[The pulmonary view on post-/Long-COVID]. / Post-COVID aus pneumologischer Sicht.

A majority of COVID patients suffers from hetereogenous symptoms after acute infection which are limiting patients participation in social life, activities of daily living and the return to work. In March 2021, the German Society of Pneumology initiated the AWMF S1 guideline Post-COVID/Long-COVID in order to show an individual practice-oriented, diagnostic and therapeutic clinical algorithm according to the individual symptoms. This article is based on the S1 guideline and highlights some trials of interest with a focus on pulmonary symptoms. The guideline and, accordingly, this article have an explicitly practical and clinical purpose. The guideline will be further developed by the author team based on the current increase in knowledge this is reflected in the clinical summary article.

Pulmonary rehabilitation in long COVID: more than just natural recovery!?

In the light of missing randomised controlled trials, some arguments suggest that pulmonary rehabilitation has beneficial effects beyond natural recovery https://bit.ly/3ze2xvw.

Rehabilitation nach COVID-19-Erkrankung

Zusammenfassung 6 Monate nach einer akuten Infektion mit dem SARS-CoV-2 Virus bleiben bei einer Mehrheit der erkrankten Patienten mit moderatem oder schwerem Verlauf Krankheitsfolgen im Sinne eines post- oder Long-COVID-Syndroms. Die Symptome sind sehr heterogen und können respiratorischer, neurologischer, muskuloskelettaler, kardiovaskulärer, psychischer oder kognitiver Natur sein. Die Lunge scheint als Eintrittspforte für das Virus über die Atmung in besonderem Maße betroffen zu sein. Die Abnormalitäten der Lunge, die sich als Folge der Corona Virus Disease 2019 (COVID-19) entwickeln, können zu einem eingeschränkten Gasaustausch und damit einer reduzierten Oxygenierung insbesondere unter Belastung führen. Um diese Symptome in ihrer Intensität und Vielfalt umfassend zu adressieren, wird eine stationäre pneumologische Rehabilitation empfohlen. Der multimodale Ansatz, der neben eingehender Diagnostik und medikamentöser Optimierung diverse therapeutische Komponenten (z.B. Trainingstherapie, Atemphysiotherapie, psychologische Beratung) beinhaltet, muss mit stetig steigendem Erkenntniszugewinn an die Besonderheiten der COVID-19 Krankheitsfolgen angepasst werden. Eine optimale Nachsorge, die bereits im Akutkrankenhaus beginnen kann, zielt auf eine Verbesserung der körperlichen Leistungsfähigkeit und Lebensqualität sowie eine Reduktion der noch vorhandenen Symptome, so dass die Selbstständigkeit des Patienten im Alltag verbessert, erhalten oder wiederhergestellt wird. Summary 6 months following an acute infection with SARS-CoV-2 virus with a moderate or severe course of Corona Virus Disease 2019 (COVID-19), a majority of patients is still suffering from sequelae which are defined as „post COVID syndrome“ or „long COVID“. Symptoms are heterogenous and can be of respiratory, neurological, musculoskeltal, cardiovascular, mental or cognitive nature. As the virus entrance into the organism via the lungs, this organ is involved in a unique manner. As a consequence of COVID-19, abnormalities of the lungs may lead to impaired gas exchange and result in a reduced blood oxygenation, especially during exercise. In order to address the intensity and diversity of symptoms, an inpatient pulmonary rehabilitation program is recommended. Beside diagnostics and pharmaceutical optimization, the multimodal approach includes several therapeutic components like exercise training, breathing therapy and psychological counseling. According to constantly new insights into this field, therapies have to be adapted permanently. An optimal postacute care, which ideally already starts during hospital stay, targets the improvement of exercise capacity, health-related quality of life as well as a reduction of ongoing symptoms in order to optimize patients daily life self-sufficiency.

Benefits of pulmonary rehabilitation in COVID-19: a prospective observational cohort study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can result in a large variety of chronic health issues such as impaired lung function, reduced exercise performance and diminished quality of life. Our study aimed to investigate the efficacy, feasibility and safety of pulmonary rehabilitation in COVID-19 patients and to compare outcomes between patients with a mild/moderate and a severe/critical course of the disease. METHODS: Patients in the post-acute phase of a mild to critical course of COVID-19 admitted to a comprehensive 3-week inpatient pulmonary rehabilitation programme were included in this prospective, observational cohort study. Several measures of exercise performance (6-min walk distance (6MWD)), lung function (forced vital capacity (FVC)) and quality of life (36-question short-form health survey (SF-36)) were assessed before and after pulmonary rehabilitation. RESULTS: 50 patients were included in the study (24 with mild/moderate and 26 with severe/critical COVID-19). On admission, patients had a reduced 6MWD (mild: median 509 m, interquartile range (IQR) 426-539 m; severe: 344 m, 244-392 m), an impaired FVC (mild: 80%, 59-91%; severe: 75%, 60-91%) and a low SF-36 mental health score (mild: 49 points, 37-54 points; severe: 39 points, 30-53 points). Patients attended a median (IQR) 100% (94-100%) of all provided pulmonary rehabilitation sessions. At discharge, patients in both subgroups improved in 6MWD (mild/moderate: +48 m, 35-113 m; severe/critical: +124 m, 75-145 m; both p<0.001), FVC (mild/moderate: +7.7%, 1.0-17.8%, p=0.002; severe/critical: +11.3%, 1.0-16.9%, p<0.001) and SF-36 mental component (mild/moderate: +5.6 points, 1.4-9.2 points, p=0.071; severe/critical: +14.4 points, -0.6-24.5, p<0.001). No adverse event was observed. CONCLUSION: Our study shows that pulmonary rehabilitation is a feasible, safe and effective therapeutic option in COVID-19 patients independent of disease severity.

[What can pulmonary rehabilitation accomplish?] / Was leistet die pneumologische Rehabilitation?

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has stated that pulmonary rehabilitation (PR) is the most effective therapeutic intervention to reduce dyspnoea and to improve physical performance and quality of life for patients with obstructive lung disease.New innovative studies raised in the area of PR:1) Pulmonary fibrosis & asthma bronchiale - While PR is recommended for chronic respiratory diseases other than COPD (chronic obstructive pulmonary disease) in the respective disease-specific treatment guidelines, PR in some pathologies is underrated. For example, there is a growing body of evidence showing the effectiveness of structured and multidisciplinary PR programs in pulmonary fibrosis and asthma bronchial patients;2) Coronavirus SARS-CoV-2 - There is preliminary evidence that COVID-19 patients can benefit from a PR program. The current COVID-19 position paper of the German Respiratory Society e. V. (DGP) regarding PR recommendations suggests that early rehabilitative therapies are already indicated during hospitalisation on the normal or intensive care unit and that rehabilitative interventions should be continued after discharge as a follow-up treatment in PR centres in order to reduce long-term consequences of COVID-19 disease;3) Telehealth meets PR - To further improve the effectiveness of PR in COPD patients using recent technologies, a supplementary "digital exercise program" can contribute to greater benefits compared to PR alone.