After hospitalization for COVID-19 ends, lung abnormalities can persist, leaving both patients and clinicians with questions about the progression, prognosis, and management of these changes.
Experts will review different types of post-COVID interstitial lung abnormalities, the latest treatments and clinical trials for post-COVID interstitial lung disease (ILD), and the current status of lung transplantation for post-COVID ILD during the panel discussion, Interstitial Lung Disease After Surviving COVID-19: An Update for 2023, on Tuesday, from 8:30 am to 9:30 am, in Room 312 of the convention center.
Session Chair, Corey Kershaw, MD, FCCP, Professor of Pulmonary and Critical Care Medicine at the University of Texas Southwestern Medical Center, will be joined by Claire McGroder, MD, and Harpreet Grewal, MD, both of Columbia University Medical Center.
The session will be a follow-up to a standing room-only presentation held during the CHEST Annual Meeting 2022, when clinicians were seeing an alarming number of patients who survived COVID-19 but had persistent radiographic abnormalities after discharge.
“All of a sudden, we had this brand new group of patients who had a lung problem who did not have a lung problem before 2020. In my practice as an ILD pulmonologist, we were seeing a lot of patients referred to us who survived COVID and either still had abnormal radiology or had symptoms after they recovered,” Dr. Kershaw said.
Survivors of COVID tend to fall into two large groups, he said. Some patients have clinical symptoms such as persistent coughing or shortness of breath and no objective findings. Others have visible lung abnormalities on CT scan or other imaging, regardless of their clinical complaints.
“Now, more than 3 years out from the start of the pandemic, we are beginning to see fewer of these patients, and we are beginning to see some data published clarifying the incidence,” Dr. Kershaw said. “But we still have questions that need to be answered about treating these patients. What clinicians really want to know is whether to treat somebody with a post-COVID lung injury that looks like fibrosis the same way we treat other forms of fibrosing lung diseases.”
Patients who had more severe COVID, were on ventilators, and are older are at greater risk for more severe ILD, Dr. Kershaw said. There are data from the United Kingdom showing objective and self-reported improvement after high-dose steroids, but it is still not clear which patients are more likely to benefit. Nor, he said, is it clear which patients are more likely to benefit from antifibrotic medications, such as nintedanib or pirfenidone.
Although there are currently no specific treatment recommendations for post-COVID ILD, he said, the good news is that most post-COVID ILD does not progress to severe disease and usually does not require treatment. “I think we have a sunnier disposition about the prospects for these patients after surviving COVID, and we’re definitely not seeing nearly as many referrals anymore for this,” Dr. Kershaw said. “We’re not quite to that point yet where we can tell everyone not to worry about it, but I’m optimistic that these patients are going to be okay.”