A 57-Year-Old African American Man with Severe COVID-19 Pneumonia Who Responded to Supportive Photobiomodulation Therapy (PBMT): First Use of PBMT in COVID-19

Abstract

BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with lung inflammation and cytokine storm. Photobiomodulation therapy (PBMT) is a safe, non-invasive therapy with significant anti-inflammatory effects. Adjunct PBMT has been employed in treating patients with lung conditions. Human studies and experimental models of respiratory disease suggest PBMT reduces inflammation and promotes lung healing. This is the first time supportive PBMT was used in a severe case of COVID-19 pneumonia. CASE REPORT A 57-year-old African American man with severe COVID-19 received 4 once-daily PBMT sessions by a laser scanner with pulsed 808 nm and super-pulsed 905 nm modes for 28 min. The patient was evaluated before and after treatment via radiological assessment of lung edema (RALE) by CXR, pulmonary severity indices, blood tests, oxygen requirements, and patient questionnaires. Oxygen saturation (SpO₂) increased from 93-94% to 97-100%, while the oxygen requirement decreased from 2-4 L/min to 1 L/min. The RALE score improved from 8 to 5. The Pneumonia Severity Index improved from Class V (142) to Class II (67). Additional pulmonary indices (Brescia-COVID and SMART-COP) both decreased from 4 to 0. CRP normalized from 15.1 to 1.23. The patient reported substantial improvement in the Community-Acquired Pneumonia assessment tool. CONCLUSIONS This report has presented supportive PBMT in a patient with severe COVID-19 pneumonia. Respiratory indices, radiological findings, oxygen requirements, and patient outcomes improved over several days and without need for a ventilator. Future controlled clinical trials are required to evaluate the effects of PBMT on clinical outcomes in patients with COVID-19 pneumonia.

Figure 1.

Orientation of the laser beams during laser treatment while in the prone position. The apex of the lung lies above the first rib. The lungs extend from the C7 to T10 vertebra, which is also from the apex of the lung to the inferior border. Laser parameters with both diodes operating synchronously and simultaneously, and the propagation axes are coincident. 1) 808 nm (GaAlAs) diode: Peak Power: 3 W, Laser Mode: Pulsed, Frequency: 1500 Hz, Pulse Duration: 333 μs, Scanning Area: 25×10=250 cm², Dose: 7.2 J/cm²; 2) 905 nm (GaAs) diode: Peak Power: 75 W×3, Laser Mode: Pulsed, Frequency: 1500 Hz, Pulse Duration: 100 ns, Area: 25×10=250 cm², Dose: 113.4 mJ/cm²; Total Energy: 3600 J. Treatment Time: (28 minutes), 14 minutes each lung, Sessions: Once daily for 4 days. Therapeutic Protocol: PBMT-COVID-19 By Dr. S. Mokmeli.

Figure 2.

Laser scanner configuration while the patient is in the prone position with scapular protraction. The laser scanner was adjusted 20 cm above the skin as per manufacturer’s guidelines. The patient is shown here with his hands under his head for maximum scapular protraction. The red light is the laser machine’s guide beam on the skin. Infrared lasers with wavelengths of 808 and 905 nm are not visible to human eyes. The 2 sources are coupled in a single system in the MLS laser system.

Figure 3.

Radiographic Assessment of Lung Edema (RALE) by CXR showed reduced ground-glass opacities and consolidation following PBMT. Lung radiographic score is dependent on extent of involvement based on consolidation or ground-glass opacities for each lung. Total score is the sum of both lungs. Scores classification: 0 – no involvement; 1 – <25% of lung involved; 2 – 25–50% of lung involved; 3 – 50–75% of lung involved; 4 – >75% of lung involved. RALE score before laser therapy (04-27-2020)=8. Laser therapy started on (04-29-2020). RALE score after laser therapy (05-03-2020)=5.