonary function testing and imaging modalities are needed to better characterize the long-term pulmonary sequelae of COVID-19 [21-23]. The findings of this study indicate that residual pulmonary symptoms are common among COVID-19 survivors and have a significant negative impact on quality of life. Early identification of affected individuals and implementation of structured follow-up and rehabilitation programs may improve recovery outcomes and enhance the long-term well-being of post-COVID patients [24].

The present study demonstrated that residual pulmonary symptoms are common among individuals recovering from COVID-19, with nearly two-thirds of participants reporting persistent respiratory complaints several months after infection. Fatigue on exertion, breathlessness, exercise intolerance, and persistent cough were the most frequently observed symptoms. Individuals with moderate-to-severe initial disease and those requiring hospitalization were at greater risk of experiencing long-term pulmonary sequelae. Persistent symptoms were associated with significantly reduced quality of life, particularly in the physical and psychological health domains. Community-based follow-up proved effective in identifying affected individuals and assessing their ongoing healthcare needs. Early recognition, regular monitoring, and implementation of pulmonary rehabilitation and supportive care strategies are essential to improve functional recovery and enhance the overall quality of life of post-COVID survivors.

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