News in post-COVID-19 syndrome treatment and rehabilitation as discussed at sites of the 31st National Congress on Respiratory Diseases

How is post-COVID-19 syndrome treated? At the 31st National Congress on Respiratory Diseases, which opened in Moscow on October 26, pulmonologists and other medical specialists were introduced to the first experience of rehabilitation and follow-up of COVID-19 patients.

The agenda of the Treatment Options for Patients with Signs of Physiological and Functional Lung Deficiency after COVID-19 workshop included the speech of Dr. Paul Bollyky, immunologist, associate professor at the Stanford University School of Medicine. He shared the first clinical insights that may open new therapeutic options for COVID-19 patients.

The therapy can target hyaluronic acid, which is a predominant component of respiratory secretions in COVID-19 patients and can cause edema and inflammation, decreased oxygen saturation, or lung function deterioration.

“At the center, we conducted a study to explore the respiratory secretions in newly intubated coronavirus patients n. We assessed the viscosity of these samples. Thick and viscous secretions was similar to that observed in cystic fibrosis (a genetic disorder famous for thick respiratory secretions).
said Dr. Paul Bollyky.

The study showed that hyaluronic acid is the main component of bronchopulmonary discharge in coronavirus patients with thick and viscous sputum, pulmonary inflammation and edema. The hyaluronic acid content is almost the same as in cystic fibrosis patients.

Currently, there are some ongoing studies assessing the possibility to use these methods in the treatment of COVID-19 patients and their efficacy.

Prof. Galina Ignatova, Dr. Sc. Med, Chief External Expert in Pulmonology in the Ural Federal District, confirmed the words of the American colleague.

“Indeed, according to the published data, the respiratory secretions from COVID-19 patients can show a 10-fold increase in the hyaluronic acid content compared to healthy individuals; therefore, from a pulmonologist’s perspective, removal of excessive hyaluronic acid can be considered one of the main tasks when treating COVID-19 patients,”
said Dr. Galina Ignatova.

Prof. Ignatova quoted data from a multicenter, open-label study of Longidaza efficacy and safety in patients with residual pulmonary abnormalities. The study was conducted in 13 Russian healthcare centers and included 160 subjects recovered from COVID-19 with signs of functional lung deficiency. After discharge from hospital, all patients were followed up on an outpatient basis and received Longidaza in the period from day 21 to 2.5 months from diagnosis establishment.

The summarized study results suggest that therapy with Longidaza, a drug intended for excessive hyaluronic acid breakdown, can improve lung function. The patients receiving the drug showed greater improvement in lung fuction measured by FVC, % (forced vital capacity) as well as more pronounced dynamics of dyspnea reduction. The results of the 6 minute walk test were also higher in the group of patients taking Longidaza, compared to those who did not take the drug product.

According to prof. Vladimir Antonov, Dr. Sc. Med, Chief Pulmonologist of Chelyabinsk, a discharge from hospital does not mean full recovery as the readmission risk is very high. The statistics suggest that among all patients with a positive PCR test for SARS-CoV-2, about 14% reported persisting dyspnea, tachypnea, hypoxia, or CT signs of ground-glass opacity after recovery.

“According to the WHO definition, the concept of post-COVID syndrome can be applied to patients with symptoms persisting for 12 weeks after COVID-19 diagnosis. Post-COVID syndrome is a new challenge that both pulmonologists and general practitioners are facing today. There is a need for rehabilitation programs. Rehabilitation is a new branch of studies aimed to find efficacious treatment methods,”
said Dr. Vladimir Antonov.

A specific feature of the current wave of coronavirus infection is a more severe treatment-resistant course with slow recovery and a high risk of disability and deterioration in the quality of life. According to Dr Vladimir Antonov, the HCPs did not see such coronavirus incidence in young people and children during the first and second waves. In this respect, rehabilitation of patients and diminution of incidence of delayed unfavorable disease consequences are high-priority tasks for HCPs.

Vladimir Antonov presented two clinical cases of severe COVID-19 complicated with dyspnea and low oxygen saturation levels. After a course of Longidaza, patients demonstrated improvement in-objective and subjective signs of the respiratory system.

“As evidence suggests, Longidaza is efficacious in these situations. The routine clinical practice confirms that the drug can be also efficacious for the treatment of post-COVID syndrome,” concluded the expert.

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