Long COVID with Pulmonary Manifestations

Long COVID with pulmonary manifestations, also known as pulmonary long COVID, refers to the persistence of lung-related symptoms following a SARS-CoV-2 infection, even after the acute phase of the illness has ended. Symptoms such as shortness of breath and cough may continue for a month or longer and are among the most commonly reported long-term effects of COVID-19.

Many individuals who have contracted the COVID-19 virus experience concurrent lung diseases, such as pneumonia, acute lung injury, pulmonary fibrosis, thromboembolism or endotheliitis. The long-term effects of these conditions can include an increased risk of lung cancer, respiratory failure, pulmonary hypertension, heart failure and lung infections. Children may also experience impaired lung development and a heightened risk of lung diseases.

The impact of a viral infection like COVID-19 on the lungs involves damage to the delicate lining, which causes fluid to leak into the tiny air sacs known as alveoli. As this fluid accumulates, it hinders gas exchange, making it difficult to breathe effectively and leading to respiratory problems. Many of these symptoms persist for weeks or months after the initial infection. Current research suggests that a combination of viral damage, immune dysregulation, inflammation and vascular injury plays a role in long COVID with pulmonary manifestations.

As research continues on the long-term effects of COVID-19, scientists are learning more about the associated risk factors. Individuals with certain preexisting health conditions are more likely to experience long-term symptoms such as shortness of breath, cough, fatigue and reduced lung function.

The main risk factors for long COVID with pulmonary manifestations include:

• Severe illness associated with COVID-19, which includes hospitalization, an intensive care unit (ICU) stay, mechanical ventilation and high oxygen requirements
• Preexisting lung disease, such as asthma, chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD)
• Those over the age of 50 are associated with a higher risk of prolonged recovery, reduced lung regeneration and fibrotic changes on imaging.
• History of smoking or vaping, which increases baseline lung vulnerability
• Health issues resulting from obesity, including impaired lung mechanics, diaphragmatic movement and oxygenation
• Women, especially those in middle age, are more likely to develop long COVID as well as pulmonary symptoms
• Autoimmune diseases, immunosuppressive therapy or poor viral clearance

The first line of defense against preventing long COVID and related pulmonary issues is to take precautions to avoid an initial COVID-19 infection. COVID-19 vaccines lower the risk of infection, severe illness and long COVID. After receiving the initial vaccinations, boosters can enhance protection.

If you contract COVID-19, you can minimize the severity of symptoms by testing early and receiving a diagnosis, and, if eligible, taking Paxlovid as prescribed. You can support strong lung recovery after COVID-19 by avoiding overexertion, resting and reducing stress on your lungs during your recovery. Many also find success in rebuilding lung capacity through breathing exercises, light aerobic activity and physical therapy. Making lifestyle changes to optimize health, such as quitting smoking, controlling your weight and managing chronic conditions, can also reduce the risk of long COVID.

Medical professionals do not use a single method to screen for long COVID; instead, they assess symptoms using physical exams and a series of diagnostic tests to evaluate lung involvement and rule out other causes. Symptoms to monitor include shortness of breath, chronic cough, fatigue with moderate exertion, chest discomfort or tightness, reduced exercise tolerance and low oxygen saturation.

Symptoms of long COVID with pulmonary manifestations include chronic fatigue, shortness of breath (dyspnea) and possible lung abnormalities detected through advanced imaging such as magnetic resonance imaging (MRI) scans. These manifestations may consist of restrictive ventilation patterns, limitations in diffusion capacity and radiological changes similar to those of ILDs.

Individuals who experience persistent respiratory conditions for weeks to months after contracting COVID-19 should be evaluated by their physician to assess their risk for serious pulmonary issues. Doctors will inquire whether the patient was hospitalized or in the ICU, whether symptoms have improved, stabilized or worsened, and whether there were any preexisting lung or heart conditions.

Doctors will also conduct a physical examination during which they will check for signs of respiratory distress and listen for crackles, rales or wheezing when you breathe, which may indicate either fibrosis or airway inflammation. The examination may also include one or more of the following tests:

• Pulmonary function tests (PFTs)
• A six-minute walking test to determine lung function and capacity
• Imaging tests, such as a chest X-ray, a high-resolution computed tomography (HRCT) scan or an echocardiogram
• Lab tests, such as D-dimer, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), B-type natriuretic peptide (BNP) or an autoimmune panel

Treating an individual with long COVID with pulmonary manifestations focuses on alleviating symptoms, enhancing lung function, preventing further damage and promoting overall recovery. There is no one-size-fits-all cure; however, a growing number of effective treatments and rehabilitation strategies are available, depending on the severity and type of lung involvement.

One invaluable approach to treatment is pulmonary rehabilitation with an individualized recovery plan. Treatment plans may include breathing exercises, graded aerobic training, strength training, education and pacing strategies that aim to improve quality of life, oxygen efficiency, lung function and endurance.

Types of symptom treatments may include one or more of the following:

• Inhalers and respiratory medications
• Oral steroids
• Pulmonary rehabilitation
• Oxygen therapy
• Antifibrotic or advanced therapies
• Lifestyle changes (smoking cessation, vaccination updates, nutritional support and hydration)
• Multidisciplinary care with a team that includes cardiology, neurology, physical therapy and psychology.

Research indicates that individuals suffering from long COVID may encounter new or persistent symptoms that can significantly affect their daily activities. These symptoms can lead to health complications that may even result in disability. Addressing symptoms, engaging in pulmonary rehabilitation and incorporating lifestyle changes can enhance quality of life and overall health.

Long COVID presents differently for everyone, and those experiencing pulmonary symptoms may discover various activities, treatments or strategies that are beneficial. Speak with your healthcare provider about a personalized medical management plan designed to improve your symptoms and enhance quality of life.