Some patients even 4 weeks after Corona Virus Disease 2019 (COVID-19) remain to be symptomatic and are known as “long-COVID”. In the present study we performed the follow up evaluation at 3 months of long-COVID patients, after treatment with systemic steroids. During the study duration, out of the 4,542 patients managed in the outpatient department of the particular unit, there were 49 patients of Long-COVID. The patients having abnormal computed tomography (CT) alongwith resting hypoxia or exertional desaturation were treated with systemic steroid (deflazacort) in tapering doses for 8-10 weeks. We retrospectively analysed the clinical and radiological findings of these patients at first presentation and at about 3 months of follow up visit. On follow up, all the 49 long-COVID patients showed improvement. The occurrence of breathlessness decreased from 91.83% to 44.89% (p<0.001) and cough from 77.55% to 8.16% (p<0.001). Twenty-four patients were prescribed systemic steroids. Out of these, nearly 58% patients had MMRC grade 4 breathlessness, which decreased to < 2 MMRC in about 86% of these patients. MMRC grade (median) decreased from 3 to 1 (p<0.001). Majority of patients who were tachypnoeic and hypoxic at rest (n=7) showed improvement (71%), post-treatment with corticosteroids. Occurrence of normal chest X-ray increased from 12% to 71% (p<0.001). All these patients had abnormal CT thorax initially, and post-treatment 25% had normal CT thorax. Hence, we conclude that systemic steroids are helpful in hastening recovery of select subset of long-COVID patients. Simultaneously, we should be cautious of immunosuppressive effects of steroids like tuberculosis reactivation, especially in tuberculosis endemic countries. These findings have therapeutic implications and may serve as guidance for future approach to the management of ‘long-COVID’ with pulmonary sequalae.

In the present COVID-19 pandemic situation, there is a gradual increase in number of patients with post-COVID-19 sequalae. The present study is a retrospective analysis of these post-COVID-19 patients presenting to one of the units of Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi in the period from 17 June 2020 to 22 October 2020. We analysed the demographic profile, history, functional assessment and all investigations of this study cohort. Out of the 2,165 patients provided consultation, there were 35 patients of post-COVID-19, which were included in the present study. These patients had a mean duration of 47 days from discharge to first visit to our hospital. Pre-existing respiratory comorbidity was present in 63%. History of hospitalisation was present in 52%. Fatigue (65%) was the most common symptom followed by breathlessness (60%), cough (45.71%) and chest pain (28.57%). Three patients had significant desaturation on 6-minute walk test and one patient had type 2 respiratory failure on presentation. Chest X-ray was abnormal in 34.28% (n=12). On CT thorax (n=17) the most common finding was diffuse reticulations (52.94%) followed by diffuse ground glass opacities (GGOs) (35.29%). One patient each were newly diagnosed as pulmonary tuberculosis and tubercular unilateral hilar lymphadenopathy. Conclusively, post-COVID-19 patients may have remnant symptoms like fatigue, breathlessness and cough. Also, patients with pre-existing respiratory diseases are more symptomatic and even may suffer from deterioration in the clinical course. Further we need to be alert of alternate diagnosis or infections like tuberculosis (TB) in these patients, especially in TB endemic countries like India. Simultaneously, the use of immunosuppressant drugs like steroids for COVID-19 management, predisposes to TB. A proper evaluation with holistic and standardised management plan is the need of the hour for post-COVID-19 patients, until its time course, evolution and manifestations are unravelled.

Unilateral pulmonary artery atresia (UPAA), commonly detected in childhood, can occasionally present in adulthood with typical symptoms of recurrent pulmonary infections, dyspnoea on exertion and hemoptysis. An 18-year-old girl presented with complaints of cough, dyspnea on exertion and hemoptysis. Chest radiograph revealed dilated pulmonary trunk, signs of left sided volume loss and cavitating lesion in left lower zone. Pulmonary CT angiography found left pulmonary artery atresia. Endobronchial lung biopsy revealed granulomatous inflammation. Diagnosis of left sided UPAA with pulmonary tuberculosis was established. She responded well to the anti-tubercular therapy. This case highlights the importance of awareness about UPAA as a possible differential for exertional dyspnea, recurrent chest infections, hemoptysis and pulmonary hypertension in adults.

Background. Many patients suffer from various manifestations even after four weeks of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) positivity and they are labelled as "Long COVID". Guidelines on pharmacological management of these patients are lacking till date.Methods. The present study is a retrospective analysis of "Long COVID" patients presenting to one of the units of Viswanathan Chest Hospital of our Institute between June 2020 and December 2020. All the records of these patients were analysed. Inclusion criteria was no pre-existing pulmonary disease and availability of follow-up visits. Systemic steroids had been given to patients with (a) resting hypoxia or (b) exertional desaturation along with radiological abnormalities, categorised as long COVID-interstitial lung disease (LC-ILD). The patients with breathlessness and wheeze or rhonchi on auscultation were categorised as long COVID-obstructive airway disease (LC-OAD). Inhaled corticosteroid and bronchodilators were given to them.Results. Out of the 3363 patients provided consultation in the OPD, 50 patients were categorised as of long-COVID. Only 10 patients fulfilled the inclusion criteria and were included in the present study. Two patients had hypoxia at rest and three patients with significant desaturation on six-minute walk test (6MWT). On chest radiography, six patients had bilateral lower zone reticulations/nonhomogeneous opacities. High resolution computed tomography confirmed ground-glass opacities (GGOs) in five of them. There were seven patients of LC-ILD, 2 of LC-OAD and 1 of "long COVID cough". LC-ILD patients responded to oral steroid therapy and showed clinical, radiological as well as functional improvement. In these patients both resting hypoxia and exertional desaturation disappeared. Also improvement in 6MWT distance was observed in these patients. Long COVID-OAD patients responded well to inhaled corticosteroids and bronchodilators with symptomatic and functional improvement.Conclusions. Patients of LC-ILD responded well to systemic steroids and LC-OAD to inhaled corticosteroids and bronchodilators. Despite the small number of patients, the present study provides a road-map for the management of "long COVID" pulmonary sequalae till large scale studies are being done.