Persistent post-COVID-19 interstitial lung disease: an observational study of corticosteroid treatment
File(s)Persistent Post–COVID-19 Interstitial.pdf (963.97 KB)
Published version
Author(s)
Myall, Katherine Jane
Mukherjee, Bhashkar
Castanheira, Ana Margarida
Lam, Jodie L
Benedetti, Giulia
Type
Journal Article
Abstract
RATIONALE: The natural history of recovery from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) remains unknown. Since fibrosis with persistent physiological deficit is a previously-described feature of patients recovering from similar coronaviruses, treatment represents an early opportunity to modify the disease course, potentially preventing irreversible impairment. OBJECTIVES: Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease (ILD) following SARS-CoV2 when treated with prednisolone. METHODS: A structured assessment protocol screened for sequelae of SARS-CoV2 pneumonitis. 837 patients were assessed by telephone four weeks after discharge. Those with ongoing symptoms had outpatient assessment at six weeks. Thirty patients diagnosed with persistent interstitial lung changes at multi-disciplinary team meeting were reviewed in the interstitial lung disease service and offered treatment. These patients had persistent, non-improving symptoms. RESULTS: At four weeks post-discharge, 39% of patients reported ongoing symptoms (325/837), and were assessed. Interstitial lung disease, predominantly organising pneumonia, with significant functional deficit was observed in 35/837 survivors (4.8%). Thirty of these patients received steroid treatment, resulting in a mean relative increase in transfer factor following treatment of 31.6% (standard deviation ± 27.64, p <0.001), and FVC of 9.6% (standard deviation ± 13.01, p = 0.014), with significant symptomatic and radiological improvement. CONCLUSION: Following SARS-CoV-2 pneumonitis, a cohort of patients are left with both radiological inflammatory lung disease and persistent physiological and functional deficit. Early treatment with corticosteroids was well tolerated and associated with rapid and significant improvement. This preliminary data should inform further study into the natural history and potential treatment for patients with persistent inflammatory ILD following SARS-CoV2 infection.
Date Issued
2021-05-01
Date Acceptance
2020-11-07
Citation
Annals of the American Thoracic Society, 2021, 18 (5), pp.799-806
ISSN
2329-6933
Publisher
American Thoracic Society
Start Page
799
End Page
806
Journal / Book Title
Annals of the American Thoracic Society
Volume
18
Issue
5
Copyright Statement
© 2021 by the American Thoracic Society. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/). For commercial usage and reprints please contact Diane Gern (dgern@thoracic.org)
Sponsor
Action for Pulmonary Fibrosis
Identifier
https://www.atsjournals.org/doi/10.1513/AnnalsATS.202008-1002OC
Grant Number
n/a
Subjects
COVID-19
fibrosis
interstitial lung disease
organizing pneumonia
Respiratory System
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2021-01-12