Respiratory follow-up of patients with COVID-19 pneumonia

Abstract

The COVID-19 pandemic has led to an unprecedented surge in hospitalised patients with viral pneumonia. The most severely affected patients are older men, individuals of black and Asian minority ethnicity and those with comorbidities. COVID-19 is also associated with an increased risk of hypercoagulability and venous thromboembolism. The overwhelming majority of patients admitted to hospital have respiratory failure and while most are managed on general wards, a sizeable proportion require intensive care support. The long-term complications of COVID-19 pneumonia are starting to emerge but data from previous coronavirus outbreaks such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) suggest that some patients will experience long-term respiratory complications of the infection. With the pattern of thoracic imaging abnormalities and growing clinical experience, it is envisaged that interstitial lung disease and pulmonary vascular disease are likely to be the most important respiratory complications. There is a need for a unified pathway for the respiratory follow-up of patients with COVID-19 balancing the delivery of high-quality clinical care with stretched National Health Service (NHS) resources. In this guidance document, we provide a suggested structure for the respiratory follow-up of patients with clinicoradiological confirmation of COVID-19 pneumonia. We define two separate algorithms integrating disease severity, likelihood of long-term respiratory complications and functional capacity on discharge. To mitigate NHS pressures, virtual solutions have been embedded within the pathway as has safety netting of patients whose clinical trajectory deviates from the pathway. For all patients, we suggest a holistic package of care to address breathlessness, anxiety, oxygen requirement, palliative care and rehabilitation.

Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study

“…We plan more specific tests such as diffusion capacity and high-resolution computed tomography, in a subsequent evaluation of patients with positive screening (persistence of respiratory symptoms, changes in chest radiography or spirometry). This approach is in accordance with a recent published guidance of respiratory follow-up of patients with COVID-19 pneumonia [14] , looking for a rational use of resources. It is important to highlight that most of the patients with spirometry alterations in our series had a mild involvement, without clear clinical impact.…”

Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort

“…10 The British Thoracic Society (BTS) COVID-19 Guidance advises follow-up guidance depending on whether the patient required intensive/higher care versus ward/community care (equivalent to severe vs mild/moderate in this cohort). 1 For mild/ moderate disease, BTS recommends virtual follow-up with a CXR. This study demonstrated a low likelihood of follow-up CXR abnormalities in patients not requiring oxygen for their acute infection, suggesting that this approach may not be necessary.…”

Persistent Post–COVID-19 Interstitial Lung Disease. An Observational Study of Corticosteroid Treatment

“…6,-7 While interest in potential pulmonary, and specifically fibrotic, complications post SARS-CoV-2 infection grows, the long-term respiratory morbidity remains unclear. 8 Given the number of infected patients, persistent functional deficits in even a relatively small proportion is likely to represent a significant disease burden and prompt therapy may avoid potentially permanent fibrosis and functional impairment. In this study, using a structured assessment protocol, we aimed to establish the incidence of persistent inflammatory ILD in patients post-infection with SARS-CoV-2, and to report the progression of disease when treated with steroids.…”