Will there be lung damage following recovery from COVID-19?

Recently, as more and more COVID-19 patients have fully recovered and discharged, everyone has begun to pay attention to whether the disease will have long-term effects on the body and whether there will be lung damage.

Most COVID-19 patients will recover with no sequalae

On January 31, Zhan Qingyuan, director of the fourth and fifth Department of Respiration of the Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, said at a press conference held by the National Health Commission that: "For 2019-nCov infection, clinical studies show that it mainly involves the lungs, and less severe cases of COVID-19 will recover without sequelae, but there may be repair of lung damage over a period of time for severe cases of COVID-19, such as those with pulmonary fibrosis. Therefore, more follow-up visits are needed for severe cases. I believe that the lung has greater repair capacity, and most of the pulmonary fibrosis can be repaired based on my own clinical experience. However, pulmonary fibrosis may exist over a relatively long period of time for a very few severe and critical cases of COVID-19, so more follow-up visits are needed."

He Bei, chief physician of the Department of Respiration of Peking University Third Hospital, said in an interview with the Tencent Medpedia that "an autopsy report from a critically ill patient with COVID-19 who died showing obvious lung damage has been released. However, according to the discharge criterion of the sixth edition of the diagnosis and treatment scheme, the lung CT scan should show obvious absorption and improvement despite the COVID-19 patient's condition; follow-up visits are advised for COVID-19 patients in the second and fourth week. Final pulmonary infection and absorption is subjected to further observation."

What is pulmonary fibrosis?

Pulmonary fibrosis is a textural anomaly (scar formation) caused by abnormal repair after normal alveoli are damaged.

The process of pulmonary fibrosis consists of inflammatory damage of lung tissue, destruction of structure in the lung tissue, and cell proliferation and accumulation in the lung interstitium.

If minor damage is produced with only a few cord-like changes, normal structure and function can be restored after repair without any impact on health. When serious or repeated damage is produced, frequent "repair" will cause fibrosis or scarring.

What are the symptoms of patients with pulmonary fibrosis?

In general, it is rare to see pulmonary fibrosis developed from viral pneumonia. If a cord-like shadow of old lesions is left, there may be no symptoms.

Specific symptoms of pulmonary fibrosis include dyspnea, chronic cough, expectoration, pant, chest tightness, and other systemic symptoms such as weight loss, loss of appetite, peripheral muscle atrophy and dysfunction, mental depression and/or anxiety.

Pulmonary fibrosis is characterized by dyspnea. If mild pulmonary fibrosis develops, dyspnea will occur in aggravating activities. As pulmonary fibrosis evolves, dyspnea also occurs in a resting state. Patients with severe pulmonary fibrosis may experience progressive dyspnea.

Which COVID-19 patients require rehabilitation?

Performing rehabilitation and restoring vigor to the body and pulmonary function as soon as possible after discharge are the most important issues faced by COVID-19 patients after recovery. Especially when COVID-19 patients recover, if partial pulmonary fibrosis remains and pulmonary function is not fully restored, dyspnea, decreased exercise tolerance, limitation of motion and other symptoms are indications for rehabilitation therapy.

What can rehabilitation improve? How?

Rehabilitation can ease the dyspnea symptoms, improve exercise tolerance, enable patients to restore vigor to the body and participate in social activities, thus improving the quality of life.

Patients can get rehabilitation therapy from the following aspects.

1. Exercise to improve pulmonary function. COVID-19 patients mainly have increased alveolar exudation, which affects alveolar oxygenation. The focus of pulmonary rehabilitation is on the exercise to improve pulmonary function, open the airway and improve pulmonary ventilation and pulmonary capacity.

Common methods of exercise to improve pulmonary function are pursed lip breathing and abdominal breathing. Specific methods are as follows:

· Pursed lip breathing: Breathe in through your nose, breathe out slowly and evenly through pursed lips. Breathe out twice as long as you breathe in. Practice pursed lip breathing for ten minutes about three to four times a day.

· Abdominal breathing: Lie down on your back in a comfortable position with your hip joint and knees slightly bent. Place your hands on your abdomen and chest, practice pursed lip breathing. Your belly expands as you inhale and retracts as you exhale. Practice for about five to ten minutes.

2. All-round exercise: It is mainly to boost the full body endurance of the patient and improve the cardiopulmonary function. Aerobic exercise is recommended, such as jogging, Taijiquan (a kind of traditional Chinese shadow boxing) and bicycle riding.

3. Maintain a balanced diet. Eat more foods rich in high-quality protein, vitamins and trace elements, and an appropriate amount of foods that nourish yin and moisturize the lung, such as pears and lilies.

4. Follow a strict daily routine, improve the home environment, pay attention to ventilation and avoid stimulating harmful gases, smoke and dust. Prohibit smoking and create a smoke-free environment. It is necessary for the patient to be careful not to catch cold.

(Reviewed by He Baimei from Xiangya Hospital Central South University)

Stories in this series were contributed by Tencent Medpedia medical team and written and reviewed by medical experts from China's top hospitals. It is intended for informational purposes only, not as a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on our website. If you think you may have a medical emergency, immediately call your doctor, or go to the hospital.