Mehta, Puja; Rosas, Ivan O; Singer, Mervyn; (2022) Understanding post-COVID-19 interstitial lung disease (ILD): a new fibroinflammatory disease entity. Intensive Care Medicine , 48 pp. 1803-1806. 10.1007/s00134-022-06877-w.

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Abstract

Immunomodulation and immunity from vaccination and natural infection have reduced mortality from coronavirus disease 2019 (COVID-19). However, there are ongoing concerns regarding emerging variants and residual pulmonary sequelae in survivors, given that the lungs are the principal site for the triumvirate of infection, inflammation and injury. The initial waves of acute, severe COVID-19 were profoundly inflammatory, usually manifest as organising pneumonia ± acute respiratory distress syndrome (ARDS). The extent of the fibrogenic potential of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the modifiability of the pathogenic processes and disease course are unclear. Interestingly patients can develop ‘post-COVID interstitial lung disease’ (PC-ILD) irrespective of having ARDS during the acute phase. Here, we describe our evolving understanding of PC-ILD and the critical need to identify risk factors, including within the critical care setting. We also discuss immunopathomechanisms that may facilitate early intervention to prevent, slow or arrest progression of lung damage e.g. with immunomodulatory and/or anti-fibrotic agents.

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