www.klinickafarmakologie.cz / Klin Farmakol Farm 2022;36(3):101-107 / KLINICKÁ FARMAKOLOGIE A FARMACIE 107 HLAVNÍ TÉMA Post-COVID-19 pľúcna fibróza a možnosti jej liečby Výsledná kategória (A–D) vychádza z kombinácie nálezu pri objektívnych vyšetreniach (pozitívne nálezy v pravom stĺpci) a subjektívnych symptómov (pozitívne nálezy v dolnom riadku). V prípade, že pacient trpí aj v dôsledku extrapulmonálnych symptómov, tak sa uvedie navyše písmeno „E“. Významné patologické nálezy v rámci patologického hodnotenia: Funkčné vyšetrenie pľúc – difúzna kapacita pľúc (transfer faktor) – DLco <80% náležitých hodnôt. 6-minútový test chôdze – 6MWT – či iná fyzická záťaž založená na chôdzi či jednoduchom pohybe vedie k poklesu saturácie kyslíka o >4% alebo pri absolútnom poklese pod 90%. Patologické nálezy pri zobrazovacích vyšetreniach pľúc: RTG (skiagram) hrudníka (prípadne CT/HRCT pľúc, ultrasonografia pľúc a iné.) nevysvetliteľné inak. Medzi typické nálezy patria opacity charakteru mliečneho skla (periférne, bilaterálne), konsolidácie parenchýmu pľúc s voľným bronchogramom, zhrubnutie interlobulárnych sept, crazy paving, fibrózne pruhy a lineárne opacity, retikulácie, mierne zhrubnutie pleury a neveľké pleurálne výpotky. LITERATÚRA 1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-733. 2. WHO1: https://www.who.int/dg/speeches/detail/who- -director-general-s-statement-on-ihr-emergency-committee-on-novel-coronavirus-(2019-ncov) [Citované 17.5.2022]. 3. WHO2: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at- -the-media-briefing-on-covid-19---11-march-2020 [Citované 17.5.2022]. 4. WHO3: WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data. https://covid19.who.int/ [Citované 9.5.2022]. 5. Koronavírus na Slovensku v číslach – Koronavírus a Slovensko (gov.sk). https://korona.gov.sk/koronavirus-na-slovensku- -v-cislach/ [Citované 9.5.2022]. 6. George PM, Wells AU, Jenkins RG. Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy. Lancet Respir Med 2020;8:807-815. https://doi.org/10.1016/S22132600(20)30225-3 [Citované 17.5.2022]. 7. Hall MW, Joshi I, Ooi EE. Immune Immunomodulation in Coronavirus Disease 2019 (COVID-19): Strategic Considerations for Personalized Therapeutic Intervention. Clin Infect Dis 2022;74(1):144-148. 8. Tanni SE, Fabro AT, de Albuquerque A, et al. Pulmonary fibrosis secondary to COVID-19: a narrative review. Expert Rev Respir Med 2021;15(6):791-803. https://doi.org/10.1080/17476 348.2021.1916472 [Citované 9.5.2022]. 9. Kumar N, Gupta A, Vardhan H et al. Post-COVID-19 Pulmonary Fibrosis: An Update. J Adv Res Med 2021;8(2):16-26. 10. Ngai JC, Ko FW, Ng SS, et al. The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology. 2010;15(3):543-550. https://doi.org/10.1111/j.1440-1843.2010.01720.x [Citované 17.5.2022]. 11. Das KM, Lee EY, Singh R, et al. Follow-up chest radiographic findings in patients with MERS-CoV after recovery. Indian J Radiol Imaging. 2017;27(3):342-349. https://doi.org/10.4103/ ijri.IJRI_469_16 [Citované 17.5.2022]. 12. Zhang P, Li J, Liu H, et al. Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study, Bone Res 2020;8:8. 13. Myall KJ, Mukherjee B, Castanheira AM, et al. Persistent Post-COVID-19 Interstitial Lung Disease An Observational Study of Corticosteroid Treatment. Ann Am Thorac Soc 2021;18(5):799-806. https://doi.org/10.1513/AnnalsATS. 202008-1002OC [Citované 9.5.2022]. 14. Mo X, Jian W, Su Z, Chen M, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J 2020;55(6):2001217. 15. George PM, Barratt SL, Condliffe R, et al. Respiratory follow- -up of patients with COVID-19 pneumonia. Thorax 2020;0:1-8. doi:10.1136/thoraxjnl-2020-215314 [Citované 9.5.2022]. 16. Sonnweber T, Sahanic S, Pizzini A, et al. Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial. Eur Respir J 2021;57:2003481. https:// doi.org/10.1183/13993003.03481-2020 [Citované 17.5.2022]. 17. Burnham EL, Hyzy RC, Paine R, et al. Chest CT features are associated with poorer quality of life in acute lung injury survivors. Crit Care Med 2013;41(2):445-456. 18. Bazdyrev E, Rusina P, Panova M, et al. Lung Fibrosis after COVID-19: Treatment Prospects. Pharmaceuticals 2021;14:807. https://doi.org/10.3390/ph14080807 [Citované 17.5.2022]. 19. Udwadia ZF, Koul PA, Richeldi L. Post-COVID lung brosis: The tsunami that will follow the earthquake. Lung India 2021;38:S41-S47. 20. Rai DK, Sharma P, Kumar R. Post covid 19 pulmonary brosis- Is it reversible? Indian Journal of Tuberculosis 2021;3:330-333. https://doi.org/10.1016/j.ijtb.2020.11.003 [Citované 9.5.2022]. 21. Arnold DT, Donald C, Lyon M, et al. Krebs von den Lungen 6 (KL-6) as a marker for disease severity and persistent radiological abnormalities following COVID-19 infection at 12 weeks. PLOSone 2021;16(4):e0249607. doi: 10.1371/journal. pone.0249607. eCollection 2021 [citované 17.5.2022]. 22. Huang W, Wu Z, Chen Z, et al. The potential indicators for pulmonary brosis in survivors of severe COVID-19. J Infect 2021;82:e5-e7. https://doi.org/10.1016/j.jinf.2020.09.027. [Citované 17.5.2022]. 23. Laššán Š, Hájková M, Solovič I. Pozičný dokument a spoločné odporúčania hlavného odborníka Ministerstva zdravotníctva sr pre odbor pneumológia a ftizeológia a výboru Slovenskej pneumologickej a ftizeologickej spoločnosti SLS pre poskytovanie zdravotnej starostlivosti pacientom s pľúcnym postihnutím po prekonanom ochorení COVID-19. Dostupné na: https://spfs.sk/images/ oznamy2021/post_covid_5-2021. pdf [Citované 17.5.2022]. 24. Kopecký M, Skála M, Neumannová K, et al. Poziční dokumenty České pneumologické a ftizeologické společnosti ČLS JEP - Post-COVID syndrom/postižení – definice, diagnostika a klasifikace. pneumologie.cz [online], 2021. http://www.pneumologie.cz/upload/1624982759.pdf [Citované 24.8.2022]. 25. Barouch DH. Covid-19 vaccines – immunity, variants, boosters. N Engl J Med 2022. DOI: 10.1056/NEJMra2206573 [Citované: 1.9.2022]. 26. Mohammed I, Nauman A, Paul P, et al. The efficacy and effectiveness of the COVID-19 vaccines in reducing infection, severity, hospitalization, and mortality: a systematic review. Human Vaccines Immunother 2022;18(1):e2027160. https:// doi.org/ 10.1080/21645515.2022.2027160 [Citované: 1.9.2022]. 27. NIH. National Institutes of Health. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. https://www.covid19treatmentguidelines.nih.gov/ management/clinical-management /nonhospitalized-adults--therapeutic-management/ [Citované: 11.8.2022]. 28. Laššán Š, Laššánová M. Stručný súhrn navrhovanej ambulantnej a ústavnej farmakologickej liečby ochorenia COVID-19 na Klinike pneumológie, ftizeológie a funkčnej diagnostiky LF SZU a Univerzitnej nemocnice Bratislava. Respiro 2021;19(4):24-67. 29. Yu W, Guo F, Song X. Effects and Mechanisms of pirfenidone, prednisone and acetylcysteine on pulmonary brosis in rat idiopathic pulmonary brosis models. Pharm Biol 2017;55:450-455. 30. Kostorz-Nosal S, Jastrzębski D, Chyra M, et al. A prolonged steroid therapy may be beneficial in some patients after the COVID-19 pneumonia. Eur Clin Respir J 2021;8:1945186. 31. Segala FV, Sgalla G, Salvati F, et al. Adjunctive corticosteroid treatment for organizing pneumonia in COVID-19 patients with persistent respiratory failure. Respir Med 2021;187:106571. 32. Dhooria S, Chaudhary S, Sehgal IS, et al. High-dose versus low-dose prednisolone in symptomatic patients with post-COVID-19 diffuse parenchymal lung abnormalities: an open-label, randomised trial (the COLDSTER trial). Eur Respir J 2022;59:2102930. DOI: 10.1183/13993003.02930-2021 [Citované 17.5.2022]. 33. Flaherty KR, Wells AU, Cottin V, et al. Nintedanib in progressive interstitial lung diseases: data from the whole INBUILD trial. Eur Respir J 2022;59:2004538. DOI: 10.1183/ 13993003.04538-2020 [Citované 17.5.2022]. 34. Behr J, Prasse A, Kreuter M, et al. Pirfenidone in patients with progressive fibrotic interstitial lung diseases other than idiopathic pulmonary fibrosis (RELIEF): a double-blind, randomised, placebo-controlled, phase 2b trial. Lancet Respir Med 2021;9:476-486. https://doi.org/10.1016/S22132600(20)30554-3 [Citované 17.5.2022]. 35. Wollin L, Wex E, Pautsch A, et al. Mode of Action of Nintedanib in the treatment of idiopathic pulmonary brosis. Eur Respir J 2015;45:1434-1445. 36. Margaritopoulos GA, Vasarmidi E, Antoniou KM. Pirfenidone in the treatment of idiopathic ulmonary brosis: An evidence-based review of its place in therapy. Core Evid 2016;11:11-22. 37. Wigén J, Löfdahl A, Bjermer L, et al. Converging pathways in pulmonary fibrosis and Covid-19 – The fibrotic link to disease severity. Respir Med 2020;2:100023. https://doi.org/10.1016/j.yrmex.2020.100023 [Citované 17.5.2022]. 38. https://clinicaltrials.gov/ct2/results?cond=covid+19&- term=pirfenidone&cntry=&state=&city=&dist= [Citované 17.9.2022]. 39. Skala M, Svoboda M, Kopecky M, et al. Heterogeneity of post-COVID impairment: interim analysis of a prospective study from Czechia. Virol J. 2021;18:73. doi.org/10.1186/ s12985-021-01546-8. 40. Zhang C, Wu Z, Li JW, et al. Discharge may not be the end of treatment: Pay attention to pulmonary fibrosis caused by severe COVID-19. J Med Virol 2021;93:1378-1386. 41. Echeverría-Esnal D, Martin-Ontiyuelo C, Navarette-Ruoco ME, et al. Azithromycin in the treatment of COVID-19: a review. Expert Rev Antiinfective Ther 2021;19(2):147-163. https:// doi.org/10.1080/14787210.2020.1813024 [Citované 17.5.2022].
RkJQdWJsaXNoZXIy NDA4Mjc=