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Lingering Lung Disorders 5 Years Post-COVID: Here's What To Know
The COVID-19 pandemic engulfed the U.S. Five years ago this month, leaving not only lingering mental health effects but also long-term physical symptoms.
One of those included a condition known as post-COVID pulmonary fibrosis, which involves scarring of the lungs that can worsen over time and may require a lung transplant, according to pulmonologists.
Early infection caused extensive inflammation in many different body systems, noted Dr. Scott Scheinin, MD, director of lung transplantation for Mount Sinai Health System in New York City.
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"Once they cleared that infection, a lot of people were left with some amount of lung tissue being destroyed," Scheinin told Fox News Digital during an interview.
Post-COVID pulmonary fibrosis involves scarring of the lungs that can worsen over time and may require a lung transplant. (iStock)
Scheinin provided medical care on the frontlines in New York City in the first wave of the pandemic.
"The early COVID experience in New York was the worst thing I've ever experienced in my life. It was just horrible," he recalled.
One patient's storyOne of Scheinin's patients was a pastor in his mid-50s who was infected with COVID-19 in March 2020.
Pastor Benjamin Thomas of East Meadow, Long Island, spent nearly 100 days in the hospital — 54 of which were on a ventilator — and six weeks in a medically induced coma.
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He was discharged in July 2020 with an oxygen tank. Despite overcoming the initial infection, Thomas' condition deteriorated.
In 2022, the pastor noticed that his daily activity tolerance diminished dramatically and he required more oxygen for simple tasks.
The inflammatory response sparked by early mutations of the novel coronavirus led to scarring of lungs in many individuals. (iStock)
"I couldn't take a shower for more than 30 seconds without being on oxygen," he told Fox News Digital in an interview.
Scheinin said the pastor had no underlying conditions before contracting COVID. A lung biopsy showed that Thomas' symptoms were consistent with post-inflammatory pulmonary fibrosis due to the COVID-19 infection.
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Thomas' story was remarkable in that he survived the first bout with COVID, but two years later, his lungs had deteriorated so badly from the scarring that he needed a double lung transplant, Scheinin shared.
After spending seven months on the wait list, Thomas opted to settle for one lung since that would be faster than waiting for two. His surgery was performed on Feb. 28, 2023.
"The flu and any other illness would be exacerbated because of the underlying scarring of the lung."
Now, two years after his lung transplant, Thomas says he no longer needs oxygen supplementation and is back to performing his daily pastoral activities at his church in Queens Village, New York, albeit at a slower pace than before.
The pastor has returned to long-distance driving and can now walk for about 30 minutes. He attributes his successful recovery to the efforts of his Mount Sinai medical team, his faith and prayers from his congregation.
What is post-COVID fibrosis?A healthy lung allows for the normal exchange of gases, such as oxygen and carbon dioxide, when one breathes air, Scheinin told Fox News Digital.
The inflammatory response sparked by early mutations of the novel coronavirus led to scarring of lungs in many individuals.
Testing for this condition is relatively non-invasive, typically including a cat scan or X-ray to check for structural lung damage, as well as blood tests and a pulmonary function test. (iStock)
In certain cases, the doctor said, the lungs no longer function as well as they did before the infection.
"The normal gas exchange is impeded because now you have areas of the lung tissue that are scarred, and therefore they're not functioning normally," he said.
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"If it's a small area, it may be insignificant and unnoticeable, but as more of the lung tissue becomes scarred, more of the normal lung function is destroyed, [and] the patient becomes short of breath."
This could lead to future issues, especially if the patient is exposed to other respiratory ailments.
"The flu and any other illness would be exacerbated because of the underlying scarring of the lung," Scheinin said. "I think it just makes the lungs more susceptible to injury."
Symptoms, diagnosis and treatmentSymptoms of post-COVID pulmonary fibrosis can mimic other types of interstitial lung diseases, which are disorders that cause progressive scarring and inflammation of lung tissue.
If a person who previously had a COVID infection continues to experience shortness of breath, chronic cough and change in their exercise tolerance — or if they smoke or have an underlying condition such as emphysema — they should see their physician or a pulmonologist, according to Scheinin.
Risk factors for post-COVID pulmonary fibrosis typically include an underlying chronic condition, older age, and the use of mechanical ventilation during the acute phase of COVID. (iStock)
Testing for this condition is relatively non-invasive, typically including a cat scan or X-ray to check for structural lung damage, as well as blood tests and a pulmonary function test, the doctor told Fox News Digital.
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Not everyone infected with COVID will develop pulmonary fibrosis, and the condition can vary in severity and recovery, the lung specialist noted.
In some cases, a person may have been susceptible to developing lung fibrosis due to an underlying condition and the COVID-19 infection may accelerate the fibrotic progression.
It is important to get checked out by a medical professional if you have symptoms, a lung specialist said, especially shortness of breath. (iStock)
It is important to get checked out by a medical professional if you have symptoms, Scheinin said, especially shortness of breath.
Risk factors for post-COVID pulmonary fibrosis typically include an underlying chronic condition, older age, and the use of mechanical ventilation during the acute phase of COVID, according to previous studies.
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Researchers are investigating the use of antifibrotic medications to treat the condition, along with steroids and other anti-inflammatories that are currently used to treat other lung diseases.
Besides medications, treatment may also include pulmonary rehabilitation, exercise training and behavioral modifications, according to lung specialists.
Amy McGorry is a contributing health writer for Fox News Digital. Follow her on Twitter @amymcgorry.
The Detective Work Of Identifying Work-related Lung Diseases
NORTH PHILADELPHIA (WPVI) -- Every job has its risks, but some jobs are linked to specific issues, such as lung disorders.
The risks change over time, but an expert in occupational lung diseases says the process of identifying them remains true.
From the Pennsylvania coal fields to battlefields in the Mideast, people have worked amidst dust, fumes, gases, and chemicals.
We've heard of some issues they develop like black lung, asbestos lung, and asthma, but there are hundreds of others, says Dr. Lijo Illipparambil, a pulmonary critical care expert at Temple Health.
"Like Farmer's lung. There's also Bird Fanciers' lung," says Dr. Illipparambil. "There used to be a Wine Growers lung."
Dr. Illipparambil says who develops an ailment depends on exposure, background, genetics, and still-unidentified factors.
"Some people get exposed their entire lives and have no issues, right? Others get exposed a couple times, and they end up having progressive pulmonary fibrosis," he says.
Among the first signs are a cough that doesn't go away, shortness of breath that gets worse and asthma. But because of the many diseases with similar symptoms, getting a thorough history is first and foremost.
"Because it helps us determine if there's an exposure, how much you were exposed, and some of the other background parts of your medical history can tell us - are you a higher risk?" says Dr. Illipparambil.
Questions may go back 20 or 30 years, because lung diseases can take decades to develop.
"I once got a box with about 2,500 pages of records and I went through them," says Dr. Illipparambil.
After the history comes lung function testing and a CT scan.
"Each of them has kind of their own specific way that they look on CT scan," says Dr. Illipparambil.
Occupational diseases evolve as the workplace and health standards evolve. Popcorn makers removed the chemical linked to popcorn lung, however, that chemical is now in many e-cigarette flavors.
"There's newer ones that are coming out as we get more synthetic fibers," says Dr. Illipparambil. "The earlier we start noticing something, the faster we start protecting the people who work with these materials."
Doctors and technicians do a lot of detective work in solving these cases and sometimes meet as a group to brainstorm tough ones.
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How To Interpret Lung Nodules On A Chest X-Ray: Can They Be Cancerous?
Chest X-rays are an effective method to assess your lungs and heart. It is often considered when a patient complains of symptoms like chest pain, shortness of breath, and persistent cough. Often incidentally, medical professionals detect small, abnormal growths in the lungs, which might cause some worry. These are also known as lung nodules. In an interaction with the OnlyMyHealth team, Dr Shriram Shenoy, Consultant Pulmonologist, Manipal Hospital, Kharadi, explains ways to interpret, assess, and monitor lung nodules.
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What Are Lung Nodules?"Lung nodules are tiny growths in the lung tissue that are round or oval in shape and generally have a diameter of less than three centimetres," describes Dr Shenoy, adding that they tend to be found by chance during a chest X-ray or CT scan that is done for unrelated purposes.
According to a 2022 study published in the JAMA, lung, or pulmonary, nodules are identified in approximately 10.6 lakh people per year in the US and are detected on about 30% of chest CT scans.
The majority of lung nodules don't cause any symptoms and could indicate either benign or cancerous.
While a chest X-ray gives a first look, a CT scan gives a more comprehensive assessment that helps identify the nodule's size, form, and features.
To differentiate benign nodules from those that need more assessment, additional imaging or follow-up procedures are sometimes required. Further treatment is influenced by variables such as the nodule's appearance, smoking status, and patient history.
Can Lung Nodules Be Cancerous?Most lung nodules are benign and are caused by inflammation, infections, or non-cancerous growths like hamartomas or granulomas. According to Dr Shenoy, the percentage of malignant lung nodules is lower, and those who have a history of smoking, exposure to chemicals, or a family history of lung cancer are at higher risk.
Size, form, and growth rate are some of the variables that affect the chance of malignancy. While larger or irregularly shaped nodules need closer examination, nodules smaller than 6 mm have a lower chance of being malignant. The type of nodule and the necessity of additional treatment are ascertained with the aid of follow-up imaging and other testing.
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Follow-Up Tests To Assess Lung NodulesWhile most lung nodules are harmless and benign, it is always advised to assess them and keep them under close observation.
Multiple types of additional tests are usually used to evaluate lung nodules based on their size, appearance, and risk factors. "To evaluate changes over time, high-resolution CT scans offer thorough imaging. PET scans can be used to evaluate metabolic activity, particularly in nodules that are bigger or appear suspicious. Before any invasive operation, pulmonary function testing aids in determining lung capacity," says Dr Shenoy.
He adds, "When cancer is suspected, a biopsy may be done for histological study using bronchoscopy, needle aspiration, or surgical excision. In certain situations, molecular profiling and blood testing are employed. Regular imaging follow-up over several months or years helps in tracking the development of nodules."
When Is A Biopsy Required?According to the doctor, monitoring of solitary lung nodules is often guided by the Fleischner Society pulmonary nodule recommendations. The Fleischner Society Guidelines provide recommendations for managing incidental pulmonary nodules detected on CT scans in adults less than or equal to 35 years old.
"After six to twelve months, follow-up imaging is often required for low-risk individuals with small nodules (less than 6 mm). Repeat CT scans may be required more frequently for larger nodules or those with questionable characteristics. If a nodule exhibits strong metabolic activity on a PET scan, has uneven or spiculated boundaries, or shows considerable growth, a biopsy is required. Patients with a high-risk profile or those who exhibit symptoms are also advised to undergo invasive testing. A multidisciplinary team approach ensures the best possible diagnosis and treatment choices," shared Dr Shenoy in detail.
ConclusionLung nodules are usually harmless; however, it is always necessary to monitor them. Size, growth pattern, and related risk factors are some of the variables that affect when lung nodules need to be monitored, says Dr Shenoy. For more information or clarification, it is best to consult a doctor and understand individual risk and circumstances
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