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Lung damage may persist long after COVID-19 pneumonia clears

Reuters Health - 04/04/2022 - CT scans show that people who have recovered from COVID-19 pneumonia often have lingering damage to their lungs even a full year later, according to a new study. 

"COVID-19 pneumonia causes marked inflammatory lung changes, most of which diminish and completely resolve after a year, although residual findings remain in half of the patients," said Dr. Christoph Schwabl of Innsbruck Medical University in Innsbruck, Austria, who worked on the study. 

"Lung changes that were still present half a year after the disease remained constant in more than 60% of the participants even after one year, so we assume they may represent permanent lung damage," Dr. Schwabl told Reuters Health by email. "Age over 60, male gender and severe course are risk factors for persisting lung changes. Long-term follow-up, both clinical and radiological, is necessary to learn more about the course and clinical role of persisting SARS-CoV-2 related lung changes." 

To explore whether COVID-19-related lung damage reversed or continued long term, Dr. Schwabl and his colleagues turned to data from the CovILD study, which was designed to evaluate pulmonary recovery after the first wave of the pandemic. 

CovILD is a prospective, multicenter, observational cohort study conducted from April 29, 2020 to August 12, 2020, with follow-up visits scheduled at two months, three months, six months and a year after the initial COVID-19 symptoms. Included in that study were 142 patients aged 18 and older with mild to severe COVID-19 who were consecutively screened at four Austrian medical centers. 

For the new study, published in Radiology, the researchers focused on the 91 CovILD patients who had one-year CT scans; their mean age was 59 and 35 were female. Twenty-one percent had mild disease and received outpatient treatment, while 25% with moderate disease were hospitalized without respiratory support, another 25% with severe disease were hospitalized and given oxygen and 29% were deemed to be critical and were treated in the intensive-care unit. 

At twelve months, 54% of the patients had pulmonary CT abnormalities, with the predominant ones being ground-glass opacities (GGO) and subpleural reticulations. In 34% of patients, both abnormalities were found. 

In four of the patients, subpleural curvilinear lines were found, and bronchial dilation were present in nine. The pure GGO and/or reticulations found in 49 patients at first follow-up resolved entirely in 39% of patients after a year as opposed to the consolidation or bronchial dilation or organizing pneumonia (OP) pattern found in 19 patients at two months, which were still found on CT after 12 months. 

Multivariable analysis revealed male gender (odds ratio, 8.9), age greater than 60 (OR, 5.8) and critical disease severity (OR, 29) were significantly associated with persisting abnormalities. 

Dr. Enid Neptune, a pulmonary-critical-care physician and a professor of medicine at the Johns Hopkins School of Medicine, in Baltimore, Maryland, said doctors treating patients with persistent lung abnormalities need to determine whether there is also functional impairment. 

"They need to do functional testing and query patients about their symptoms, such as reduced exercise capacity and shortness of breath," she added. "I would have heightened concern that these findings might have some kind of clinical consequence." 

It's important to determine whether these patients might be at risk for a different evolution of interstitial lung disease, said Dr. Neptune, who was not involved in the new study. "Could this be an early stage of progressive lung fibrosis? We all know that sometimes you can early on predict progression in disorders such as lung fibrosis, even airway disorders." 

The study also places a mandate on the research community to follow COVID-19 patients in a systematic and rigorous fashion to determine long-term outcomes, Dr. Neptune said. 

SOURCE: https://bit.ly/3DGEl8G and https://bit.ly/3NMNIZ5  Radiology, online March 29, 2022. 

By Linda Carroll 

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