Persistent Inflammatory Interstitial Lung Disease Found After COVID-19

Persistent inflammatory interstitial lung disease (ILD) has been observed among patients following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, according to results published in the Annals of the American Thoracic Society.

Researchers conducted a single-center, prospective, observational study in patients with a diagnosis of SARS-CoV-2 pneumonitis 6 weeks following hospital discharge. To establish the incidence and depict the progression of persistent inflammatory ILD after SARS-CoV-2 infection among patients treated with prednisolone. A total of 837 patients who had presented at Guy’s and St. Thomas’ NHS (National Health System) Foundation Trust — a central London, United Kingdom, teaching hospital and tertiary ILD unit — with either a polymerase chain reaction (PCR) diagnosis of SARS-CoV-2 infection or a negative swab but highly suspicious radiologic/clinical diagnosis were contacted by phone 4 weeks following hospital discharge. Patients who had ongoing symptoms were invited to participate in a structured clinical evaluation that was reviewed by a senior respiratory or infectious disease specialist at 6 weeks.

Overall, 39% (325 of 837) of patients reported experiencing ongoing symptoms and were thus evaluated. Of the survivors, 4.8% (35 of 837) had ILD, which presented mainly as organizing pneumonia, with significant functional deficit. Among these individuals, 30 were diagnosed with persistent interstitial lung changes and were offered oral corticosteroid therapy.

These participants subsequently reported that their breathlessness and function had significantly improved following prednisolone treatment, with their median Medical Research Council (MRC) dyspnea score improving significantly from 3±2 to 2±1 (P  =.002). This was associated with a mean relative increase in forced vital capacity of 9.63% (95% CI, 4.49-14.70; P =.004) at 3 weeks and a mean increase in transfer factor of the lung for carbon dioxide of 31.49%, with significant symptomatic and radiologic improvement.

The researchers concluded that the preliminary data from the current analysis should inform additional study into the natural history and potential therapy for patients who have persistent inflammatory ILD following SARS-CoV-2 infection.

Reference

Myall KJ, Mukherjee B, Castanheira AM, et al. Persistent post-COVID-19 inflammatory interstitial lung disease: an observational study of corticosteroid treatment. Ann Am Thorac Soc. Published online January 12, 2021. doi:10.1513/AnnalsATS.202008-1002OC