ABSTRACT
BACKGROUND: The S1 guideline on long/post-COVID of the AWMF [German Association of the Medical Scientific Societies] registration number 020-027) was updated in August 2022. METHODS: Under the coordination of the German Society of Pneumology, the guideline was updated by 21 scientific associations, two professional associations and clinical centers each and one institute and statutory accident insurance each. Each scientific association was responsible for its own chapter. The German Pain Society prepared the chapter "Pain". The coordinators of each chapter performed a selective literature search and also received approval for the chapter within their scientific association. During an internal period of comments, all representatives of the participating institutions could comment on all chapters. The AWMF task force commented on the draft of the guideline, which was then finally approved by the boards of all participating institutions. RESULTS: Coronavirus disease 2019 (COVID-19) increases the risk of persistent headache and musculoskeletal pain. Long/Post-COVID pain is frequently associated with fatigue and cognitive problems. A specialist assessment might be considered if symptoms with limitations of daily activities persist 3 months after the infection. The diagnostic workup of long/post-COVID-associated pain should be performed according to the standards of pain medicine. Management should follow the pain guidelines of the AWMF. CONCLUSIONS: The updated S1 guideline on long/post-COVID is a clinical manual which offers orientation for diagnostics and treatment despite limited data.
ABSTRACT
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.
Subject(s)
COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Humans , Lung/physiopathology , Practice Guidelines as Topic , Post-Acute COVID-19 SyndromeABSTRACT
The German Society of Pneumology initiated the AWMFS1 guideline Post-COVID/Long-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendation describes current post-COVID/long-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an expilcit practical claim and will be continuously developed and adapted by the author team based on the current increase in knowledge.
Subject(s)
COVID-19 , Pulmonary Medicine , COVID-19/complications , Consensus , Humans , SARS-CoV-2 , Post-Acute COVID-19 SyndromeABSTRACT
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.
ABSTRACT
BACKGROUND: Coronavirus disease 2019 has become a health problem spreading worldwide with pandemic characteristics since March 2020. Post coronavirus disease 2019 symptoms are more frequent than initially expected, with fatigue as an often-mentioned issue. CASE PRESENTATIONS: We describe a 32-year-old white male and a 55-year-old white female who suffered from post coronavirus disease 2019 fatigue syndrome. On polysomnography, rapid eye movement associated sleep apnea with an increased hypopnea index during rapid eye movement phases of 36.8 and 19.5 events per hour was found. Based on the patients' burdensome fatigue symptoms, we initiated automatic positive airway pressure therapy, which diminished sleep apnea (rapid eye movement index: 0.0 in both patients) and, consequently, also the fatigue symptoms. CONCLUSIONS: Since sleep apnea and coronavirus disease 2019 are both associated with fatigue, a screening for sleep apnea might be considered in coronavirus disease 2019 patients with fatigue syndrome.
Subject(s)
COVID-19/complications , Fatigue/virology , Sleep Apnea Syndromes/virology , Adult , Female , Humans , Male , Middle Aged , Sleep, REMABSTRACT
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.âV. (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.