Post-COVID-19 Interstitial Lung Disease: a new entity, what do we deal with?

Introduction: In the post-acute phase, COVID-19 survivors may have persistent symptoms, lung function abnormalities and sequela lesions on thorax CT. This new entity is defined as post-COVID Interstitial Lung Disease (ILD) or a residual disease. Aim(s): To investigate the characteristics and clinical significance of post-COVID-19 ILD. Method(s): Patients with persistent respiratory symptoms after recovery were evaluated by a team including two pulmonologists and a radiologist. Pulmonary function tests, 6-minute walking test, thorax HRCT were performed. Post-COVID ILD was defined as presence of all the followings: respiratory symptoms, hypoxemia, restrictive lung functions and interstitial changes on follow-up HRCT. Result(s): A total of 375 post-COVID-19 patients were evaluated on average 91 days after recovery and 262 of them were included. 17.9 % of the patients were non-hospitalized with mild COVID-19;10.8 % of the patients had received high flow nasal oxygen, of 17.5 % had required non-invasive mechanical ventilation, of 8.8 % had been intubated. The most prevalent symptoms were dyspnoea, exercise intolerance and fatigue. The mean mMRC score was 1.82, oxygen saturation was 94.1, 6-minute walking distance was 374 meters. Pulmonary functions (percentage of mean predicted value +/- SD) were as follows;FEV1:79+/-19, FVC: 73+/-19, FEV1/FVC: 87+/-9, DLCO: 64.5+/-21.8. On CT, GGOs, fibrotic bands, and a combination of them were detected. The mean CT score was 13.5. Discussion(s): The presence of symptoms and functional defects in addition to radiological parenchymal lesions requires the definition of this new entity is post-COVID-19 ILD which could be seen even in non-hospitalised patients with mild COVID-19.

Methylprednisolone in the treatment of post-COVID-19 Interstitial Lung Disease (STERCOV-ILD)

Introduction: Post-COVID-19 Interstitial Lung Disease (ILD) is controversial and need for treatment is unclear. Aim(s): To investigate the efficacy of methylprednisolone in the treatment of post-COVID-19 ILD. Method(s): This multicentre, prospective, randomized controlled clinical trial, included post-COVID ILD patients (ClinicalTrials.gov, NCT:04988282). Post-COVID ILD was defined as the presence of respiratory symptoms, hypoxemia, restrictive lung functions and parenchymal infiltrates on thorax HRCT. 262 post-COVID-19 patients were randomly assigned to one of two arms: the steroid group (n:135) or control group (n:127). For 4 weeks, the steroid group received oral methylprednisolone at a dose of 0.5 mg/kg/day (maximum dose: 48 mg/day). At the end of the study, thorax HRCT, 6-minute walking test and lung function tests were re-evaluated. A good response was defined as a mMRC score of 0, a FVC percentage greater than 80% and absence of hypoxemia at rest or during exercise, greater than 90% resolution of lesions on CT. Result(s): Good clinical and functional response rates were higher in steroid group compared to the control group (62.9% vs 33.3%;54.1% vs 33.7%, p<0.001, respectively). Patients with a radiological response in steroid group tend to be higher than control group, but not statistically significant (61.1 % vs 51.1 %, p=0.159). The increase in oxygen saturation, FVC, and 6-minute walking distance were significantly higher in the steroid group compared to the control. Discussion(s): Systemic corticosteroids improves clinical and functional characteristics and increases oxygen saturation, FVC, and exercise capacity in post-COVID ILD patients compared to the natural course of the disease.

Mental health, quality of life, and COVID-19 fear in Turkish healthcare workers practicing in pandemic hospitals

Background: Healthcare workers (HCWs) face work-related psychosocial risks. The ongoing pandemic is causing widespread concern in a variety of ways, including COVID-19 fear and anxiety. Objective(s): We aimed to evaluate mental health, quality of life, COVID-19 fear and related factors in Turkish HCWs practicing in pandemic hospitals. Method(s): The data were collected in 13 provinces between 27 September and 11 November 2021 by researchers from the Early Career Task Force of the Turkish Thoracic Society. The study survey included sociodemographic, health- and work-related characteristics, the General Health Questionnaire-12 (GHQ-12) evaluating mental health, the World Health Organization Quality of Life-BREF (WHOQoL-BREF) questionnaire and the Fear of COVID-19 Scale (FCV-19S). Result(s): Of 1,556 participants, 522 (33.5%) reported a need for mental health support (MHS) in the previous year. The FCV-19S weakly correlated with the GHQ-12 (r=0.234, p<0.001) and WHOQoL-BREF domains (r=-0.245 for physical health, r=-0.182 for psychological health, r=-0.141 for social relationships and r=-0.183 for environmental health domains;p<0.001). The need for MHS was the common significant variable for all scale scores in univariate analyses and multiple linear regression. After multiple linear regression, the FCV-19S score was significantly related to the GHQ-12 and all WHOQoL-BREF domain scores. Conclusion(s): Our results indicate a remarkable level of need for MHS. The need for MHS and COVID-19 fear are related to mental health and quality of life in Turkish HCWs. The self-reported need for MHS may serve as an alarming characteristic for HCWs' psychosocial burden.