The consequences of the coronavirus can be more dangerous than its acute phase. According to statistics, almost half of recovered patients find changes in the lungs after infection. And re-hospitalization after discharge and mortality of elderly patients occurs in approximately 27% of cases. Such data were announced at the All-Russian conference “Covid-19: Expert experience in a pandemic. All about diagnostics, prevention, treatment, rehabilitation of patients.
What is the danger of post-COVID syndrome?
Today, doctors have to reconsider the tactics of treating post-covid syndrome in favor of antifibrotic therapy, Professor, Academician of the Russian Academy of Sciences Alexander Chuchalin shared with colleagues. The post-covid period in a patient is accompanied by a number of changes in the lungs — they are diagnosed in about half of patients who have had covid. These processes are characterized by remodeling of the lung tissue, with the participation of the vessels of the pulmonary circulation, and the recovery process is disrupted. Collagen is deposited in the connective tissue, which leads to the formation of fibrous changes. The main manifestation of these post-covid changes in the lung tissue is shortness of breath, the intensity of which increases with physical exertion.
“A large amount of hyaluronic acid accumulates in the lungs at this moment, which leads to edema. There is a violation of the regulation of water-electrolyte metabolism. It is reduced in volume, gas exchange functions are disturbed in it, a scar is formed. The lung begins to resemble burnt rubber,” said Alexander Chuchalin.
According to Tatyana Nikolaevna Bilichenko, professor, pulmonologist at the Research Institute of Pulmonology of the Federal Medical and Biological Agency of Russia, patients with severe COVID-19 at the recovery stage have a high chance of developing post-covid syndrome due to systemic organ damage and a long-term inflammatory process. Therefore, a clinical examination in the post-COVID period must necessarily include studies aimed at assessing the inflammatory process. The 6-minute walk test is also important to help monitor patient exercise tolerance during treatment. With a decrease in the level of saturation when walking by more than 4%, it can be assumed that the ongoing methods for restoring lung function are insufficient and additional therapy is required.
New approaches to lung recovery after covid
Drugs containing the enzyme hyaluronidase are now regarded by physicians as promising for the treatment of patients with residual changes in the lungs after covid. Scientists explain this by the fact that hyaluronidase is able to enhance the diffusion of oxygen into tissues, so that the patient recovers faster. The discovery of such enzyme properties can be considered a real achievement of science and medicine.
Professor of the Department of Phthisiology and Pulmonology of the Medical Faculty of Moscow State Medical University named after A.I. Evdokimov, Doctor of Medical Sciences Sergey Babak told what the strategy of drug therapy for post-COVID patients should be based on. It is important to remember that shortness of breath and fatigue persist in 52.4%, and difficulty breathing in 47.6% of post-COVID patients. The expert identified 5 positions that practitioners should focus on. This is an improvement in ventilation and gas exchange, nutritional support for the patient, an increase in his physical endurance, overcoming external and internal «stress agents», correction of sleep disorders.
Professor Sergei Babak spoke about the original domestic drug Longidaza®, which contains bovhyaluronidase on an azoximer carrier, which allows the drug to retain its activity for a long time.
“The DISSOLVE study on the activity of Longidase in post-COVID patients showed that 58.4% of patients had a positive effect, and among them in 44.6% it exceeded 10%1. The second most important result was the improvement in gas exchange as measured by the 6-minute walk test. The result is impressive: a significant improvement in performance (by 30 percent or more) was observed both on the 75th day and on the 180th day of observation, which clinically means the almost complete elimination of dyspnea both at rest and during exercise in this category of patients.
< h2>Restoration of lung tissue and elimination of respiratory symptoms
Professor Sergey Babak shared the results of his own experience of prescribing antifibrotic therapy to outpatients of the Center for Respiratory Medicine. He demonstrated a clinical example of a 44-year-old man with obvious radiological interstitial changes with impaired diffusive capacity of the lungs, which were eliminated by complex outpatient therapy with the inclusion of bovhyaluronidase azoximer. Assessment of the radiographic and functional picture in the second month of therapy established the restoration of the structure and function of the lung tissue, an increase in the vital capacity of the lungs by +810 ml, and the diffusion capacity of the lungs up to 100% of the proper values. “Clinically, this was characterized by the complete elimination of respiratory symptoms, especially shortness of breath during physical activity,” said Professor Sergei Babak.
At the conference, data on the use of Longidaza were also announced, which showed that during the first 4 days of the course the drug significantly softened the regimens of respiratory therapy in a severe patient, and after 9 days the patient's health improved so much that he was transferred from intensive care to the somatic department, where he already dispensed with oxygen support. At discharge, the patient's saturation level was close to normal. And the full effect of this therapy was assessed by physicians after 2 months during the control visit of the patient. By that time, the lung tissue was already almost completely restored, which indicates a very good clinical dynamics. >Links:
1. Statistical report of the DISSOLVE v1.0 study of 20.09.2021