Small Airway Disease as long-term Sequela of COVID-19: Use of Expiratory CT despite Improvement in Pulmonary Function test

Abstract

BackgroundIt is important to understand the spectrum of pulmonary diseases that patients are presenting after recovery from initial SARS-CoV-2 infection. We aim to study small airway disease and changes in Computed Tomography (CT)and pulmonary function tests (PFTs) with time.MethodsThis is retrospective observation study including adult patients with confirmed SARS-CoV-2 infection with at-least two CT scans either during acute (defined as <1 month) or subacute (1-3 months) or chronic (>3months) phase after positive test. Radiological features and follow up PFTs were obtained.Results22 patients met the inclusion criteria with mean age 57.6 years (range 36-83). Out of these,18 (81.81%) were hospitalized. Mean duration of diagnosis to CT and PFT was 192.68(112-385) days and 161.54(31-259) days respectively. On PFTs, restrictive pulmonary physiology was predominant finding during subacute 56.25% (9/16) and chronic phases 47% (7/15). PFTs improved significantly with time {FEV1((p=0.0361), FVC (p=0.0341), FEF 25%-75% (p=0.0259) and DLCO (p=0.0019)}, but there was persistent air trapping in the expiratory chronic phase CT. There was resolution of ground glass opacity, consolidation, and bronchiectasis however air trapping increased with time in 41.61% (10/21) of subacute CTs compared to 81.25% (13/16) in chronic CTs.ConclusionOur study shows evidence of airway as well as parenchymal disease as relatively long-term sequel of SARS-CoV-2 infection. It also highlights the natural course and spontaneous recovery of some radiological and pulmonary function test abnormalities over time with evidence of persistent small airway disease (air trapping) on expiratory CT imaging months after infection.HighlightsLong term pulmonary complication of SARS-CoV-2 infection include small airway diseaseThere is role of inspiratory and expiratory Computed tomography (CT) scan to identify air trapping in patients with persistent respiratory symptoms after SARS-CoV-2 infectionNormal spirometry and normal routine CT may not be sufficient to characterize and identify cause of persistent respiratory complains in patients after COVID-19This study highlights persistent parenchymal and physiological airway abnormalities more than six months after recovery from initial SARS-CoV-2 infection

Bronchiolitis obliterans syndrome following SARS-CoV-2 infection in an allogeneic hematopoietic stem cell recipient

“…In a retrospective study, 80% of the patients had, between 3 and 6 months after the infection, air trapping on the CT scan in accordance with the involvement of the small airways. 16 Among these patients, only 20% had an obstructive ventilatory disorder on PFTs, and 35% had a restrictive ventilatory disorder. This suggests a bronchiolar tropism of SARS-CoV-2, corroborating its involvement in the occurrence of BOS.…”

Incidence and follow-up of persistent lung perfusion abnormalities as a result of suspected air trapping or microthrombosis in non-hospitalised COVID-19 patients during the early half of the pandemic – experience in a tertiary institution in South Afr

“…Being small in diameter, these small airways are susceptible to occlusion by inhaled toxins or pathogens, or by inflammatory damage. [9,10] Small airway disease has also been known to be associated as a complication with the previous Middle East respiratory syndrome (MERS) and SARS respiratory infections. [7] Available clinical data have also highlighted that COVID-19 is associated with a significant risk of thrombotic complications ranging from microvascular thrombosis, venous thromboembolic disease, and stroke.…”