Pulmonary Function and Chest Computed Tomography (CT) Scan Findings After Antifibrotic Treatment for COVID-19-Related Pulmonary Fibrosis

Abstract

Patient: Female, 51-year-old Final Diagnosis: COVID-19 pneumonia • severe • recovered Symptoms: Cough Medication: — Clinical Procedure: None Specialty: Pulmonology Objective: Unusual setting of medical care Background: Physicians worldwide have been reporting many cases of COVID-19-induced pulmonary fibrosis. We report the case of a 51-year-old Filipino asthmatic woman who developed post-COVID-19 pulmonary fibrosis subsequently treated with Nintedanib. Case Report: The patient presented with a 4-day history of flu-like symptoms in September 2020 and was eventually diagnosed with severe COVID-19 pneumonia. Despite receiving Dexamethasone, Tocilizumab, Remdesivir, and multiple antibiotics, there was increasing oxygen requirement, necessitating ICU admission and high-flow nasal cannula (HFNC). An additional course of hydrocortisone was given due to asthma exacerbation, gradually liberating her from the HFNC. A chest CT scan showed extensive parenchymal changes, for which she received methylprednisolone and physical rehabilitation with persistence of respiratory symptoms. After 40 days of hospitalization, she was sent home on oxygen support and Nintedanib. The patient initially had severe dyspnea (Borg Scale 7) with 6-minute walk distance (6MWD) of 295 meters. Pulmonary function showed moderately severe restrictive lung defect at 52% predicted total lung capacity (TLC) and severely reduced DLCO (28% predicted). Chest CT scoring indicated severe lung involvement. One month after Nintedanib treatment, her Borg Scale improved to 4. Her 6MWD, TLC, and DLCO increased to 434 meters, 64% predicted, and 36% predicted, respectively. A chest CT scan showed regressing fibrosis. After 6 months of treatment, her pulmonary function normalized. DLCO remained moderately reduced (59% predicted) but her 6MWD (457 meters) and CT scan results continued to improve. Conclusions: Nintedanib, along with other interventions, may have potentially improved pulmonary function and CT scan findings in a COVID-19 survivor with pulmonary fibrosis 6 months after treatment.

COVID-19 and fibrosis: Mechanisms, clinical relevance, and future perspectives

“… [44] , [45] A recent report showed that six months of nintedanib treatment reduced pulmonary fibrosis and restored lung functions, as shown by a reduced Borg score, improved total lung capacity, diffusive lung capacity for carbon monoxide (DLCO), CT scoring, and a 6-min walk test score. 46 The adverse effects reported included mild dysphagia, frontal headache, and upper-extremity numbness, which eventually resolved a few weeks after treatment without causing any treatment discontinuation. Furthermore, two ongoing clinical trials (NCT04619680 and NCT04338802) aim to investigate the potential of nintedanib against COVID-19 associated pulmonary fibrosis.…”

COVID-19 and interstitial lung diseases: A multifaceted look at the relationship between the two diseases

“…There are some case reports of PCPF treated by pirfenidone or nintedanib, which were well tolerated, resulting in the improvement of fibrosis [ 161 , 162 , 163 ]. In an interventional study from Japan, nintedanib led to improvement in the length of mechanical ventilation and CT volumetry in patients with mechanically ventilated COVID-19, though no benefit on mortality was found [ 164 ].…”

Current Understanding of Post-COVID Pulmonary Fibrosis: Where Are We?

“…1 ). 4 , 5 , 6 , 7 Additionally, further studies are warranted to determine the role of antifibrotic drugs in preventing or attenuating changes consistent with post-COVID-19 pulmonary fibrosis, and in which scenarios they will be recommended.

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