Swiss Recommendations for the Follow-Up and Treatment of Pulmonary Long COVID

Abstract

<b><i>Introduction:</i></b> Emerging evidence suggests that long-term pulmonary symptoms and functional impairment occurs in a proportion of individuals following SARS-CoV-2 infection. Although the proportion of affected patients remains to be determined, physicians are increasingly being confronted with patients reporting respiratory symptoms and impairment beyond the acute phase of COVID-19. In face of limited evidence, the Swiss Society for Pulmonology established a working group to address this area of unmet need and formulated diagnostic and treatment recommendations for the care of patients with pulmonary long COVID (LC). <b><i>Method:</i></b> The Swiss COVID Lung Study group and Swiss Society for Pulmonology (SSP) formulated 13 questions addressing the diagnosis and treatment of pulmonary LC. A survey within the SSP special interest groups involved in care of LC patients was conducted in Switzerland. A CORE process/Delphi-like process was used to formulate recommendations. Forty experienced pulmonologists replied to the first survey and 22 completed the second follow-up survey. Agreement of ≥70% consensus led to formulation of a recommendation. <b><i>Results:</i></b> The participants in the survey reached consensus and formulated a <i>strong recommendation for</i> regarding the following points. Patients hospitalized for COVID-19 should have a pulmonary assessment including pulmonary function tests. Symptomatic subjects affected by COVID-19, including those with mild disease, should benefit from a pulmonary follow-up. Persistent respiratory symptoms after COVID-19 should be investigated by a pulmonary follow-up including plethysmography, diffusion capacity measurement, and blood gases analysis. Individuals having suffered from COVID-19 and who present with persistent respiratory symptoms should be offered a rehabilitation. Additional questions were given <i>moderate</i>or<i> weak recommendations for</i>. The panel did not reach sufficient consensus for pharmacological therapy (e.g., therapy specifically targeting lung fibrosis) to formulate recommendations for LC drug treatment. <b><i>Conclusion:</i></b> The formulated recommendations should serve as an interim guidance to facilitate diagnosis and treatment of patients with pulmonary LC. As new evidence emerges, these recommendations may need to be adapted.

Recovering from a pandemic: pulmonary fibrosis after SARS-CoV-2 infection

“…The British Thoracic Society recommends obtaining PFTs at 3 months post-discharge in all survivors of critical COVID-19 and recommends PFTs in those with mild to moderate disease if they have abnormal radiographic imaging [ 33 ]. Similar guidance is given by the Swiss Society of Pulmonology [ 34 ] but such statements are lacking, at this time, from leading North American Thoracic Societies. Data in uncomplicated influenza A infection, as well as a recent study with a younger, less symptomatic acute COVID-19 group suggest that even a minimally symptomatic population may suffer from reduced lung function and impaired gas transfer 1–2 months after acute illness [ 35 , 36 ].…”

Long COVID in Children and Adolescents

“…In Figure 2, we propose a stepwise approach for screening, assessing and monitoring children infected by COVID 19. According to the recommendations of NICE, the first step can be a questionnaire to determine the acute phase of the disease and assess the most common symptoms of long COVID [5]. Questionnaires such as the COVID-19 Yorkshire Rehabilitation Screen (C19-YRS) [47] or the questionnaire developed by the Swiss COVID Study Group and the Swiss Society for Pulmonology (SSP) were used to address the diagnosis and treatment of pulmonary long COVID in adult patients [48]. Conversely, no specific and standardized questionnaires are available for the pediatric population.…”

Long COVID-19 Syndrome: A Comprehensive Review of Its Effect on Various Organ Systems and Recommendation on Rehabilitation Plans

“…Radiological findings of pulmonary fibrosis 4 months after COVID-19 infection are associated with pulmonary function decline and frailty [135]. The Swiss COVID Study Group and Swiss Society for Pulmonology (SSP) formulated a 13-question screening tool to address the diagnosis and are treatment of pulmonary lung damage in Long COVID-19 Syndrome patients [136]. They recommended pulmonary assessment, such as pulmonary function tests, plethysmography, diffusion capacity measurements, and blood gas analysis, in discharged patients with persistent respiratory symptoms after previously PCR-confirmed COVID-19 infections.…”