Pulmonary Fibrosis in COVID-19 Recovered Patients: Problem and Potential Management

Kayarat, Bhavana; Khanna, Puneet; Sarkar, Soumya

doi:10.5005/jp-journals-10071-23733

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…Furthermore, the tailored timing of pirfenidone administration reflects the efficacy in the prevention of pulmonary fibrosis; on the other hand, due to its antifibrotic properties, pirfenidone would cure persistent pulmonary fibrotic changes ( Seifirad. 2020 ; Kayarat et al, 2021 ). Not all expectations were fulfilled until now.…”

Section: Methodsmentioning

confidence: 99%

Pharmacological approaches to pulmonary fibrosis following COVID-19

et al. 2023

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Background: In the past few years, COVID-19 became the leading cause of morbidity and mortality worldwide. Although the World Health Organization has declared an end to COVID-19 as a public health emergency, it can be expected, that the emerging new cases at the top of previous ones will result in an increasing number of patients with post-COVID-19 sequelae. Despite the fact that the majority of patients recover, severe acute lung tissue injury can in susceptible individuals progress to interstitial pulmonary involvement. Our goal is to provide an overview of various aspects associated with the Post-COVID-19 pulmonary fibrosis with a focus on its potential pharmacological treatment options.Areas covered: We discuss epidemiology, underlying pathobiological mechanisms, and possible risk and predictive factors that were found to be associated with the development of fibrotic lung tissue remodelling. Several pharmacotherapeutic approaches are currently being applied and include anti-fibrotic drugs, prolonged use or pulses of systemic corticosteroids and non-steroidal anti-inflammatory and immunosuppressive drugs. In addition, several repurposed or novel compounds are being investigated. Fortunately, clinical trials focused on pharmacological treatment regimens for post-COVID-19 pulmonary fibrosis have been either designed, completed or are already in progress. However, the results are contrasting so far. High quality randomised clinical trials are urgently needed with respect to the heterogeneity of disease behaviour, patient characteristics and treatable traits.Conclusion: The Post-COVID-19 pulmonary fibrosis contributes to the burden of chronic respiratory consequences among survivors. Currently available pharmacotherapeutic approaches mostly comprise repurposed drugs with a proven efficacy and safety profile, namely, corticosteroids, immunosuppressants and antifibrotics. The role of nintedanib and pirfenidone is promising in this area. However, we still need to verify conditions under which the potential to prevent, slow or stop progression of lung damage will be fulfilled.

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Section: Methodsmentioning

confidence: 99%

Pharmacological approaches to pulmonary fibrosis following COVID-19

et al. 2023

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“…Therefore, timing administration of PFN reflects its efficacy in the prevention of pulmonary fibrosis; however, PFN can cure residual pulmonary fibrotic changes in recovered Covid-19 patients with severe SARS-CoV-2 pneumonia (Seifirad 2020 ). Thus, PFN has potential therapeutic effects against Covid-19 both in the early hyperinflammatory phase through inhibition of pro-inflammatory cytokines, and in the late phase through anti-fibrotic mechanism since it is effective for post-inflammatory pulmonary fibrosis (Kayarat et al 2021 ).…”

Section: Role Of Pirfenidone In Post-covid-19 Pulmonary Fibrosismentioning

confidence: 99%

Pirfenidone and post-Covid-19 pulmonary fibrosis: invoked again for realistic goals

Al-Kuraishy¹,

Batiha

Faidah

et al. 2022

Inflammopharmacol

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Pirfenidone (PFN) is an anti-fibrotic drug with significant anti-inflammatory property used for treatment of fibrotic conditions such as idiopathic pulmonary fibrosis (IPF). In the coronavirus disease 2019 (Covid-19) era, severe acute respiratory syndrome 2 (SARS-CoV-2) could initially lead to acute lung injury (ALI) and in severe cases may cause acute respiratory distress syndrome (ARDS) which is usually resolved with normal lung function. However, some cases of ALI and ARDS are progressed to the more severe critical stage of pulmonary fibrosis commonly named post-Covid-19 pulmonary fibrosis which needs an urgent address and proper management. Therefore, the objective of the present study was to highlight the potential role of PFN in the management of post-Covid-19 pulmonary fibrosis. The precise mechanism of post-Covid-19 pulmonary fibrosis is related to the activation of transforming growth factor beta (TGF-β1), which activates the release of extracellular proteins, fibroblast proliferation, fibroblast migration and myofibroblast conversion. PFN inhibits accumulation and recruitment of inflammatory cells, fibroblast proliferation, deposition of extracellular matrix in response to TGFβ1 and other pro-inflammatory cytokines. In addition, PFN suppresses furin (TGFβ1 convertase activator) a protein effector involved in the entry of SARS-CoV-2 and activation of TGFβ1, and thus PFN reduces the pathogenesis of SARS-CoV-2. Besides, PFN modulates signaling pathways such as Wingless/Int (Wnt/β-catenin), Yes-Associated Protein (YAP)/Transcription Co-Activator PDZ Binding Motif (TAZ) and Hippo Signaling Pathways that are involved in the pathogenesis of post-Covid-19 pulmonary fibrosis. In conclusion, the anti-inflammatory and anti-fibrotic properties of PFN may attenuate post-Covid-19 pulmonary fibrosis.

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“…Due to the influence of various factors like environment, genetics, and lifestyle, the prevalence of PF continues to rise annually. Consequently, there is an urgent need to identify effective therapeutic solutions ( Bhavana et al, 2021 ). While MMDD has been widely employed in PF treatment, its precise mechanism remains unclear.…”

Section: Introductionmentioning

confidence: 99%

A Chinese classical prescription Maimendong decoction in treatment of pulmonary fibrosis: an overview

Lao,

Wang,

Zhu

et al. 2024

Front. Pharmacol.

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Pulmonary fibrosis (PF) is a chronic and progressive disease characterized by fibrosis and interstitial pneumonia. It has similar clinical symptoms to “Fei Bi” and “Fei Wei” as described in the traditional Chinese medicine (TCM) classic Jingui Yaolue written by Zhang Zhongjing in the Han Dynasty. This study explored the potential of Maimendong Decoction (MMDD). MMDD consists of Ophiopogon japonicus (L.f) (ophiopogonis), Pinellia ternata (Thunb.) Breit. (pinellia), Panax ginseng C. A. Mey. (ginseng), Glycyrrhiza uralensis Fisch. (glycyrrhiza), Zizi phus jujuba Mill. (jujuba), and Oryza sativa L. (oryza sativa), with the function of nourishing the lung and stomach, and reducing the effect of reverse qi. It has been used clinically for over two thousand years to treat conditions like “Fei Bi” and “Fei Wei”. Previous research suggests that MMDD and its individual herbal extracts have anti-fibrotic effects. The main focus of MMDD in treating PF is to reduce inflammatory cytokines, inhibit pro-fibrotic factors and oxidative stress, promote differentiation and homing of bone marrow mesenchymal stem cells, and enhance cell autophagy activity. This review summarized the clinical applications, mechanisms, and pharmacological effects of MMDD in treating PF based on existing clinical applications and experimental research. It also discussed current issues and prospects, aiming to provide a reference for further research on the mechanism of PF, drug development, and clinical trials.

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Pulmonary Fibrosis in COVID-19 Recovered Patients: Problem and Potential Management

Abstract: How to cite this article: B, Khanna P, Sarkar S. Pulmonary Fibrosis in COVID-19 Recovered Patients: Problem and Potential Management. Indian J Crit Care Med 2021;25(2):242–244.

Cited by 6 publications

References 15 publications

Pharmacological approaches to pulmonary fibrosis following COVID-19

Pharmacological approaches to pulmonary fibrosis following COVID-19

Pirfenidone and post-Covid-19 pulmonary fibrosis: invoked again for realistic goals

A Chinese classical prescription Maimendong decoction in treatment of pulmonary fibrosis: an overview

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