Impact of COVID-19 on Diaphragmatic Function: Understanding Multiorgan Involvement and Long-Term Consequences

The COVID-19 pandemic has brought significant attention to the respiratory system, with much focus on lung-related disorders. However, the diaphragm, a crucial component of respiratory physiology, has not been adequately studied, especially in the context of long COVID. This review explores the multipotential role of the diaphragm in both respiratory health and disease, emphasizing its involvement in long-term complications following SARS-CoV-2 infection. The diaphragm's fundamental role in respiratory physiology and its impact on balance and posture control, breathing patterns, and autonomic nervous system regulation are discussed. This review examines complications arising from COVID-19, highlighting the diaphragm's involvement in neurological, musculoskeletal, and inflammatory responses. Particular attention is given to the neuroinvasive impact of SARS-CoV-2, the inflammatory response, and the direct viral effects on the diaphragm. The diaphragm's role in long COVID is explored, with a focus on specific symptoms such as voice disorders, pelvic floor dysfunction, and sleep disturbances. Diagnostic challenges, current methods for assessing diaphragmatic dysfunction, and the complexities of differentiating it from other conditions are also explored. This article is the first to comprehensively address diaphragmatic dysfunction resulting from COVID-19 and long COVID across various physiological and pathological aspects, offering a new perspective on its diagnosis and treatment within a multisystem context.