ISSN : 2146-3123
E-ISSN : 2146-3131

Post-COVID Interstitial Lung Disease: How do We Deal with This New Entity?
Aycan Yüksel1, Dilek Karadoğan2, Nur Hürsoy3, Tahsin Gökhan Telatar4, Neslihan Köse Kabil5, Feride Marım6, İlknur Kaya6, Aslıhan Banu Er7, Merve Erçelik8, Demet Polat Yuluğ9, Merve Yumrukuz Şenel10, Ceren İlgar11, Ökkeş Gültekin12, Selin Çakmakcı Karakaya13, Bilge Yılmaz Kara2, Neslihan Özçelik2, İnci Selimoğlu2, Kübra Uyar Er2, Abdurrahman Kotan2, Hasan Veysel Keskin2, Metin Akgün14
1Department of Respiratory Medicine, Başkent University Faculty of Medicine, Ankara, Türkiye
2Department of Respiratory Medicine, Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Türkiye
3Department of Radiology, Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Türkiye
4Department of Public Health, Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Türkiye
5Department of Respiratory Medicine, Yalova Training and Research Hospital, Yalova, Türkiye
6Department of Respiratory Medicine, Kütahya Health Sciences University Faculty of Medicine, Kütahya, Türkiye
7Department of Respiratory Medicine, Uşak University Faculty of Medicine, Uşak, Türkiye
8Department of Respiratory Medicine, Süleyman Demirel University Faculty of Medicine, Isparta, Türkiye
9Department of Respiratory Medicine, Mersin City Hospital, Mersin, Türkiye
10Department of Respiratory Medicine, Balıkesir University Faculty of Medicine, Balıkesir, Türkiye
11Department of Respiratory Medicine, Ufuk University Faculty of Medicine, Ankara, Türkiye
12Department of Respiratory Medicine, Oltu State Hospital, Erzurum, Türkiye
13Subdivision of Work and Occupational Diseases, Hacettepe University Faculty of Medicine, Ankara Türkiye
14Department of Respiratory Medicine, Ağrı İbrahim Çeçen University Faculty of Medicine, Ağrı, Türkiye
DOI : 10.4274/balkanmedj.galenos.2024.2024-3-82
Pages : 377-386

Abstract

Background: In the postacute phase of coronavirus disease-2019 (COVID-19), survivors may have persistent symptoms, lung function abnormalities, and sequelae lesions on thoracic computed tomography (CT). This new entity has been defined as post-COVID interstitial lung disease (ILD) or residual disease.
Aims: To evaluate the characteristics, risk factors and clinical significance of post-COVID ILD.
Study Design: Multicenter cross-sectional analysis of data from a randomized clinical study.
Methods: In this study, patients with persistent respiratory symptoms 3 months after recovery from COVID-19 were evaluated by two pulmonologists and a radiologist. post-COVID ILD was defined as the presence of respiratory symptoms, hypoxemia, restrictive defect on lung function tests, and interstitial changes on follow-up high-resolution computed tomography (HRCT).
Results: At the three-month follow-up, 375 patients with post-COVID-19 syndrome were evaluated, and 262 patients were found to have post-COVID ILD. The most prevalent complaints were dyspnea (n = 238, 90.8%), exercise intolerance (n = 166, 63.4%), fatigue (n = 142, 54.2%), and cough (n = 136, 52%). The mean Medical Research Council dyspnea score was 2.1 ± 0.9, oxygen saturation was 92.2 ± 5.9%, and 6-minute walking distance was 360 ± 140 meters. The mean diffusing capacity of the lung for carbon monoxide was 58 ± 21, and the forced vital capacity was 70% ± 19%. Ground glass opacities and fibrotic bands were the most common findings on thoracic HRCT. Fibrosis-like lesions such as interlobular septal thickening and traction bronchiectasis were observed in 38.3% and 27.9% of the patients, respectively. No honeycomb cysts were observed. Active smoking [odds ratio (OR), 1.96; 95% confidence interval (CI), 1.44-2.67), intensive care unit admission during the acute phase (OR, 1.46; 95% CI, 1.1-1.95), need for high-flow nasal oxygen (OR, 1.55; 95% CI, 1.42-1.9) or non-invasive ventilation (OR, 1.31; 95% CI, 0.8-2.07), and elevated serum lactate dehydrogenase levels (OR, 1.23; 95% CI 1.18-1.28) were associated with the development of post-COVID ILD. At the 6-month follow-up, the respiratory symptoms and pulmonary functions had improved spontaneously without any specific treatment in 35 patients (13.4%). The radiological interstitial lesions had spontaneously regressed in 54 patients (20.6%).
Conclusion: The co-existence of respiratory symptoms, radiological parenchymal lesions, and pulmonary functional abnormalities which suggest a restrictive ventilatory defect should be defined as post-COVID-19 ILD. However, the term “fibrosis” should be used carefully. Active smoking, severe COVID-19, and elevated lactate dehydrogenase level are the main risk factors of this condition. These post-COVID functional and radiological changes could disappear over time in 20% of the patients.

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