Lung Scarring Secondary to COVID-19: A Call to Arms?

COVID 19 infection may advance to pneumonia and ARDS, which may require assistive breathing support.ARDS is a severe respiratory failure characterized by inflammation in the lungs. A subset of patients who survive COVID-19 infection and recover from ARDS may develop lung fibrosis.ILD is a group of disorders associated with fibrosis (scarring) of the lungs.

ILD includes IPF  and other lung diseases. The fibrosis that develops after surviving ARDS is severe but is usually not progressive. Because fibrosis in ARDS and chronic ILD may share underlying commonalities, however, there is a possibility that treatment for fibrosis may be beneficial for that associated with COVID 19

The main problem of COVID is post-recovery repercussions you may get all sorts of conditions and problems like fibrosis its’ even more problematic if you are suffering from other chronic lung diseases like asthma. On the occasion of world lung day, I warn that COVID 19 is undisputedly the most serious disease.

We in Outpatient pulmonary clinic are seeing many patients with significant lung fibrosis, months after their acute illness from COVID was declared “cured”, the damage is apparently permanent. We have treated dozens of coronavirus sufferers in the past few weeks, from symptom-free spreaders to intensive care patients on HFNO machine. They have suffered very painful lung damage.

Recovered patients are also at particular risk in swimming. The severe changes in the lungs can significantly increase the risk of accidents. 

In the check-up after several weeks, many patients showed a significant oxygen deficiency during exercise as a typical sign of persistent lung damage. Many of asthmatics with COVID showed more sufferings or breathing difficulty than usual “you have to have regular checks with lung damage like this”.The extent to which long term effects remain on the lungs is unclear and currently speculative, according to many observations across the world. 

We don’t think anybody has the data now, only predictions based on small series from SARS and MERS, it may be similar or different and potentially not limited to the lung parenchyma.

Recently in Chennai and Hyderabad post-COVID patients with pulmonary fibrosis are listed for lung transplantation.

I am sure that pulmonary fibrosis will be a diagnosis spoken a lot in the post COVID world. Chronic lung disease and the costs to our healthcare system and economy go far and beyond the immediate mortality rate.

There is been extensive debate on the persistence of fibrosis after COVID 19 and also the effective medications to manage it, but most of them seem to be experimental therapies

A small study presented at the virtual European respiratory society international congress shows the importance of pulmonary rehabilitation in patients recovering from COVID 19.

The specialized pulmonary rehabilitation centre demonstrates recovery and had normal lung volume and 

The researches observed that the longer a patient waited to begin pulmonary rehabilitation, the less and the slower the patient would recover from COVID 19 infection. These researches tell us the importance of pulmonary rehabilitation post-COVID 19. 

Dr. Prabhu Prasad N.C Heads the department of pulmonology at Manipal Hospitals Goa is responsible for clinical management of post-COVID lung crisis and also heads the Pulmonary Rehabilitation unit.

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