Unraveling the complexity of the ‘prolonged novel coronavirus’ and its impact on breathing

In a recent article published in lancet, researchers focused on pulmonary and extrapulmonary sequelae to explain the heterogeneous nature of long-term coronavirus infection (Long-COVID).they investigated pre-existing respiratory diseases [e.g., lung fibrosis, asthma, and chronic obstructive pulmonary disease (COPD)] These may exacerbate or influence the outcome of the pulmonary sequelae of COVID-19. We also discussed clinical care, rehabilitation, and non-pharmacological strategies for people suffering from post-COVID-19 dyspnea, a form of sustainable and disabling shortness of breath.

study: Respiratory sequelae of novel coronavirus disease (COVID-19): pulmonary and extrapulmonary causes and approaches to clinical care and rehabilitation. Image credit: Lightspring / Shutterstock

Background

Acute sequelae (PASC) of novel coronavirus 2019 (COVID-19) systematically affect multiple organs, especially people with chronic lung diseases such as thromboembolism.

Previous studies have reported respiratory deterioration during PASC due to destabilization of pre-existing symptoms and COVID-19-related effects, independent of acute illness severity. However, the precise mechanisms controlling these changes are still unclear.

Several published studies have also used large datasets to describe the spectrum of respiratory symptoms that compose PASC, e.g., irregular breathing, hyperventilation, and persistent cough. Mechanisms such as viral persistence, autoimmunity, interferon (IFN) I and III, and systemic inflammation such as interleukin-6 activation probably contribute to respiratory deterioration during PASC. .

By March 2023, global COVID-19 deaths had fallen from 101,600 to 6,500 per week. It also significantly reduced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related hospitalizations. The researchers attribute this improvement in part to increased availability of treatments such as vaccines and IL-6 therapy. However, for studies focused on the post-COVID-19 situation, it remains important to understand the long-term effects of COVID-19 on the respiratory system.

About research

To this end, in this study, researchers used keywords such as respiratory insufficiency, fibrosis after COVID-19, fibrosis, and rehabilitation, to name a few. We searched extensively databases such as PubMed and CINAHL.

Regarding the post-COVID-19 situation, they found that the most common symptoms were independent of acute illness severity. For example, the precise underlying symptoms of acute lung injury, which is the predominant symptom in critically ill acute COVID-19 patients requiring mechanical ventilation, in contrast to any post-COVID-19 sequelae. Appropriate assessment and targeted interventions are needed to understand the underlying mechanisms.

The team found that a meta-analysis of 54 studies and two medical records discussed respiratory symptoms as an important cluster alongside fatigue and cognitive problems after prolonged COVID-19. bottom. In contrast, another study found a positive correlation between symptom burden and its severity when all symptoms were combined.

Extrapulmonary and pulmonary sequelae of COVID-19

In this study, researchers discussed the incidence and mechanisms of pulmonary fibrosis, pulmonary embolism, and microvascular thrombosis (COPD)., Reduced exercise tolerance and frailty after COVID-19. In addition, they highlight studies that discuss all these hallmarks of COVID-19 over time, and that they contribute to shortness of breath and impaired breathing patterns, requiring caution in designing treatment and rehabilitation strategies. It drew attention to the fact that

It is worth noting here that conventional measures of lung function do not consistently predict shortness of breath. This is a complex condition that, when caused pathologically, does not always improve after treatment with bronchodilators. Therefore, therapeutic approaches for shortness of breath should be guided by extensive assessment, including routine spirometry.

In the largest cohort study of 1,733 people who had recovered from COVID-19 and were discharged from hospital, pulmonary function tests were performed on 349 participants 6 months after discharge. It was intended for adults with clinical manifestations of lung disease. In addition, a dyspnea profile questionnaire investigating multidimensional components of breathlessness should also be covered. Clinicians should also consider more complex tests such as cardiopulmonary exercise testing and magnetic resonance imaging (MRI) when shortness-related diagnoses are uncertain.

In the post-COVID-19 situation, cardiopulmonary exercise testing confirmed respiratory insufficiency and irregular breathing patterns, despite the absence of respiratory limitation and oxygen supply disruption, and people with persistent shortness of breath recovered completely. It has been reported that peak oxygen uptake is lower compared to humans. After the new coronavirus infection.

In a small cohort study, about 20% of people hospitalized with acute COVID-19 had altered breathing patterns, and those who were not hospitalized were referred to specialized follow-up clinics. They attributed the abnormal breathing pattern to changes in lung function and the effects of sedation and mechanical ventilation on the respiratory center.

The Nijmegen questionnaire specifically accessed hyperventilation syndrome and the breathing pattern assessment tool (BPAT) accessed all breathing pattern disorders with high sensitivity and specificity.

Similarly, similarities in mechanisms between COVID-19-associated pneumonia and idiopathic pulmonary fibrosis (IPF) raise the possibility of a potential global burden of long-term fibrosis following COVID-19. ing.

At present, rehabilitation programs for people with post-COVID-19 symptoms are very diverse, but should cover aerobic and strength exercises and spread awareness of symptom management. A recent systematic review showed improvements in dyspnea, physical function and QoL. However, patients should be selected by symptom profile, and further research should focus on high-quality evidence, especially for those who have not been hospitalized with COVID-19.

Studies evaluating the efficacy of non-pharmacological interventions are ongoing. However, respiratory and rehabilitation specialists should be the core of an integrated, multidisciplinary team that provides support to patients with post-COVID-19 symptoms. Most importantly, these teams ensure culturally appropriate and equitable access to the diverse populations affected, using treatment and rehabilitation strategies tailored to each patient’s symptom profile and specific needs. is what you need to provide to

Conclusion

Like any other serious illness, severe COVID-19 leaves patients with long-term morbidity and impacts quality of life (QoL) and physical and mental health. give. As we all know, symptoms like brain fog and cognitive impairment are common in long-term COVID-19 patients. These symptoms may be related to the disease, its treatment, or both. In particular, physicians perform such care in the intensive care unit (ICU) to complement life-sustaining care.

In the future, research should aim to characterize in detail the long-term complications of the pulmonary and extrapulmonary sequelae of COVID-19, for example, the mechanisms that cause injury. Additionally, these studies are needed to determine the optimal diagnostic and management approaches for this debilitating condition to improve outcomes in this population.

Other future research priorities include:

i) Identification of mechanisms governing asthma reduction and control of COPD after COVID-19

ii) extrapulmonary complications that cause or exacerbate shortness of breath after COVID-19;

iii) Diagnostic tools for detecting pulmonary vascular disease after COVID-19

iv) Strategies to prevent, reduce and treat pulmonary fibrosis

v) Mechanisms leading to symptoms of shortness of breath after COVID-19 and rehabilitation or respiratory exercises that effectively alleviate it.