COVID-19 survivors benefit from structured follow-up

The preliminary results of the CovILD study show that many COVID-19 patients suffer from long-term pulmonary impairment that is not detected by lung function, but the impairment does seem to improve over time [1].

The CovILD study assessed the frequency and patterns of pulmonary abnormalities in moderate-to-critical COVID-19 patients after recovery. All participants lived in a ‘hot spot’ area in the Tyrolean region of Austria. They were hospitalised at the University Clinic of Internal Medicine in Innsbruck, the St. Vincent Hospital in Zams, or the cardio-pulmonary rehabilitation centre in Münster, Austria. At the virtual ERS meeting, Dr Sabina Sahanic (Medical University of Innsbruck, Austria) presented data of the first 86 patients enrolled between 29 April and 9 June 2020.

The average age of the 86 patients was 61, and 35% were female. Nearly half of the participants were current or former smokers and 65% were overweight or obese. The average length of stay of the 86 participants was 13 days; 21% of the participants were admitted to the ICU and 19% had had invasive mechanical ventilation. Follow-up visits were scheduled for 6, 12, and 24 weeks after their discharge from hospital. During these visits, clinical examinations, laboratory tests, lung function tests, computed tomography (CT) scans, and echocardiograms were carried out.

At the 6-week follow-up visit, 56 patients (65%) showed persistent symptoms; the most common symptom was dyspnoea in 40 patients (47%), followed by coughing in 13 patients (15%). By the 12-week visit, breathlessness had improved but was still evident in 31 patients (39%); yet there was no change in the percentage of patients with cough.

Lung function parameters (i.e. forced expiratory volume in one second [FEV₁], forced vital capacity [FVC], and diffusing capacity for carbon monoxide [DLCO]) improved between the visits at 6 and 12 weeks. At 6 weeks, 20 patients (23%) showed FEV₁ <80% predicted normal. At 12 weeks, this improved to 18 patients (21%). At 6 weeks, 24 patients (28%) showed FVC <80% predicted normal, which improved to 16 patients (19%) at 12 weeks, and 28 patients (33%) showed DLCO <80% predicted versus 19 patients (22%) at 12 weeks.

Pathological CT findings were present in 74 patients (88%) at 6 weeks and in 48 patients (56%) at 12 weeks. Severe pathological CT findings were more frequent in patients that were admitted to the ICU. The main patterns of damage at follow-up were ground glass opacities and reticulation. “Fortunately, we could not find any signs of progressive pulmonary fibrosis in our population,” Dr Sahanic said.

After 6 weeks, more than half of the patients had at least 1 persistent symptom, predominantly breathlessness and coughing, and CT scans still showed lung damage in 88% of patients. However, by the time of their next visit at 12 weeks after discharge, the symptoms had improved and lung damage was reduced to 56%. At the time of Dr Sahanic’s presentation, results at 24 weeks were still being evaluated.

“The findings from this study show the importance of implementing structured follow-up care for patients with severe COVID-19 infection,” concluded Dr Sahanic. “Importantly, CT unveiled lung damage in this patient group that was not identified by lung function tests. Knowing how patients have been affected long-term by the coronavirus might enable symptoms and lung damage to be treated much earlier and might have a significant impact on further medical recommendations and advice.”

 

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   1. Sahanic S et al. Persisting pulmonary impairment following severe SARS-CoV-2 infection, preliminary results from the CovILD study. LBA 4143, ERS International Virtual Congress 2020, 7-9 Sept.

Posted on 29 October 2020