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Persistent Post–COVID-19 Inflammatory Interstitial Lung Disease
TAKE-HOME MESSAGE
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In this study, the authors conducted a structured telephone assessment of 837 patients 4 weeks after hospital discharge from treatment for COVID-19 and identified 325 patients with ongoing symptoms, and found ongoing interstitial lung disease (such as organizing pneumonia) with significant functional impairment in 35 patients. Of these, 30 patients were treated with prednisolone, which was associated with significant improvements in both DLCO and FVC, as well as symptomatic and radiographic improvement.
- These results suggest that corticosteroids may be beneficial in patients with sustained inflammatory interstitial lung disease following acute infection with COVID-19. The findings are limited due to the low number of patients as well as study design, so further research is warranted to determine the optimal role for steroids in this patient population.
abstract
This abstract is available on the publisher's site.
Access this abstract nowRATIONALE
The natural history of recovery from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) remains unknown. Since fibrosis with persistent physiological deficit is a previously-described feature of patients recovering from similar coronaviruses, treatment represents an early opportunity to modify the disease course, potentially preventing irreversible impairment.
OBJECTIVES
Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease (ILD) following SARS-CoV2 when treated with prednisolone.
METHODS
A structured assessment protocol screened for sequelae of SARS-CoV2 pneumonitis. 837 patients were assessed by telephone four weeks after discharge. Those with ongoing symptoms had outpatient assessment at six weeks. Thirty patients diagnosed with persistent interstitial lung changes at multi-disciplinary team meeting were reviewed in the interstitial lung disease service and offered treatment. These patients had persistent, non-improving symptoms.
RESULTS
At four weeks post-discharge, 39% of patients reported ongoing symptoms (325/837), and were assessed. Interstitial lung disease, predominantly organising pneumonia, with significant functional deficit was observed in 35/837 survivors (4.8%). Thirty of these patients received steroid treatment, resulting in a mean relative increase in transfer factor following treatment of 31.6% (standard deviation ± 27.64, p <0.001), and FVC of 9.6% (standard deviation ± 13.01, p = 0.014), with significant symptomatic and radiological improvement.
CONCLUSION
Following SARS-CoV-2 pneumonitis, a cohort of patients are left with both radiological inflammatory lung disease and persistent physiological and functional deficit. Early treatment with corticosteroids was well tolerated and associated with rapid and significant improvement. This preliminary data should inform further study into the natural history and potential treatment for patients with persistent inflammatory ILD following SARS-CoV2 infection.
Additional Info
Disclosure statements are available on the authors' profiles:
Persistent Post-COVID-19 Inflammatory Interstitial Lung Disease: An Observational Study of Corticosteroid Treatment
Ann Am Thorac Soc 2021 Jan 12;[EPub Ahead of Print], KJ Myall, B Mukherjee, AM Castanheira, JL Lam, G Benedetti, SM Mak, R Preston, M Thillai, A Dewar, PL Molyneaux, AG WestFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Respiratory Medicine
As the number of cases rises through the pandemic; a pivotal question is how to reduce and treat the long-term morbidity of COVID-19 survivors. The natural history of pulmonary infiltrates after COVID-19 recovery and whether treatment with corticosteroids is beneficial requires further inquiry.
Myall and colleagues address these questions by studying the incidence and response to steroid therapy of persistent inflammatory interstitial lung disease (ILD) after SARS-CoV-2 infection. This was a prospective observational study from a large academic hospital in the UK. They screened all adult COVID-19 patients discharged over a 3-month period (N = 837). The patients were contacted 4 weeks after discharge and invited to undergo evaluation if they had persistent symptoms. All patients with physiologic impairment or abnormal imaging underwent a CT scan, which was reviewed by a multidisciplinary team (MDT). The diagnosis of post–COVID-19 inflammatory ILD was based on MDT consensus of the radiologic pattern. The final cohort was composed of 59 patients. The majority of them were considered to have organizing pneumonia (35/59) and were offered therapy with corticosteroids. A total of 30 patients completed treatment, with an average dose of 26.6 mg of prednisolone tapered over 3 weeks without significant side effects. The treated patients were predominantly male (72%), overweight (BMI, 28.3 ± 4), and had persistently elevated inflammatory markers (CRP, ferritin, D-dimer). All of them reported improvement of their dyspnea and functional capacity. This was also associated with pulmonary function tests and radiologic improvement. Due to this study's observational nature, we don’t know how much improvement would have occurred with expectant management. Another limitation is generalizability to smaller centers that don’t have MDT availability to review cases. This study supports a potential role for corticosteroids in a small subset of COVID-19 survivors; however, randomized controlled trials are needed to confirm these results.