Abstract
The human coronavirus 2019 disease (COVID-19) and the associated acute respiratory distress syndrome (ARDS) are responsible for the worst global health crisis of the last century. Similarly, to previous coronaviruses leading to past pandemics, including severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS), a growing body of evidence support that a substantial minority of patients surviving the acute phase of the disease present with long-term sequelae lasting for up to 6 months following acute infection. The clinical spectrum of these manifestations is widespread across multiple organs and consists of the long-COVID-19 syndrome. The aim of the current review is to summarize the current state of knowledge on the pulmonary manifestations of the long COVID-19 syndrome including clinical symptoms, parenchymal, and functional abnormalities, as well as highlight epidemiology, risk factors, and follow-up strategies for early identification and timely therapeutic interventions. The literature data on management considerations including the role of corticosteroids and antifibrotic treatment, as well as the therapeutic potential of a structured and personalized pulmonary rehabilitation program are detailed and discussed.
Highlights
On 12 March 2020, the human coronavirus disease 2019 (COVID-19) outbreak was declared as a pandemic by the World Health Organization (WHO) [1], and almost one and a half years later, COVID-19 remains the major infectious disease concern globally, causing significant morbidity and mortality [2]
The scope of this review is to summarize the current state of knowledge on the (a) risk factors, outcome measures, and management options among COVID-19 survivors who develop fibrotic-like features, (b) clinical features and mechanisms of functional and physiologic limitation in patients with persistent post-acute COVID-19 manifestations, and (c) basic principles, structure, and outcomes of a pulmonary rehabilitation program that should be offered to these patients
Control of complications from the disease: The British Thoracic Society (BTS) has published a series of possible complications of the COVID-19 infection that must be taken into account during the initial evaluation of patients who will be admitted to the rehabilitation program [49]: (a)
Summary
On 12 March 2020, the human coronavirus disease 2019 (COVID-19) outbreak was declared as a pandemic by the World Health Organization (WHO) [1], and almost one and a half years later, COVID-19 remains the major infectious disease concern globally, causing significant morbidity and mortality [2]. A wide spectrum of pulmonary manifestations including dyspnea on exertion, restrictive pulmonary physiology, and reduction in diffusion capacity as well as fibrotic lung lesions in HRCT have been reported in up to 35% of survivors directly related to the severity of acute illness. A second functional and radiographic follow up at 6 months could be performed in a substantial minority of individuals with features predictive of residual ILAs including age (>50 yrs), fibrotic-like CT features at first follow-up (parenchymal bands, irregular interfaces, traction bronchiectasis, and/or honeycombing), and markers of disease severity including persistent dyspnea on exertion, tachycardia, prolonged hospital stay (>2 weeks) and history of non-invasive and/or invasive mechanical ventilation. Immunologic profile investigation should be restrained to those with persistent symptomatology suggestive of an autoimmune disease
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