Long COVID-19 Pulmonary Sequelae and Management Considerations

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.

Global Trends and Research Hotspots in Long COVID: A Bibliometric Analysis

“…There was no standardized treatment for patients with long COVID. Instead, personalized treatment was recommended for each patient [ 30 , 49 , 50 ]. For specific symptoms, there were the following studies: (1) Robbins Tim et al used hyperbaric oxygen therapy to treat chronic fatigue syndrome, which significantly improved fatigue [ 51 ]; Vollbracht C and Kraft K believed that injections of Vitamin C can help relieve symptoms of fatigue [ 52 ]; and (2) Dzubera A et al used spinal surgery with radicular decompression to treat spinal pain in patients [ 42 ].…”

Organbezogene Folgeerscheinungen von COVID‑19 bei Erwachsenen

“…Hierbei zeigen sich in der Frühphase nach COVID-19 (0-3 Monate) hauptsächlich Einschränkungen der Lungenfunktion und Diffusionskapazität sowie radiologische Veränderungen in Form von "Milchglasinfiltraten", Konsolidierungen und einem breiten Spektrum fibrotischnarbigen Umbaus; deutlich seltener treten pulmonal-vaskuläre Komplikationen auf (z. B. Lungenarterienembolien; [17][18][19][20][21]).…”

COVID-19-Related Complications

“…A range of pulmonary symptoms may occur; dyspnea on exertion, restrictive pulmonary conditions, diminished diffusing capacity for carbon monoxide (DLCO) as well as fibrotic lesions on high resolution computed tomography (HRCT) all associated to the intensity of acute COVID-19 infection [4].…”

“…[2,3] The National Institute for Health and Care Excellence (NICE) has suggested the following terminology; "Acute COVID-19", for signs and symptoms of COVID-19 lasting up to four weeks, "Ongoing symptomatic COVID-19", for signs and symptoms of COVID-19 lasting 4-12 weeks, "Post-COVID-19 syndrome", for symptoms that develop during or after COVID-19 infection and persist for more than 12 weeks; Ongoing symptomatic and Post-COVID-19 syndrome may be both included in the term "Long COVID-19". [4,5] METHODS Authors collected, analyzed, and presented information on pulmonary and cardiovascular complications of COVID-19. English language literature was searched across multiple journals until May 2022 using combinations of relevant terms, such as COVID-19, long-COVID, cardiovascular, pulmonary, endocrinologic, and neurologic complications.…”