. 2023 Oct 1;27(10):729-741.

doi: 10.5588/ijtld.23.0248.

Clinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease

D Visca¹, R Centis², E Pontali³, E Zampogna⁴, A-M Russell⁵, G B Migliori², C Andrejak⁶, M Aro⁷, H Bayram⁸, K Berkani⁹, J Bruchfeld¹⁰, J M Chakaya¹¹, J Chorostowska-Wynimko¹², B Crestani¹³, M P Dalcolmo¹⁴, L D'Ambrosio¹⁵, A-T Dinh-Xuan¹⁶, S Duong-Quy¹⁷, C Fernandes¹⁸, J-M García-García¹⁹, A de Melo Kawassaki²⁰, L Carrozzi²¹, M A Martinez-Garcia²², P Carreiro Martins²³, M Mirsaeidi²⁴, Y Mohammad²⁵, R N Naidoo²⁶, N Neuparth²³, L Sese²⁷, D R Silva²⁸, I Solovic²⁹, T M Sooronbaev³⁰, A Spanevello¹, N Sverzellati³¹, L Tanno³², S Tiberi³³, T Vasankari³⁴, E Vasarmidi³⁵, M Vitacca³⁶, I Annesi-Maesano³²

Affiliations

¹ Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici (ICS) Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese.
² Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate.
³ Department of Infectious Diseases, Galliera Hospital, Genoa, Italy.
⁴ Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici (ICS) Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate.
⁵ Faculty of Health and Life Sciences, University of Exeter, Exeter, Royal Devon University Hospitals NHS Trust, Exeter, North Bristol NHS Trust, Bristol, UK.
⁶ Respiratory Department, Centre Hospitalier Universitaire Amiens Picardie, Amiens, Unité de Recherche 4294, Agents Infectieux, Résistance et Chimiothérapie, Picardie Jules Verne University, Amiens, GREPI (Group pour la Recherche et enseignement en pneumo-infectiologie) Work group of French society of respiratory diseases, Paris, France.
⁷ Finnish Lung Health Association (FILHA), Helsinki, Finland.
⁸ Department of Pulmonary Medicine, Koc University Research Center for Translational Medicine, Koc University School of Medicine, Istanbul, Turkey.
⁹ Pierre de Soleil Clinic, Respiratory Rehabilitation, Vetraz Monthoux, France.
¹⁰ Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
¹¹ Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
¹² Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
¹³ Université Paris Cité, Physiopathologie et épidémiologie des maladies respiratoires, Institut national de la santé et de la recherche médicale (INSERM), Paris, Assistance Publique des Hôpitaux de Paris (APHP), Hôpital Bichat, Service de Pneumologie A, FHU APOLLO, Paris, France.
¹⁴ Hélio Fraga Reference Center, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.
¹⁵ Public Health Consulting Group, Lugano, Switzerland.
¹⁶ Service de Physiologie-Explorations Fonctionnelles, APHP, Hôpital Cochin, Université Paris Cité, Paris, France.
¹⁷ Respiratory Department, Lam Dong Medical College, Dalat, Vietnam.
¹⁸ Heart Institute, Cardio-pulmonology Department, University of Sao Paulo, Sao Paulo, SP, Brazil.
¹⁹ Tuberculosis Research Programme (PII-TB), Sociedad Española de Neumología y Cirugía Torácica, Barcelona, Spain.
²⁰ Serviço de Pneumologia, Instituto do Câncer do Estado de São Paulo (ICESP) e do ambulatÓrio de Doenças Pulmonares Intersticiais, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.
²¹ Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
²² Respiratory Department, University and Polytechnic La Fe Hospital, Valencia, Centro de InvestigaciÓn Biomédica en Red, Respiratory Disorders, Madrid, Spain.
²³ Allergy and Clinical Immunology Department, Dona Estefânia Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, NOVA Medical School-Comprehensive Health Research Center, Lisbon, Portugal.
²⁴ Division of Pulmonary and Critical Care, University of Florida, Jacksonville, FL, USA.
²⁵ Al Sham private University, Faculty of Medicine and Pharmacy, Damascus and Latakia, Centre for Research on Chronic Respiratory Diseases, Tishreen University, Lattakia, Syria.
²⁶ Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
²⁷ Department of Physiology and Functional Explorations, Hôpital Avicenne, INSERM, Unité mixte de recherche 1272 Hypoxia and the Lung, Université Sorbonne Paris Nord, Bobigny, Department of Pneumology, Centre Constitutif de référence des maladies pulmonaires rares, Hôpital Avicenne, Bobigny, France.
²⁸ Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
²⁹ National Institute for TB, Lund Diseases and Thoracic Surgery, Vysne Hagy, Catholic University, Ruzomberok, Slovakia.
³⁰ Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.
³¹ Department of Medicine and Surgery, University of Parma, Parma, Italy.
³² Institut Desbrest of Epidemiology and Santé Publique, INSERM & Montpellier University, Montpellier and Department of Allergic and Respiratory Diseases, Montpellier University Hospital, Montpellier, France.
³³ Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
³⁴ FILHA, Helsinki, University of Turku, Department of Pulmonary Diseases and Clinical Allergology, Turku, Finland.
³⁵ Department of Respiratory Medicine and Laboratory of Molecular and Cellular Pneumonology, School of Medicine, University of Crete, Heraklion, Greece.
³⁶ ICS Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.

PMID: 37749839
PMCID: PMC10519381
DOI: 10.5588/ijtld.23.0248

Clinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease

D Visca et al. Int J Tuberc Lung Dis. 2023.

. 2023 Oct 1;27(10):729-741.

doi: 10.5588/ijtld.23.0248.

Authors

Affiliations

¹ Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici (ICS) Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese.
² Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate.
³ Department of Infectious Diseases, Galliera Hospital, Genoa, Italy.
⁴ Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici (ICS) Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate.
⁵ Faculty of Health and Life Sciences, University of Exeter, Exeter, Royal Devon University Hospitals NHS Trust, Exeter, North Bristol NHS Trust, Bristol, UK.
⁶ Respiratory Department, Centre Hospitalier Universitaire Amiens Picardie, Amiens, Unité de Recherche 4294, Agents Infectieux, Résistance et Chimiothérapie, Picardie Jules Verne University, Amiens, GREPI (Group pour la Recherche et enseignement en pneumo-infectiologie) Work group of French society of respiratory diseases, Paris, France.
⁷ Finnish Lung Health Association (FILHA), Helsinki, Finland.
⁸ Department of Pulmonary Medicine, Koc University Research Center for Translational Medicine, Koc University School of Medicine, Istanbul, Turkey.
⁹ Pierre de Soleil Clinic, Respiratory Rehabilitation, Vetraz Monthoux, France.
¹⁰ Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
¹¹ Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
¹² Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
¹³ Université Paris Cité, Physiopathologie et épidémiologie des maladies respiratoires, Institut national de la santé et de la recherche médicale (INSERM), Paris, Assistance Publique des Hôpitaux de Paris (APHP), Hôpital Bichat, Service de Pneumologie A, FHU APOLLO, Paris, France.
¹⁴ Hélio Fraga Reference Center, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.
¹⁵ Public Health Consulting Group, Lugano, Switzerland.
¹⁶ Service de Physiologie-Explorations Fonctionnelles, APHP, Hôpital Cochin, Université Paris Cité, Paris, France.
¹⁷ Respiratory Department, Lam Dong Medical College, Dalat, Vietnam.
¹⁸ Heart Institute, Cardio-pulmonology Department, University of Sao Paulo, Sao Paulo, SP, Brazil.
¹⁹ Tuberculosis Research Programme (PII-TB), Sociedad Española de Neumología y Cirugía Torácica, Barcelona, Spain.
²⁰ Serviço de Pneumologia, Instituto do Câncer do Estado de São Paulo (ICESP) e do ambulatÓrio de Doenças Pulmonares Intersticiais, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.
²¹ Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
²² Respiratory Department, University and Polytechnic La Fe Hospital, Valencia, Centro de InvestigaciÓn Biomédica en Red, Respiratory Disorders, Madrid, Spain.
²³ Allergy and Clinical Immunology Department, Dona Estefânia Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, NOVA Medical School-Comprehensive Health Research Center, Lisbon, Portugal.
²⁴ Division of Pulmonary and Critical Care, University of Florida, Jacksonville, FL, USA.
²⁵ Al Sham private University, Faculty of Medicine and Pharmacy, Damascus and Latakia, Centre for Research on Chronic Respiratory Diseases, Tishreen University, Lattakia, Syria.
²⁶ Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
²⁷ Department of Physiology and Functional Explorations, Hôpital Avicenne, INSERM, Unité mixte de recherche 1272 Hypoxia and the Lung, Université Sorbonne Paris Nord, Bobigny, Department of Pneumology, Centre Constitutif de référence des maladies pulmonaires rares, Hôpital Avicenne, Bobigny, France.
²⁸ Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
²⁹ National Institute for TB, Lund Diseases and Thoracic Surgery, Vysne Hagy, Catholic University, Ruzomberok, Slovakia.
³⁰ Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.
³¹ Department of Medicine and Surgery, University of Parma, Parma, Italy.
³² Institut Desbrest of Epidemiology and Santé Publique, INSERM & Montpellier University, Montpellier and Department of Allergic and Respiratory Diseases, Montpellier University Hospital, Montpellier, France.
³³ Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
³⁴ FILHA, Helsinki, University of Turku, Department of Pulmonary Diseases and Clinical Allergology, Turku, Finland.
³⁵ Department of Respiratory Medicine and Laboratory of Molecular and Cellular Pneumonology, School of Medicine, University of Crete, Heraklion, Greece.
³⁶ ICS Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.

PMID: 37749839
PMCID: PMC10519381
DOI: 10.5588/ijtld.23.0248

Abstract
in English, French

BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice' care for the diagnosis, treatment and prevention of post-COVID-19 lung disease.METHODS: A panel of international experts representing scientific societies, associations and groups active in post-COVID-19 lung disease was identified; 45 completed a Delphi process. A 5-point Likert scale indicated level of agreement with the draft standards. The final version was approved by consensus (with 100% agreement).RESULTS: Four clinical standards were agreed for patients with a previous history of COVID-19: Standard 1, Patients with sequelae not explained by an alternative diagnosis should be evaluated for possible post-COVID-19 lung disease; Standard 2, Patients with lung function impairment, reduced exercise tolerance, reduced quality of life (QoL) or other relevant signs or ongoing symptoms ≥4 weeks after the onset of first symptoms should be evaluated for treatment and pulmonary rehabilitation (PR); Standard 3, The PR programme should be based on feasibility, effectiveness and cost-effectiveness criteria, organised according to local health services and tailored to an individual patient's needs; and Standard 4, Each patient undergoing and completing PR should be evaluated to determine its effectiveness and have access to a counselling/health education session.CONCLUSION: This is the first consensus-based set of clinical standards for the diagnosis, treatment and prevention of post-COVID-19 lung disease. Our aim is to improve patient care and QoL by guiding clinicians, programme managers and public health officers in planning and implementing a PR programme to manage post-COVID-19 lung disease.

CONTEXTE :: L’objectif de ces normes cliniques est de fournir des conseils sur les « meilleures pratiques » en matière de diagnostic, de traitement et de prévention des maladies pulmonaires post-COVID-19.

MÉTHODES :: Un groupe d’experts internationaux représentant des sociétés scientifiques, des associations et des groupes actifs dans le domaine des maladies pulmonaires post-COVID-19 a été constitué ; 45 d’entre eux ont participé à un processus Delphi. Une échelle de Likert en 5 points a permis d’indiquer le niveau d’accord avec les projets de normes. La version finale a été approuvée par consensus (100% d’accord).

RÉSULTATS :: Quatre normes cliniques ont été approuvées pour les patients ayant des antécédents de COVID-19 : Norme 1, les patients présentant des séquelles non expliquées par un autre diagnostic doivent être évalués en vue d’une éventuelle maladie pulmonaire post-COVID-19 ; Norme 2, les patients présentant une altération de la fonction pulmonaire, une diminution de la tolérance à l’effort, une réduction de la qualité de vie (QoL) ou d’autres signes pertinents ou des symptômes persistants, quatre semaines ou plus après l’apparition des premiers symptômes, doivent être évalués en vue d’un traitement et d’une réadaptation pulmonaire (PR, de l’anglais ‘pulmonaire rehabilitation’) ; Norme 3, le programme de PR doit être basé sur des critères de faisabilité, d’efficacité et de rentabilité, organisé en fonction des services de santé locaux et adapté aux besoins individuels des patients ; et Norme 4, chaque patient qui suit et termine un programme de PR doit être évalué pour déterminer son efficacité et avoir accès à une session de conseil/éducation à la santé.

CONCLUSION :: Il s’agit du premier ensemble consensuel de normes cliniques pour le diagnostic, le traitement et la prévention des maladies pulmonaires post-COVID-19. Notre objectif est d’améliorer les soins et la qualité de vie des patients en guidant les cliniciens, les responsables de programmes et les responsables de la santé publique dans la planification et la mise en œuvre d’un programme de relations publiques pour la prise en charge des maladies pulmonaires post-COVID-19.

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Conflict of interest statement

Conflicts of interest: none declared.

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Clinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease

Affiliations

Clinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease

Authors

Affiliations

Abstract
in English, French

Conflict of interest statement

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Cited by

References

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MeSH terms

LinkOut - more resources

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Research Materials

Abstract in English, French

Conflict of interest statement

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Abstract
in English, French