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Review
. 2022 Mar 9;31(163):210185.
doi: 10.1183/16000617.0185-2021. Print 2022 Mar 31.

Post-acute COVID-19 syndrome

David Montani  1 , Laurent Savale  2 , Nicolas Noel  3 , Olivier Meyrignac  4 , Romain Colle  5 , Matthieu Gasnier  5 , Emmanuelle Corruble  5 , Antoine Beurnier  2 , Etienne-Marie Jutant  2   6 , Tài Pham  7 , Anne-Lise Lecoq  8 , Jean-François Papon  9 , Samy Figueiredo  10 , Anatole Harrois  10 , Marc Humbert  2 , Xavier Monnet  7 ; COMEBAC Study Group
Affiliations
Review

Post-acute COVID-19 syndrome

David Montani et al. Eur Respir Rev. .

Abstract

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic that has resulted in millions of deaths and a major strain on health systems worldwide. Medical treatments for COVID-19 (anticoagulants, corticosteroids, anti-inflammatory drugs, oxygenation therapy and ventilation) and vaccination have improved patient outcomes. The majority of patients will recover spontaneously or after acute-phase management, but clinicians are now faced with long-term complications of COVID-19 including a large variety of symptoms, defined as "post-acute COVID-19 syndrome". Most studies have focused on patients hospitalised for severe COVID-19, but acute COVID-19 syndrome is not restricted to these patients and exists in outpatients. Given the diversity of symptoms and the high prevalence of persistent symptoms, the management of these patients requires a multidisciplinary team approach, which will result in the consumption of large amounts of health resources in the coming months. In this review, we discuss the presentation, prevalence, pathophysiology and evolution of respiratory complications and other organ-related injuries associated with post-acute COVID-19 syndrome.

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Conflict of interest statement

Conflict of interest: D. Montani has no conflicts to disclose. Conflict of interest: L. Savale has no conflicts to disclose. Conflict of interest: N. Noel has no conflicts to disclose. Conflict of interest: O. Meyrignac has no conflicts to disclose. Conflict of interest: R. Colle has no conflicts to disclose. Conflict of interest: M. Gasnier has no conflicts to disclose. Conflict of interest: E. Corruble has no conflicts to disclose. Conflict of interest: A. Beurnier has no conflicts to disclose. Conflict of interest: E-M. Jutant has no conflicts to disclose. Conflict of interest: T. Pham has no conflicts to disclose. Conflict of interest: A-L. Lecoq has no conflicts to disclose. Conflict of interest: J-F. Papon has no conflicts to disclose. Conflict of interest: S. Figuereido has no conflicts to disclose. Conflict of interest: A. Harrois has no conflicts to disclose. Conflict of interest: M. Humbert has no conflicts to disclose. Conflict of interest: X. Monnet has no conflicts to disclose.

Figures

FIGURE 1
FIGURE 1
Visualisation of symptoms that did not exist before COVID-19 and their overlap in 192 patients (of 478 patients) who presented at least one symptom at teleconsultation. Of note, 52 patients had experienced a new symptom that was not dyspnoea, cognitive or neurological. Reproduced from [7] with permission.
FIGURE 2
FIGURE 2
a) Sagittal, b) coronal and c) axial multiplanar reconstructions of a thoracic high-resolution computed tomography scan performed at 4 months after COVID-19 showing the sequellar involvement of the pulmonary parenchyma associated with the presence of fibrosing irreversible lesions with traction bronchiectasis (upper right panel, high magnification image from c), reversible lesion ground-glass opacities (upper left panel, high magnification image from c) and subpleural linear lesions with indeterminate evolution (lower right panel, high magnification image from c).
FIGURE 3
FIGURE 3
Schematic summary of post-COVID-19 symptoms.
FIGURE 4
FIGURE 4
Proposal of a multidisciplinary follow-up algorithm for patients after COVID-19. ICU: intensive care unit; HFO: high-flow oxygen; IMV: invasive mechanical ventilation; mMRC: modified Medical Research Council; HRCT: high-resolution computed tomography; 6MWT: 6-min walk test; CPET: cardiopulmonary exercise testing; ENT: ear, nose and throat.
See this image and copyright information in PMC

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