4.6 Review

Lung Fibrosis after COVID-19: Treatment Prospects

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Healing after COVID-19: are survivors at risk for pulmonary fibrosis?

Lindsay T. McDonald

Summary: The novel SARS-CoV-2 coronavirus, responsible for COVID-19, was first reported in Wuhan, China, in December 2019, and the World Health Organization declared a pandemic by March 2020. Concerns have been raised about potential long-term effects of COVID-19 on respiratory health, but with limited data available, predictions on long-term outcomes remain speculative. Improved recognition of potential risk factors for fibrotic disease through studying previous coronavirus outbreaks is crucial in understanding the potential long-term implications of COVID-19.

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Summary: The study found that inflammation and vascular injury persisted in COVID-19 patients 3 months after discharge, and were closely correlated with abnormal clinical features, especially in severe patients. Immune cell levels had returned to normal levels and were not significantly correlated with abnormal clinical features.

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3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study

Xiaojun Wu et al.

Summary: Most patients recovering from severe COVID-19 showed improvement in dyspnoea scores and exercise capacity over time, but a subgroup of patients still exhibited persistent physiological and radiographic changes at 12 months post-discharge. A unified pathway for respiratory follow-up is needed for COVID-19 patients.

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Deependra K. Rai et al.

Summary: Lung fibrosis is a common lung issue faced by post-COVID patients, especially those who were severe cases requiring ICU stay and mechanical ventilation. There is currently no definitive therapy for managing pulmonary fibrosis, but various options are under exploration. This case series discusses three cases of post-COVID lung fibrosis and reviews the existing literature on the topic.

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Pulmonary fibrosis and its related factors in discharged patients with new corona virus pneumonia: a cohort study

Xiaohe Li et al.

Summary: Older age, higher BMI, severe/critical condition, fever, longer viral clearance time, pre-existing disease, and delayed hospitalization were identified as risk factors for developing persistent pulmonary fibrosis in COVID-19 patients. About one-third of fibrotic patients could reverse their condition after around 120 days from onset, and less than half of the patients had their lung function return to normal condition after three months from onset. An effective predictive model with an average AUC of 0.84 was established for early diagnosis of the persistence of pulmonary fibrosis in COVID-19 patients.

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Post-COVID-19 pneumonia lung fibrosis: a worrisome sequelae in surviving patients

Rasha Mostafa Mohamed Ali et al.

Summary: This study aimed to identify potential cases of post-COVID-19 pulmonary fibrosis early in order to prevent or modify such disabling complications, with factors like old age, cigarette smoking, high CT severity score, and long-term mechanical ventilation being potential predictors of lung fibrosis.

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Katherine Jane Myall et al.

Summary: Following SARS-CoV-2 infection, some patients develop persistent radiological inflammatory lung disease and functional deficits. Early treatment with corticosteroids is well tolerated and associated with rapid and significant improvement.

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Post COVID-19 fibrosis, an emerging complication of SARS-CoV-2 infection

Mousa Ahmad Alhiyari et al.

Summary: SARS-COV-2 has led to a massive pandemic, with pulmonary fibrosis being one of the sequelae of COVID-19. Accurate data on the prevalence of post-COVID-19 pulmonary fibrosis is lacking.

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Fibrotic interstitial lung disease occurring as sequelae of COVID-19 pneumonia despite concomitant steroids

Zarir Farokh Udwadia et al.

Summary: A 75-year-old female developed severe pulmonary fibrosis within 1 month of acute severe COVID-19 pneumonia despite being on steroids during most of her hospital stay. The effectiveness of antifibrotic drugs in this case is still uncertain and will require large clinical trials for confirmation.

LUNG INDIA (2021)

Review Respiratory System

Post-COVID lung fibrosis: The tsunami that will follow the earthquake

Zarir F. Udwadia et al.

Summary: This article discusses potential pulmonary sequelae post-COVID-19, which may progress to serious conditions such as PC-ILD. It also introduces clinical, laboratory, and radiographic clues at presentation that could help predict future lung fibrosis development. Responsible use of antifibrotic drugs is discussed, along with the biological rationale and potential roles in specific patient groups.

LUNG INDIA (2021)

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Severe organising pneumonia following COVID-19

Istvan Vadasz et al.

Summary: Various forms of diffuse parenchymal lung disease have been proposed as potential consequences of severe COVID-19, including severe organising pneumonia. Understanding these implications may help improve therapeutic modalities in the late-phase of severe COVID-19, and shed light on why a subgroup of patients benefit from systemic corticosteroids.

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Restrictive Lung Disease in Patients With Subclinical Coronavirus Infection: Are We Bracing Ourselves for Devastating Sequelae?

Rahul Dadhwal et al.

Summary: Patients with mild or asymptomatic COVID-19 infection may develop interstitial lung disease four to eight weeks after diagnosis, highlighting the importance of routine follow-up for both symptomatic and subclinical cases.

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Commonalities Between COVID-19 and Radiation Injury

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Wenqiang Su et al.

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Clinical Characteristics of Coronavirus Disease 2019 in China

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Victor J. Costela-Ruiz et al.

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Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis

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Rapid onset honeycombing fibrosis in spontaneously breathing patient with COVID-19

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c-Jun N-terminal kinase (JNK)-mediated induction of mSin1 expression and mTORC2 activation in mesenchymal cells during fibrosis

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Increased Expression of Epidermal Growth Factor Receptor (EGF-R) in Patients with Different Forms of Lung Fibrosis

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