Management of COVID-19 from the pulmonologist’s perspective: a narrative review

Kumar, Sanchit; Mehta, Samira K.; Sarangdhar, Nikhil; Goel, Ayush; Sinha, Sanjeev; Wig, Naveet

doi:10.1080/17476348.2021.1853529

Cited by 9 publications

(8 citation statements)

References 65 publications

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“…All of them had severe COVID‐19 illness, with six patients (60%) being admitted in intensive care unit and four (40%) patients in general ward. All of them had received steroids for COVID‐19 illness in variable doses and durations, as per local guidelines 5 . During the present hospitalisation, eight (80%) patients presented with cough as the predominant complaint, shortness of breath was present in five (50%) and haemoptysis was seen in four (40%) of them.…”

Section: Resultsmentioning

confidence: 95%

COVID‐19‐associated subacute invasive pulmonary aspergillosis

Swain

Goel

Sarda

et al. 2021

Mycoses

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Background Though invasive pulmonary aspergillosis is a well known complication of COVID‐19 pneumonia, indolent forms of aspergillosis have been rarely described. Methods We prospectively collected the clinico‐radio‐microbiological data of 10 patients of subacute invasive pulmonary aspergillosis (SAIA), who presented to our hospital with recent history of COVID‐19 pneumonia along with cavitary lung disease, positive IgG (against Aspergillus) with or without positive respiratory samples for Aspergillus spp. Result The mean age of presentation of SAIA was 50.7 ± 11.8 years. All the patients had recently recovered from severe COVID‐19 illness with a mean duration of 29.2 ± 12 days from COVID‐19 positivity. Cough was the predominant symptom seen in 8/10 (80%) patients followed by haemoptysis. 7/10 (70%) patients were known diabetic. While serum galactomannan was positive in 5/9 patients (55.5%), fungal culture was positive in 2/7 patients (28.5%) and polymerase chain reaction (PCR) for Aspergillus was positive in three patients. Eight (80%) patients presented with a single cavitary lesion; pseudoaneurysm of pulmonary artery was seen in two patients and post‐COVID‐19 changes were seen in all patients. All patients were treated with voriconazole, out of which four (40%) patients died during the follow‐up period. Conclusion SAIA should be considered in the differential diagnosis of cavitating lung lesions in patients with recent history of COVID‐19 in the background of steroid use with or without pre‐existing diabetes.

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Section: Resultsmentioning

confidence: 95%

COVID‐19‐associated subacute invasive pulmonary aspergillosis

Swain

Goel

Sarda

et al. 2021

Mycoses

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“…The diverse subjective viewpoints of the public as well as the objective viewpoints of science both need to be taken into account in order to obtain workable solutions for the common good. A careful consideration of the consequences of specific options for specific age groups and medical comorbidities also being required. Specialists from internal medicine like pulmonologists (Kumar et al 2020 28 ), together with radiologists (Huang et al 2020 29 ), showed very early the morphological features of lung affection by the virus. Pulmonology also showed long‐term consequences of COVID‐19 (LongCovid) by means of functional diagnostics and radiology imaging (Greenhalgh et al 2020 30 ).…”

Section: Brief Timeline Of Engagement Of Medical Disciplines and Thei...mentioning

confidence: 99%

Toward a big picture of COVID‐19

Tretter

McIntyre‐Mills

Smith³

2022

Pharmacology Res & Perspec

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The paper aims to illustrate and explain the problems and opportunities for improvement in Covid management that become evident when taking a systems perspective. Critical time delays occurred in the regulation of the pandemic that the management cycle of political cybernetics makes explicit. In general, the executive management of the pandemic in global, regional, and national organizations was unprepared in detecting and responding to the onset of the waves and making appropriate decisions towards differential instead of general lockdowns based on available data. This was further complicated by the mutants of SARS‐CoV2 that perpetuated the high dynamics of the pandemic. In addition, the diversity of medical specialisms, without appropriate big picture thinking, led to an imbalanced response that failed to appreciate the role of virology and epidemiology compared to clinical and public health‐related issues. In consequence, laboratory experts suggested everyday regulations for the citizens without taking into account wider considerations for empirical research. There was an insufficient effort made for proposed treatment studies using existing agents based on the established understanding of essential physiology and the role of local and systemic chronic inflammation. In contrast, driven by media popularization, drugs that later proved beneficial were put in doubt and other drugs that lacked benefit and potentially caused harm were driven to clinical trials and utilization. Person‐centered systems view backed by scientific knowledge and established data would have set better priorities. Finally, we need to take a step back and consider the Corona crisis pandemic in the context of the unidimensional utility‐driven handling of natural ecosystems by the culture of industrialized countries. This ever‐accelerating destruction of life spaces for species drives adaptations are the basis of zoonoses. There is strong evidence that future pandemics should be faced with a more systemic socio‐ecological conceptual framework that also reflects the fatal impact of human civilization on natural ecosystems, no matter if SARS CoV2 is a zoonosis or a laboratory accident. It is critical for the future of our species that we collectively learn from this experience, address limitations in our perspectives, enhance our system‐based science and bolster global, regional, and national crisis management. The impact of climate change and biodiversity loss has crossed the horizon and is now clearly in full sight.

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“…COVID-19 is caused by the SARS-CoV-2 virus, and respiratory system is the most commonly involved organ system in COVID-19. 1 The respiratory manifestations of COVID-19 range from mild upper respiratory symptoms to life-threatening severe acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilatory support. CT of the chest shows typically bilateral ground-glass opacities predominantly in the lower lobes, mainly in a peripheral and subpleural location.…”

Section: Introductionmentioning

confidence: 99%

Platypnoea–orthodeoxia syndrome in COVID-19

Singh

Goel

et al. 2021

BMJ Case Rep

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Platypnoea–orthodeoxia syndrome (POS) is a rare entity characterised by respiratory distress and/or hypoxia developing in the sitting/upright posture, which is relieved in the supine posture. It is caused by cardiac, pulmonary and non-cardiopulmonary diseases. COVID-19 can have varying respiratory manifestations including acute respiratory distress syndrome (ARDS) and sequelae-like pulmonary fibrosis. POS has been rarely reported in patients with COVID-19. Here we report a case of POS in a patient recovering from severe COVID-19 ARDS. As he was gradually mobilised after his improvement, he had worsening dyspnoea in the sitting position with significant relief on assuming a supine posture. He was diagnosed with POS after ruling out other causes of POS. He was treated with oxygen support in upright posture and chest physiotherapy was continued, to which he showed improvement. POS is a rare manifestation of COVID-19 which needs awareness as it can be diagnosed easily and can respond to continued supportive care.

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Management of COVID-19 from the pulmonologist’s perspective: a narrative review

Cited by 9 publications

References 65 publications

COVID‐19‐associated subacute invasive pulmonary aspergillosis

COVID‐19‐associated subacute invasive pulmonary aspergillosis

Toward a big picture of COVID‐19

Platypnoea–orthodeoxia syndrome in COVID-19

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