Description
Post-COVID pulmonary sequelae, including fibrosis, persistent cough, dyspnea, and reduced lung function, require comprehensive long-term management. Pulmonary rehabilitation is central, focusing on breathing exercises, physical conditioning, and oxygen therapy when needed. Regular follow-up with pulmonary function tests and imaging helps monitor disease progression. Anti-fibrotic therapy may be considered in cases with progressive fibrosis. Management of comorbidities, vaccination, and psychological support are also important. Inhaled bronchodilators or corticosteroids may benefit selected patients with airway involvement. A multidisciplinary approach involving pulmonologists, physiotherapists, and primary care providers ensures optimal recovery and improves the quality of life in affected individuals.
Summary Listen
- Dr. Rajni Shuasthom discussed the persistent symptoms experienced by some individuals after recovering from COVID-19, often referred to as long COVID or post-COVID syndrome. She highlighted that these symptoms, such as fatigue, breathlessness, and cognitive dysfunction, can persist for months and significantly impact quality of life. WHO defines long COVID as symptoms lasting more than three months with a duration of at least two months.
- The pathophysiology of long COVID involves an initial inflammatory phase followed by potential immune suppression. This inflammation can lead to epithelial damage in the lungs, resulting in the overproduction of inflammatory cytokines and ultimately, lung fibrosis. The mechanism is similar to that seen in idiopathic pulmonary fibrosis (IPF), involving macrophage activation, epithelial cell apoptosis, and fibroblast activation.
- Long COVID can affect various organs beyond the lungs, including the heart, muscles, brain, kidneys, and gastrointestinal tract. Cardiac effects may include chest pain and arrhythmias, while GI issues can manifest as diarrhea and abdominal pain. Kidney problems may involve the aggravation of existing chronic kidney disease.
- Risk factors for post-COVID pulmonary sequelae include advanced age, smoking, pre-existing comorbidities (diabetes, hypertension, respiratory diseases), and the need for oxygen therapy or mechanical ventilation during the acute phase of COVID-19. Evaluation of persistent symptoms like breathlessness requires assessing oxygen saturation, and potentially conducting CT scans, ABG tests, and spirometry. CT scans may reveal fibrotic changes like traction bronchiectasis and honeycombing.
- Management of post-COVID lung fibrosis involves addressing the underlying cause and symptoms. While some patients improve spontaneously or remain stable, those with progressive fibrosis may require antifibrotic medications like nintedanib or pirfenidone. Anticoagulants are used to treat pulmonary embolism. Symptomatic treatment focuses on nutritious diet, exercise, and potentially oxygen therapy.
- Pulmonary rehabilitation is crucial for improving lung function and reducing breathlessness. Cough should be evaluated to determine if it originates from the nose, throat, stomach, or lungs, and treated accordingly. Breathing exercises are also helpful. Treatments should be individualized based on clinical features and involve a multidisciplinary approach, targeting treatable traits such as infections, bronchospasm, or progressive fibrosis, alongside nutritional support and psychological counseling. Novel therapies, such as daginemotors ARBs, are under trial but have no guidelines yet.
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