EVEN weeks after discharge, some patients hospitalized for Covid-19 they may still have respiratory symptoms, such as persistent inflammation of the lung interstitium, or interstitial lung disease (Ild), characterized by inflammation of the supporting structure of the lungs. But there is, however, the good news: corticosteroids, widely available and low-cost drugs, can be used to treat it.
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To tell it is an observational study carried out by researchers of the Guy’s and Saint Thomas’ Nhs (National Health System) Foundation Trust which, in addition to identifying who is most at risk of developing it, have shown how corticosteroid therapies are effective in improving lung function and therefore reducing symptoms. The study was published in the journal Annals of the American Thoracic Society.
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To reach these conclusions, the research team involved 837 patients hospitalized between February 28 and May 29, 2020 with a diagnosis of pneumonia from Covid. Four weeks after their discharge, a telephone survey revealed that 39% (325 out of 837) still had ongoing respiratory symptoms. From subsequent analyzes carried out on this subgroup of patients and performed six weeks after discharge, the researchers found that approximately 42% showed no signs and symptoms of persistent inflammation, 33% had symptoms but no radiological findings, while 24% , about 77 patients, was referred to the multidisciplinary team of post-Covid lung disease. And again: in this last group, the researchers observed that 4.8% (35 out of 837) had persistent inflammation of the lung interstitium.
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After identifying these patients, the team decided to resort to corticosteroids, treating 30 cases with a maximum initial dose of 0.5mg / kg of prednisolone and gradually decreasing over the next three weeks. After treatment, the researchers observed that these patients had a significant improvement in symptoms, and in particular an increase of approximately 31% in the gas exchange capacity of the lung and of 9.6% in the forced vital capacity, i.e. the volume of air that can be expelled through exhalation. “In this study, researchers were concerned about the consequences of Covid-19 in acute form on a large population of people who had had Covid pneumonia of varying severity, ”he explains Marco Confalonieri, director of the Pneumology department of the University Hospital of Trieste and member of the executive committee of the Italian Association of Hospital Pulmonologists (Aipo). “These results are excellent, absolutely in line with our experience”.
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In particular, the expert points out, British doctors have shown that the use of cortisone helps prevent the disease from developing into fibrosis, the formation of scar tissue in the lungs that causes permanent damage to respiratory function. “This study gives us hope, because it shows that if lung problems remain weeks later, in most cases they can still be solved with low-cost, easy-to-use drugs that for a not too long period they can lead to healing, ”he comments Confalonieri. Acute pneumonia occurs in coronavirus disease, but there is also a not very high percentage (less than 5% in fact) of patients who may have persistent inflammation in the lung support structure.
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“Inflammation is a defense reaction, but in pneumonia from Covid-19 has been observed in a number of patients that this reaction is not well regulated. The inflammation, therefore, can be excessive or prolonged. The latter responds, as does the acute form, to the corticosteroid “, explains the expert, recalling that the cortisone treatment has already proved capable, in the most acute phase of the most severe forms of Covid-19, to significantly reduce mortality.
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Furthermore, the British researchers were able to identify who is most at risk of presenting a persistent inflammatory disease of the pulmonary interstitium: the study, in fact, showed that the patients were predominantly male (71.5%) and overweight or obese (the latter only 26%). Most had at least one comorbidity, and the most common were diabetes and asthma.
The hospital stay averaged approximately 16 days, 82.9% of patients required oxygen therapy, 55% were admitted to intensive care units, and 46% required invasive mechanical ventilation. “They are also observed for acute pneumonia. This does not mean that only these categories of people are affected, but that there are additional risk factors that can increase the probability “, concludes Confalonieri. “Right now, my dispassionate advice is not to be afraid of the vaccine, but to be more afraid of the disease, even in light of these studies. Vaccination is the way to get out of it together ”.
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