Persistent Post-COVID-19 Interstitial Lung Disease. An Observational Study of Corticosteroid Treatment

Abstract

Rationale: The natural history of recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unknown. Because fibrosis with persistent physiological deficit is a previously described feature of patients recovering from similar coronaviruses, treatment represents an early opportunity to modify the disease course, potentially preventing irreversible impairment.Objectives: Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease (ILD) following SARS-CoV-2 when treated with prednisolone.Methods: A structured assessment protocol screened for sequelae of SARS-CoV-2 pneumonitis. Eight hundred thirty-seven patients were assessed by telephone 4 weeks after discharge. Those with ongoing symptoms had outpatient assessment at 6 weeks. Thirty patients diagnosed with persistent interstitial lung changes at a multidisciplinary team meeting were reviewed in the interstitial lung disease service and offered treatment. These patients had persistent, nonimproving symptoms.Results: At 4 weeks after discharge, 39% of patients reported ongoing symptoms (325/837) and were assessed. Interstitial lung disease, predominantly organizing pneumonia, with significant functional deficit was observed in 35/837 survivors (4.8%). Thirty of these patients received steroid treatment, resulting in a mean relative increase in transfer factor following treatment of 31.6% (standard deviation [SD] ± 27.6, P < 0.001), and forced vital capacity of 9.6% (SD ± 13.0, P = 0.014), with significant symptomatic and radiological improvement.Conclusions: Following SARS-CoV-2 pneumonitis, a cohort of patients are left with both radiological inflammatory lung disease and persistent physiological and functional deficit. Early treatment with corticosteroids was well tolerated and associated with rapid and significant improvement. These preliminary data should inform further study into the natural history and potential treatment for patients with persistent inflammatory ILD following SARS-CoV-2 infection.

Keywords: COVID-19; fibrosis; interstitial lung disease; organizing pneumonia.

Figure 1.

Flowchart of the study population recruited between February and May 2020. COVID = coronavirus disease; CT = computed tomography; ILD = interstitial lung disease; MDT = multidisciplinary team meeting; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

Figure 2.

Steroid dosing by week. Data are presented as median and interquartile range.

Figure 3.

Change in lung function after treatment with oral prednisolone in patients with interstitial lung disease after infection with SARS-CoV-2. FVC = forced vital capacity; KCO = transfer coefficient; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; SI = International System of Units; transfer; Tl_CO = transfer factor of the lung for carbon monoxide.

Figure 4.

Axial image and coronal reconstruction from computed tomographic (CT) imaging of the thorax acquired immediately before discharge in a previously fit and well 57-year-old man (A and B) shows a radiological pattern of organizing pneumonia disease with predominant peribronchial and perilobular dense consolidation mild traction bronchiectasis of the airways. At this stage, the patient could only walk 30 yards. Follow-up CT imaging of the thorax acquired after 3 weeks of oral prednisolone (C and D) shows resolution of consolidation with residual ground glass and fine subpleural reticulation. The airways still have a slightly nontapering appearance. The patient was now able to run for 30 minutes a day.