From the Research
The correct term for lung changes that persist after COVID-19 infection is "post-COVID-19 lung disease" or more specifically "post-COVID-19 pulmonary fibrosis" when referring to the scarring that can develop. These terms describe the residual lung damage that may remain after the acute infection has resolved. Patients who experienced severe COVID-19 pneumonia are more likely to develop these persistent changes, which can be seen on CT scans as ground-glass opacities, reticulation, traction bronchiectasis, or fibrotic bands, as reported in a study published in 2022 1. The development of fibrosis occurs when the normal healing process is disrupted, leading to excessive collagen deposition and permanent structural changes in the lung tissue. Management typically involves pulmonary rehabilitation, oxygen therapy if needed, and regular follow-up with pulmonary function tests and imaging to monitor progression. Some patients may experience gradual improvement over time, while others may have permanent lung damage. Early recognition and appropriate management of these post-COVID lung changes are important for optimizing long-term respiratory function and quality of life. A recent study published in 2023 compared the effects of treatment with nintedanib and pirfenidone in patients with COVID-19-related fibrosis, and found that both treatments were effective in improving radiological score and pulmonary function test parameters, but nintedanib was more effective in increasing exercise capacity and saturation values 2. However, the use of antifibrotic agents such as pirfenidone and nintedanib is still being studied, and larger, randomized studies on the efficacy and safety of these agents are required, as noted in a multicenter survey study published in 2022 3. In addition, the precise mechanism of post-COVID-19 pulmonary fibrosis is related to the activation of transforming growth factor beta (TGF-β1), and pirfenidone has been shown to inhibit accumulation and recruitment of inflammatory cells, fibroblast proliferation, deposition of extracellular matrix in response to TGFβ1 and other pro-inflammatory cytokines, as reported in a study published in 2022 4. Overall, the management of post-COVID-19 lung disease requires a comprehensive approach, including pulmonary rehabilitation, oxygen therapy, and regular follow-up with pulmonary function tests and imaging, as well as consideration of antifibrotic treatment in selected cases. Key points to consider in the management of post-COVID-19 lung disease include:
- Early recognition and diagnosis of persistent lung changes
- Regular follow-up with pulmonary function tests and imaging to monitor progression
- Consideration of antifibrotic treatment in selected cases
- Pulmonary rehabilitation and oxygen therapy as needed
- Regular assessment of symptoms and functional impairment.