Corticosteroid Therapy in Post-COVID-19 Pulmonary Fibrosis

Lam, Eric; Sayedy, Najia; Anjum, Fatima; Akella, Jagadish; Iqbal, Javed

doi:10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2429

Cited by 8 publications

(8 citation statements)

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“…The factors associated with the poor prognosis of COVID-19 patients, such as older age, comorbidities, and smoking, align with similar risk factors observed in IPF patients, predominantly affecting male smokers over the age of 60 years with cardiovascular disease [16,17]. Many IPF patients are currently treated with antifibrotic drugs, like nintedanib and pirfenidone, as well as those in the investigational phase (buloxibutid and saracatinib), demonstrating a decrease in the rate of lung function decline [18,19].…”

Section: Pathophysiology Of Post-covid-19 Pulmonary Fibrosismentioning

confidence: 83%

Perspectives on Post-COVID-19 Pulmonary Fibrosis Treatment

Cojocaru,

Pînzariu

et al. 2023

JPM

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Pulmonary fibrosis, a critical outcome of chronic inflammatory diseases, has gained prominence in the context of post-coronavirus (post-COVID-19) complications. This review delves into the multifaceted landscape of post-COVID-19 pulmonary fibrosis, elucidating the intricate molecular mechanisms underlying its pathogenesis and highlighting promising therapeutic avenues. Examining the aftermath of severe acute respiratory syndrome-2 (SARS-CoV-2) infection, the review reveals key signaling pathways implicated in the fibrotic cascade. Drawing parallels with previous coronavirus outbreaks enhances our understanding of the distinctive features of post-COVID-19 fibrosis. Antifibrotic drugs, like pirfenidone and nintedanib, take center stage; their mechanisms of action and potential applications in post-COVID-19 cases are thoroughly explored. Beyond the established treatments, this review investigates emerging therapeutic modalities, including anti-interleukin agents, immunosuppressants, and experimental compounds, like buloxybutide, saracatinib, sirolimus, and resveratrol. Emphasizing the critical importance of early intervention, this review highlights the dynamic nature of post-COVID-19 pulmonary fibrosis research. In conclusion, the synthesis of current knowledge offers a foundation for advancing our approaches to the prevention and treatment of these consequential sequelae of COVID-19.

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Section: Pathophysiology Of Post-covid-19 Pulmonary Fibrosismentioning

confidence: 83%

Perspectives on Post-COVID-19 Pulmonary Fibrosis Treatment

Cojocaru,

Pînzariu

et al. 2023

JPM

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“…При этом соотношение ОФВ 1 /ФЖЕЛ значимо не изменялось, что свидетельствовало о возможном наличии у некоторых пациентов в исходной точке измерения скрытых, преимущественно рестриктивных вентиляционных нарушений, которые нормализовались на фоне приема сГК. Положительное влияние сГК на вентиляционные нарушения у пациентов, перенесших COVID-19, отмечалось и в других исследованиях [20,22], хотя однозначно можно судить о наличии рестриктивных нарушений только после исследования диффузионной способности легких.…”

Section: Discussionunclassified

“…Таким образом, сГК могут улучшить исход постковидного повреждения легких, уменьшая воспаление и фиброзоподобные изменения в них. В подтверждение этой гипотезы серия случаев из трех пациентов после COVID-19 показала, что одномесячный курс лечения преднизолоном привел к значимому клиническому улучшению (снижение потребления кислорода в домашних условиях, улучшение результатов рентгенографии грудной клетки) без серьезных побочных эффектов [13,22]. Более того, сГК являются общепринятой терапией первой линии организующейся пневмонии, которая, как было показано, является преобладаю щим состоянием через 6 нед.…”

Section: Covid-19unclassified

Experience of using systemic glucocorticoids during reconvalescence of patients after a new coronavirus infection of moderate severity

et al. 2023

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Introduction. Part of the reconvalescents after new coronavirus infection (NCI), have residual respiratory structural and functional abnormalities.Aim. To evaluate the efficacy and safety of low-dose systemic glucocorticoids (SSG) in patients with respiratory symptoms and residual “fibrosis-like” changes in lung tissue after a moderately severe NCI with up to 50% lesion volume.Materials and methods. Reconvalescents with moderate NKI who had respiratory symptoms and residual fibrosis-like changes in lung tissue at the time of discharge were randomly divided into two groups: those receiving systemic glucocorticoids (n = 15) and those not (n = 27). Complaint assessment, 6-minute walk test (6-MHT), spirometry, and high-resolution computed tomography (HRT) were performed at baseline, 2, and 9 months later. The primary endpoint of the study was complete disappearance of pathological changes in the lungs according to CTVR. Secondary endpoints of the study were: disappearance of respiratory complaints, increase in the distance traveled in 6-MCG test, regression of functional ventilatory disturbances according to spirometry data.Results and discussion. In both groups by the 9th month of the study there was a significant positive dynamics: respiratory symptoms regressed, tolerance to physical activity improved, residual changes of lung tissue according to CTBPR decreased and in most cases completely disappeared. However, respiratory symptoms and residual changes in lung tissue remained in 9% of cases. Significant improvement of ventilatory lung function and exercise tolerance by the 9th month of follow-up was established in the systemic glucocorticoids group, with no adverse events detected.Conclusions. In the acute phase of moderate NKI, both spontaneous resolution of respiratory symptoms and residual lung tissue changes and their effective and safe resolution due to the use of systemic glucocorticoids can be assumed.

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“…Corticosteroids mitigate inflammatory response in the lungs and are used for the treatment of exacerbations of IPF. A case report of 3 patients with post-COVID-19 pulmonary fibrosis also showed improvement of symptoms and chest X-ray findings after varying durations of steroid treatment [ 43 ]. The use of corticosteroids in this case may have contributed to the patient’s improvement, as she was liberated from HFNC during the early part of the disease at the time steroids were being given.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Function and Chest Computed Tomography (CT) Scan Findings After Antifibrotic Treatment for COVID-19-Related Pulmonary Fibrosis

et al. 2022

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Patient: Female, 51-year-old Final Diagnosis: COVID-19 pneumonia • severe • recovered Symptoms: Cough Medication: — Clinical Procedure: None Specialty: Pulmonology Objective: Unusual setting of medical care Background: Physicians worldwide have been reporting many cases of COVID-19-induced pulmonary fibrosis. We report the case of a 51-year-old Filipino asthmatic woman who developed post-COVID-19 pulmonary fibrosis subsequently treated with Nintedanib. Case Report: The patient presented with a 4-day history of flu-like symptoms in September 2020 and was eventually diagnosed with severe COVID-19 pneumonia. Despite receiving Dexamethasone, Tocilizumab, Remdesivir, and multiple antibiotics, there was increasing oxygen requirement, necessitating ICU admission and high-flow nasal cannula (HFNC). An additional course of hydrocortisone was given due to asthma exacerbation, gradually liberating her from the HFNC. A chest CT scan showed extensive parenchymal changes, for which she received methylprednisolone and physical rehabilitation with persistence of respiratory symptoms. After 40 days of hospitalization, she was sent home on oxygen support and Nintedanib. The patient initially had severe dyspnea (Borg Scale 7) with 6-minute walk distance (6MWD) of 295 meters. Pulmonary function showed moderately severe restrictive lung defect at 52% predicted total lung capacity (TLC) and severely reduced DLCO (28% predicted). Chest CT scoring indicated severe lung involvement. One month after Nintedanib treatment, her Borg Scale improved to 4. Her 6MWD, TLC, and DLCO increased to 434 meters, 64% predicted, and 36% predicted, respectively. A chest CT scan showed regressing fibrosis. After 6 months of treatment, her pulmonary function normalized. DLCO remained moderately reduced (59% predicted) but her 6MWD (457 meters) and CT scan results continued to improve. Conclusions: Nintedanib, along with other interventions, may have potentially improved pulmonary function and CT scan findings in a COVID-19 survivor with pulmonary fibrosis 6 months after treatment.

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Corticosteroid Therapy in Post-COVID-19 Pulmonary Fibrosis

Cited by 8 publications

References 0 publications

Perspectives on Post-COVID-19 Pulmonary Fibrosis Treatment

Perspectives on Post-COVID-19 Pulmonary Fibrosis Treatment

Experience of using systemic glucocorticoids during reconvalescence of patients after a new coronavirus infection of moderate severity

Pulmonary Function and Chest Computed Tomography (CT) Scan Findings After Antifibrotic Treatment for COVID-19-Related Pulmonary Fibrosis

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