From the Guidelines
For a 70-year-old male with suspected long COVID, the most effective treatment approach is to focus on symptom management, as there is no single proven cure, and consider treatments such as pacing for postexertional malaise, pharmacological options like β-blockers for POTS, and cognitive pacing for cognitive dysfunction, as recommended in the most recent study 1. When managing long COVID symptoms, it's crucial to start with a thorough evaluation to rule out other conditions that might explain the symptoms.
- For fatigue, consider treatments like coenzyme Q10, d-ribose, or low-dose naltrexone, which have shown promise in ME/CFS literature 1.
- Cognitive symptoms may benefit from cognitive pacing, postconcussion syndrome protocols, or low-dose aripiprazole, as suggested in the ME/CFS literature 1.
- For breathing difficulties or POTS, breathing exercises, pulmonary rehabilitation, and pharmacological options like β-blockers, pyridostigmine, fludrocortisone, or midodrine may be helpful, based on POTS and ME/CFS literature 1.
- Sleep disturbances might improve with sleep hygiene practices and possibly short-term use of melatonin.
- Pain can be managed with acetaminophen or NSAIDs if not contraindicated.
- For anxiety or depression, consider SSRIs like sertraline or cognitive behavioral therapy. Given the complexity and variability of long COVID symptoms, a multidisciplinary care approach is often beneficial, involving physical therapy, occupational therapy, and mental health support, as there is no single proven cure and the pathophysiology likely involves persistent inflammation, immune dysregulation, and possibly viral persistence 1. Regular monitoring is essential as our understanding of long COVID continues to evolve.
From the Research
Treatment Options for Long Covid Symptoms
- Pulmonary rehabilitation is a key treatment for adults with chronic respiratory diseases and has shown promise in managing long Covid symptoms, particularly for patients with respiratory symptoms such as dyspnea 2, 3.
- A pulmonary rehabilitation program may be optimal to meet the needs of those with ongoing symptoms after Covid-19, including aerobic and strength training, breathing techniques, education, and psychological support 3, 4.
- Exercise training during pulmonary rehabilitation is a successful strategy for improving functional exercise capacity measures and related symptoms, such as dyspnea and fatigue, in people with long Covid 5.
Components of Pulmonary Rehabilitation
- Aerobic and strength training has shown benefit for adults living with long Covid, although there is little evidence on structured education in this population 3.
- Breathing pattern disorder is common in adults with long Covid, and considerations on treatment before rehabilitation, or alongside rehabilitation, are necessary 3.
- Postexertional malaise is an important consideration in this population, and evidence from the chronic fatigue syndrome literature supports the need for individualization of exercise programs 3.
Effectiveness of Pulmonary Rehabilitation
- Pulmonary rehabilitation has been shown to improve exercise capacity, functional status, dyspnea, fatigue, and quality of life in patients with long Covid 4, 6.
- A systematic review and meta-analysis found that pulmonary rehabilitation improved physical capacity, lung function, and quality of life, and alleviated dyspnea, fatigue, and anxiety in long Covid-19 patients 6.
- The optimal duration of pulmonary rehabilitation programs for long Covid patients is 4-8 weeks, and a combination of breathing exercises and multicomponent training is most effective for managing long-term Covid-19 syndromes 6.