The effectiveness of glucocorticoid treatment in post-COVID- 19 pulmonary involvement

Abstract

Abstract Rationale: Persistent respiratory symptoms following Coronavirus Disease 2019 (COVID-19) are associated with residual radiological changes in lung parenchyma, with a risk of development into lung fibrosis; and with impaired pulmonary function. Previous studies hinted the possible efficacy of corticosteroids (CS) in facilitating the resolution of post-COVID residual changes in the lungs, but the available data is limited. Aim: To evaluate the effects of CS treatment in post-COVID respiratory syndrome patients. Patients and methods: Post-COVID patients were recruited into a prospective single-center observational study and scheduled for an initial (V1) and follow-up visit (V2) at the Department of Respiratory Medicine and Tuberculosis, University Hospital Olomouc, comprising of pulmonary function testing, chest x-ray, and complex clinical examination. The decision to administer CS or maintain watchful waiting (WW) was in line with Czech national guidelines. Results: The study involved 2729 COVID-19 survivors (45.7% male; mean age: 54.6). From 2090 patients with complete data, the largest proportion of patients with persistent lung abnormalities on imaging studies was seen in moderate (14.5%) and severe (31.4%) COVID-19 groups. The patients selected for CS therapy showed significantly worse radiological and functional impairment at V1. At V2, the rates of subjective and radiological improvement, and dynamic lung volumes, were similar in CS and WW groups. However, static lung volumes and lung diffusion capacity for carbon monoxide (DLCO) improved significantly more in the CS group, with the vital capacity (VC) increasing by a mean of 493.72 ml (13.01 %predicted) and DLCO by a mean of 9.19 %predicted (p <0.0001). Conclusion: While the rates of subjective and radiological improvement were similar between the study groups, the CS group saw significantly better rates of improvements of static lung volumes and DLCO. Our findings suggest that glucocorticoid therapy could benefit selected patients with persistent dyspnea, significant radiological changes, and decreased DLCO.