One in five severe COVID patients may end up with some pulmonary fibrosis

Pulmonary fibrosis after COVID-19 is more common than people have realised yet it remains unclear how best to manage the condition, UK respiratory specialists say.

Speaking at a British Thoracic Society virtual conference, Professor Gisli Jenkins a respiratory physician and researcher at Imperial College London said from the emerging data it appears that around 20% of patients with severe COVID-19 are getting “some degree of interstitial lung disease”.

He added that it was more likely to affect people with co-morbidities such as diabetes, hypertension or ischaemic heart disease.

Professor Jenkins told delegates he is often asked if COVID-19 will cause pulmonary fibrosis and to which the short answer is yes but the the more important questions are what this lung fibrosis will look like, how may will suffer and who is most at risk.

Studies have shown that while lung function improves for most people over time it is a slow process, he added.

The UKILD Long COVID study will be looking at the development of interstitial lung disease following COVID, stratifying patients by severity and following up for 12 months to understand who gets it and how bad it is, Professor Jenkins added.

That will provide more answers around how common and how bad the problem of pulmonary fibrosis after COVID is, he told the meeting.

“It’s likely to involve three phenotypes this is what we’ve observed clinically. The first is resolving organising pneumonia, that is the most common. A static fibrosis in people who have reticulation which doesn’t get worse but unfortunately doesn’t get better.

“And finally the most uncommon of the phenotypes is a progressive fibrotic disease akin to IPF,” he said.

“What I say to my patients is we think you will improve slowly over time, most patients will improve slowly over time but some may not and some will get worse and we just don’t know yet.”

When asked about treatment options he added: “At the current time we don’t know what the right thing to do is. If the reduced gas transfer is not improving quickly enough and there’s evidence of inflammation you may want to give steroids. There’s no good evidence for it at the moment, there’s some circumstantial evidence but no hard evidence. That’s probably the most vexing question at the moment, should we or should we not use steroids in post-COVID ILD.”

Other treatments where there may be plausibility but no hard evidence as yet, such as pirfenidone should not be used outside of clinical trials, he added.

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