Persistent lung disease after acute COVID-19: how to recognize it and how long to expect it to last

The disease caused by SARS-CoV-2 is already known to cause an inflammatory condition throughout the body. The consequences of the famous “cytokine storm” are evident not only on the respiratory system, but there are patients who present – during the infection and even later – effects on the cardiovascular system, renal alterations. and even neurological sequelae. . . .

The truth is that it is only now a year since the first patients who suffered from the disease were seriously discharged from the hospital, so it can be said that science discovers ‘in real time’ the long-term effects COVID-19 leaves on those who suffer from it.

It appears that 15 months later, specialists’ understanding of complications after hospital treatment for COVID-19 is improving. A UK study of 47,780 discharged patients reported 12% all-cause mortality and one-third readmissions after 140 days of follow-up. “With curiosity, Although respiratory disease was diagnosed in 29.6% after discharge, rates of extrapulmonary complications including diabetes, adverse cardiovascular events, and liver and kidney dysfunction also increased compared to matched controls in the population., which indicates that the effect of COVID-19 extends far beyond the lungs ”, indicates a recent publication of BMJ.

Cohort outcome data from a single health center in this country showed that the lungs often show physiological and radiological changes three to four months after discharge from hospital.

According to the same publication, in a prospective study conducted in Italy, the diffusing capacity of carbon monoxide (DLCO, a marker of pulmonary vascular integrity) was lower than normal in 52% of 238 patients four months after discharge. More, A study in Canada found that 55% of patients who underwent follow-up CT scans had persistent radiologic abnormalities 12 weeks after discharge., as did a French cohort study, which reported similar results, with signs of fibrosis in 12% and 37% of unintubated and intubated patients, respectively.

But what is persistent lung disease after COVID? How to recognize it? Are some patients more likely than others to have it? What follow-up studies should patients undergo after discharge? Especially that, Infobae consulted specialists.

“This is a continuation of some of the respiratory symptoms such as shortness of breath, persistent cough either at the level of the tomodensitometry, the presence of images, opacities or frosted glass thickening of the partitions which correspond to these sequelae that can leave the disease COVID-19 “. The pulmonologist Ana Putruele (MN 55966) is chief from the pneumonology department at the Clínicas hospital and, questioned by this medium, she indicated One of the ways to recognize this sequel is both through a history of having had COVID or by performing diagnostic imaging studies.

To the internal doctor and pulmonologist Alexis Doreski (MN 141740), “There is post-COVID lung damage even in patients who pass the disease without major shock.”

As to whether there are patients more likely than others to suffer from this sequel, Putruele felt that “this has not been evaluated, but it can be said that groups with pre-existing disease may have it. more frequently”. “It shows more in men, but you can’t say that there is a fully identified risk group,” he said. Probably the severe forms can leave sequelae and one of them is that there is septal thickening, alveolar images or what we call fibrotic images; all these boxes are generally resolved over time”.

And after making sure that “In patients who have had bilateral pneumonia or who have generally required oxygen, this type of sequelae persists”, the specialist argued that “there are certain risk groups who may be more likely to suffer from it, such as patients with chronic heart or lung disease.” And he clarified: “A serious image does not always end with these after-effects.”

“There are more prone patients, in fact there are clear indications that the patient’s previous inflammatory state is decisive in the result of the disease, in the way the disease passes and the sequelae it has Doreski in turn contributed. We know that asthma is not a risk factor, but COPD, which is particularly severe, and being a smoker determine poorer results and a greater risk of chronic post-COVID injuries ”.

Regarding the post-discharge control studies that should be done in those who have suffered from this disease, taking Putruele into account, “in a spirometry after discharge it is possible to see if the patient has ended up with obstruction or restriction of the lung; it’s a simple study that measures lung capacity ”. In addition to a CT scan and a laboratory routine upon receipt of the epidemiological discharge.

With her agreed Doreski, for whom “It is necessary to follow up with a pulmonologist for up to a year after discharge, as well as perform respiratory function studies such as spirometry at one month, three, six, nine and 12 months depending on the results.”

“If there was fibrosis during the period of hyperinflammation throughout the disease, it is necessary to control the pulmonary diffusion of gases, which is measured with a study called DLCO”, he added, while stressing that “it is to be expected that fibrosis does not, it becomes progressive in these patients, but there is not enough experience in the world yet to determine that”.

And after pointing out that “there are more than 60 so-called ‘long COVID’ clinics in the UK,” the pulmonologist pointed out that the Respirar Foundation, which for 20 years has been dedicated to the care, prevention and treatment of disease respiratory systems and of which he is the research director, was a pioneer in the country in the long-term follow-up of infected patients. “We do free follow-up for these patients with post-COVID sequelae,” he said.

How is the processing and what is the prospect of solving the picture

As Putruele explains, “the treatment against COVID is in addition to the use of corticosteroids for a period of time, which should not be too long”. “The vast majority of patients recover lung function after some time, however, there is a subgroup being evaluated in different countries that end up with pulmonary fibrosis. and there, although it is not completely elucidated, the different antifibrotic agents can be useful – explained the expert. There aren’t many publications yet, but a monoclonal antibody or some drugs that are used for another type of fibrosis or rheumatoid arthritis could be used ”.

“Ultimately, you might be thinking about a lung transplant, but we don’t yet have information available on this small percentage of patients who become dependent on oxygen,” he said. And concluded: “This minor subgroup of patients who have the condition unresolved is causing specialists to see what therapy is best to avoid a lung transplant.”.

In summary, studies conducted around the world to date show that persistent respiratory complications occur and the severity of infection and previous health are likely the main determinants of long-term radiological and functional deterioration. Just as SARS-CoV-2 seems to have come to teach both doctors and the general population, only time will be able to shed light on the doubts which – after a year and a half of pandemic – remain to be clarified.

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