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COVID-19 And Pulmonary Fibrosis: Causes, Symptoms, Risk Factors And Treatments

According to a news report, patients cured of COVID-19 at Mumbai's KEM hospital have reported a serious lung condition called pulmonary fibrosis, after being discharged a month earlier. The hospital committee has reported around 22 such cases. The report also mentions that none of the patients has a history of lung injury and was also not facing any breathing problems at the time of discharge.

COVID-19 is a viral disease that mainly impacts the lungs. However, it is still unclear how those patients got pulmonary fibrosis, even when they recovered from the condition. The only common thing among them were all had pneumonia at the time of their treatment for COVID-19.

In this article, we will discuss pulmonary fibrosis, its causes, symptoms, treatments and other details. Take a look.

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What Is Pulmonary Fibrosis?

Pulmonary fibrosis is a progressive and chronic lung condition that causes scarring in the lung tissues. The scarring leads to low oxygen levels in the blood, making a person unable to breathe properly, especially during exercise or walking. [1]

Pulmonary fibrosis is not a single disease but consists of a large number of lung diseases that include scar tissue in the lungs. Several factors are responsible for the scarring and a medical expert is sometimes unable to point out just a single cause. From the aforementioned report, COVID-19 infection is also considered one of the risk factors for pulmonary fibrosis.

Like diabetes or other chronic diseases, pulmonary fibrosis cannot be treated and only its symptoms can be managed to improve the quality of life.

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COVID-19 And Pulmonary Fibrosis

Pulmonary fibrosis can develop as a result of chronic inflammation to the lungs due to Acute respiratory distress syndrome (ARDS). Several reports suggest that around 40 per cent of people with COVID-19 were admitted to intensive care due to the development of ARDS. [2]

Possible factors such as cytokine release due to COVID-19 viral antigen, high airway pressure, drug-induced lung toxicity and acute lung injury due to exposure to high levels of oxygen in ill patients can be the possible cause.

It was also noticed that the average age of people who were admitted due to severe COVID-19 was more compared to people admitted during SARS and MARS. This shows that advancing age can be one of the risk factors for pulmonary fibrosis induced due to severe COVID-19.

Pulmonary fibrosis leads to declining of the lung functions and quality of life. Though a person gets recovered from COVID-19 after reduction in viral load, the development of fibrosis cannot be prevented due to the removal of the virus. This is because even a small amount of residual but non-progressive fibrosis can increase the mortality risk in older adults with COVID-19, especially those who have a pre-existing lung disease.

Therefore, the long-term results of COVID-19 are speculative and need further study.

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Causes Of Pulmonary Fibrosis

When the air sacs of the lungs called alveoli gets stiff or thick due to scarring, the oxygen supply to the bloodstream gets difficult that causes pulmonary fibrosis. Some of the causes of the scarring of the lung tissues include:

  • Radiation [3]
  • Autoimmune disorders such as lupus and rheumatoid arthritis.
  • Environmental and occupational factors such as exposure to silica dust, moulds, hard metal dust or coal dust. [4]
  • Infections such as hepatitis or herpes.
  • Chemotherapy or anti-inflammatory drugs.
  • Medical conditions such as pneumonia and dermatomyositis.
  • Tobacco smoke

Note: Pulmonary fibrosis is called idiopathic pulmonary fibrosis when no particular cause can be identified. In some cases, the condition is hereditary.

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Symptoms Of Pulmonary Fibrosis

The severy of the symptoms of pulmonary fibrosis varies from person to person. In some people, the symptoms get progressed very slowly while in others very quickly.

  • Shortness of breath (first symptom) [5]
  • Fatigue
  • Weakness
  • Clubbing of the fingernails [6]
  • Dry cough
  • Discomfort in the chest region
  • Muscle ache

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Risk Factors Of Pulmonary Fibrosis

The factors that increase the risk of pulmonary fibrosis include:

  • Gender[7](Men have increased risk)
  • Age (Age group 40-70 has increased risk)
  • Smoking
  • An occupation that involves mining, construction or farming.
  • Exposure to radiation
  • Chemotherapy treatment
  • Having a history of pulmonary fibrosis.
  • Having an autoimmune disorder. [8]

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Complications Of Pulmonary Fibrosis

Untreated pulmonary fibrosis can cause complications such as:

  • Respiratory failure
  • Lung cancer [9]
  • Pulmonary hypertension
  • Heart failure
  • Collapsed lung
  • Severe infections of the lungs

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Diagnosis Of Pulmonary Fibrosis

The diagnosis of pulmonary fibrosis is often confused with other lung conditions such as pneumonia or bronchitis. [10] Common diagnosis methods include:

  • Blood tests: To identify infections or an autoimmune condition.
  • Blood oxygen level test: To evaluate the amount of oxygen in the blood.
  • Lung function tests: To find out whether the lungs are working properly or not.
  • Sputum sample test: To detect if infections (bacteria or virus) are the cause.
  • CT scan: To look for signs of lung damage due to pulmonary fibrosis.
  • Biopsy: To exactly determine the scarring of the lungs and rule out other lung diseases.

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Treatments Of Pulmonary Fibrosis

Treatment methods are mainly to manage the progression of the condition. They include:

  • Medications: To slow the progression of pulmonary fibrosis by managing symptoms. [11]
  • Prednisone medications: To suppress the immune system if an autoimmune condition is the cause of pulmonary fibrosis.
  • Antifibrotic drugs: To reduce or minimise the further scarring of the lung tissues.
  • Oxygen therapy: For easier breathing.
  • Rehabilitation programs: To learn breathing techniques and other factors to improve lung efficacy.
  • Lung transplant: Can be done only if the above treatment methods do not work out. [12]

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Prevention Of Pulmonary Fibrosis

  • Quit smoking
  • If your occupation involves mining, farming, construction or exposure to radiation, silica dust or other harmful pollutants, take precautionary measures to prevent the entry of those pollutants in the respiratory system.
  • Maintain a balanced diet.
  • Exercise regularly or get involved in physical activities.
  • Change your lifestyle habits to cope well with the condition and minimise its progression.

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Common FAQs

1. What is the life expectancy of a person with pulmonary fibrosis?

Usually, the life expectancy of a person with pulmonary fibrosis is 3-5 years after the diagnosis. But due to the advancement in medical science, several ways have been discovered to increase the lifespan of people with the condition.

2. What are the signs of end-stage pulmonary fibrosis?

The signs of end-stage of pulmonary fibrosis include persistent cough, prolonged chest pain, weight loss, a feeling of anxiousness and disturbance in sleep patterns.

3. How do pulmonary fibrosis patients die?

Patients with pulmonary fibrosis die mainly due to right-sided heart failure, increased pressure to the lungs' arteries (pulmonary hypertension) and lung cancer.