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Updated: Jul 24, 2025
Breath Collection from Children for Disease Biomarker Discovery
Published on: February 14, 2019
Exhaled Breath Condensate and Respiratory Sequelae in Children Post-COVID-19
Einat Fireman Klein1,2, Karin Yaacoby-Bianu2,3, Ido Orlin4
1Pulmonology division, Carmel Medical Center, Haifa, Israel.
Insights
Most children experience mild COVID-19 and recover without long-term respiratory issues. Post-COVID-19 evaluation in children showed no significant pulmonary sequelae in those without persistent symptoms.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Respiratory Medicine
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes acute respiratory illness, with a notable percentage of adults experiencing persistent symptoms.
- Data on long-term respiratory effects in children following SARS-CoV-2 infection are limited.
- Exhaled breath condensate (EBC) offers a non-invasive method for assessing airway inflammation.
Purpose of the Study:
- To evaluate exhaled breath condensate (EBC) parameters in children after COVID-19.
- To assess respiratory, mental, and physical abilities in pediatric populations post-COVID-19.
- To investigate potential pulmonary sequelae in children following SARS-CoV-2 infection.
Main Methods:
- An observational study involving children aged 5-18 years with confirmed SARS-CoV-2 infection.
- Evaluations included spirometry, 6-minute walk test (6MWT), EBC analysis (pH, interleukin-6), and questionnaires on medical history, mental health (DASS-21), and physical activity.
- COVID-19 severity was classified using World Health Organization (WHO) criteria.
Main Results:
- Fifty-eight children were analyzed, categorized as asymptomatic (n=14), mild (n=37), and moderate (n=7) disease.
- Asymptomatic children were younger and reported lower Depression, Anxiety, and Stress Scale (DASS-21) scores compared to mild and moderate groups.
- No significant differences were observed across groups in EBC markers, 6MWT, spirometry, BMI percentile, or activity scores.
Conclusions:
- COVID-19 presents as an asymptomatic to mild illness in most young, healthy children, with emotional symptoms gradually decreasing.
- Children without prolonged respiratory symptoms showed no significant pulmonary sequelae based on EBC, spirometry, 6MWT, and activity assessments.
- Further research with larger cohorts is necessary to understand long-term pediatric consequences of SARS-CoV-2 and determine the need for pulmonology surveillance.
Background:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes an acute respiratory illness. A substantial proportion of adults experience persistent symptoms. There is a paucity of data on respiratory sequelae in children. Exhaled breath condensate (EBC) is a non-invasive tool used to assess airway inflammation.
Objectives:
This study aimed to evaluate EBC parameters, respiratory, mental and physical ability among children post COVID-19 infection.
Methods:
Observational study of confirmed SARS-CoV-2 infection cases among children, aged 5-18 years, evaluated once, 1-6 months post positive SARS-CoV-2 PCR testing. All subjects performed spirometry, 6-min walk test (6MWT), EBC (pH, interleukin-6), and completed medical history questionnaires, Depression, Anxiety, and Stress Scale (DASS-21), and physical activity scores. Severity of COVID-19 disease was classified according to WHO criteria.
Results:
Fifty-eight children were included and classified asymptomatic (n = 14), mild (n = 37), and moderate (n = 7) disease. The asymptomatic group included younger patients compared to the mild and moderate groups (8.9 ± 2.5y vs. 12.3 ± 3.6y and 14.6 ± 2.5y, respectively, p = 0.001), as well as lower DASS-21 total scores (3.4 ± 4 vs. 8.7 ± 9.4 and 8.7 ± 0.6 respectively, p = 0.056), with higher scores in proximity to positive PCR (p = 0.011). No differences were found between the 3 groups regarding EBC, 6MWT, spirometry, body mass index percentile, and activity scores.
Conclusions:
COVID-19 is an asymptomatic-mild disease in most young healthy children, with gradually diminishing emotional symptoms. Children without prolonged respiratory symptoms revealed no significant pulmonary sequelae as evaluated by EBC markers, spirometry, 6MWT, and activity scores. Larger studies are required to assess long-term pediatric consequences of post SARS-CoV-2 infection, to assess the need for pulmonology surveillance.
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