The unprecedented coronavirus pandemic has triggered large-scale anxiety all over the world. As COVID-19 pandemic continues to pose challenges, health care providers try to efficiently balance the risk factors that predisposes them to a more severe course of COVID-19– related illness, including older age, higher prevalence of comorbidities. There are different comorbidities which increase the risk in Covid-19 infections. This includes diabetes, hypertension, ischemic heart disease, chronic kidney disease, chronic liver disease etc. However, the increased risk of chronic respiratory disease is of paramount importance
In 2020, the Lung diseases affected hundreds of millions of people around the world across all ages and levels of socioeconomic status. Despite a high burden of Chronic Respiratory Diseases worldwide, CRDs (such as asthma or COPD) has been consistently identified as a significant comorbidity for COVID-19.
However, the greatest morbidity and mortality is amongst the elderly, specially above the age 60 years. While the world is still coping with a overwhelming amount of COVID cases, there are additional problems that are being observed amidst the ongoing crisis. Many patients seem to have post-covid sequel after having successfully recovered. A majority of are suffering from fibrotic complications of post Covid sequel. Highlighting the post covid sequel, Dr. Raja Dhar, Director & HOD, Department of Pulmonology, CMRI says “The lungs in the post covid period specially in patients with severe covid pneumonia or in patients who are dependent on oxygen during the course of their hospital stay have a post covid fibrotic disorder which seems to behave similar to interstitial lung disease. These patients are either hypoxic at rest (low oxygen level during rest) or they dropped their oxygen levels when they walk or indulge in any activities. Doing the CT scan in these individuals shows these areas of scarring within the lung. The expert team has noticed that often the scarring is permanent and there are certain scan features which indicate that the scarring might be permanent. In these individuals, there is specific treatments which is directed to reducing the progression of fibrosis. These medications are called Anti-fibrotic medications which seem to help also in post Covid fibrosis. Besides, there are steroids which reduce the progression of fibrosis in Covid patients. However, steroids need to be used with caution in this scenario because steroids cause immuno suppression which increases the risk of secondary infections”.
He further explains “Covid fibrosis is not the only post Covid sequel. A small minority of patients can also get what has been described as reactive airways disease. These individuals can experience an Asthma like condition where there is chronic cough, there is wheezing and people feel breathless on exertion. Often these patients have had previous allergic Asthma which has got unmasked due to the presence of Covid-19 infection. Treating these patients with inhaled and Corticosteroids prednisolone as you would do in a patient with Asthma remains the standard of care. Beside this, the tiredness, lethargy, fatigue, neurological symptoms like headache etc. are all sequel of Covid which not only a pulmonologist be aware of but various specialities and specialist should be well informed, to treat these complications effectively with care and empathy”.
CMRI wishes to build a state of the art pulmonology department which would hopefully compete with the very best in the country or even in the continent. The aim would be on a team approach where a group of specialists with interest with various subspecialty areas of pulmonology work together in delivering care which would be compassionate and would involve good communication with patients and their families. Interventional pulmonology is an upcoming speciality which is of great interest to the young pulmonologist throughout country. This involves diagnostics procedures like endobronchial ultrasound where the sampling of clans within the mediastinum (the space between the lung and the heart) can be achieved with great accuracy. It is resulted in almost the abolishment of invasive procedures like surgical mediastinoscopy and other surgical procedures. Then there is thoracoscopy where samples are taken from the lining of lung and fluid accumulation around the lung can be drained in an effective manner. There are hot and cold procedures where tumours can be debulked, stents can be placed within the breathing tubes to keep them open, foreign bodies can be removed from the breathing tubes and there is host of other interventions which are of great importance and of interest to a pulmonologist.
“Building of specialist clinics like the flight assessment clinic. A flight assessment clinic assesses the capability of an individual with chronic respiratory disease to fly short or long distances. On a flight at high-altitude patients tend to drop their oxygen level and often supplemental oxygen is required in flights which gets assessed during the flight assessment test. The other area of interest would be pulmonary rehabilitation. A lot of you have heard about cardiac rehabilitation which is for patients with heart ailments, Pulmonary rehabilitation is equally important if not more because it helps in graded exercises for patients with chronic respiratory disabilities. These individuals not only exercise with specific focus on their breathing muscles but also have dietetic support get looked at by an occupational therapist, have psychiatric sessions to improve their mood etc. We also hope to do a post Covid lung clinic where the Covid complications are looked at by specialist pulmonologist and again a team approach has been described before. However above all this is working together as a group of doctors, nurses, therapist, administrative staff together emphasizing on patient care and making sure that we deal with patients the way we would deal with our own families. We hope this compassionate attitude will reflect in the quality of care that we deliver to our patients” expressed Dr. Dhar.
