By Suchitra Pilli, MD, MPH, FCCP, DAABIP | HonorHealth Heart Care

As the medical community continues to address the long-term impacts of the COVID-19 pandemic, one area of growing importance is the management of post-COVID lung conditions. For many patients, respiratory symptoms persist long after the acute phase of the infection, presenting unique diagnostic and treatment challenges for both primary care and specialty physicians.
 

Post-COVID lung conditions: Current understanding

Common presentations

• Dyspnea
• Decreased exercise capacity or tolerance
• Hypoxia (low oxygen saturation on pulse oximeter)
• Reduced diffusion capacity
• Restrictive pulmonary physiology¹

Management strategies

1. Systematic assessment
   • Comprehensive pulmonary function testing (PFTs)
   • Exercise capacity evaluations and six-minute walk test to determine exertional hypoxia
   • High-resolution CT imaging when indicated
   • Assessing for sequelae such as pulmonary hypertension, chronic lung infections and bronchiectasis
   • Quality of life assessments questionnaires²
2. Targeted interventions
   • Cardio-pulmonary rehabilitation programs
   • Breathing exercises and respiratory muscle training
   • Gradual exercise progression plans
   • Treatment of conditions diagnosed in the assessment phase as needed
   • Chronic oxygen supplementation where necessary³
3. Monitoring and follow-up
   • Regular assessment of symptoms at follow-up
   • Sequential pulmonary function testing
   • Quality of life metrics assessments and questionnaires
   • Return-to-activity guidance

Emerging diseases: Monkeypox (Mpox) and respiratory manifestations: What you should know

Transmission of disease

A recent upsurge of Mpox cases in the Democratic Republic of Congo with spread to neighboring countries led to it being declared a public health emergency of international concern on Aug. 14, 2024. Mpox is caused by two viruses, clade 1 and clade 2. Clade 1 causes more severe disease. Mpox spreads through close or intimate contact with the diseased person or contact with surfaces or items used by an affected person. It usually does not have respiratory transmission alone. Healthcare professionals should however remain cautious of potential airborne spread, particularly in healthcare settings.⁴
 
Pulmonary manifestations

• Starts with fever, chills, rash, muscle aches and can involve upper or lower respiratory tract with symptoms of sore throat, nasal congestion and cough
• Bronchopneumonia presentation
• Potential for severe respiratory distress, including acute respiratory distress syndrome (ARDS)⁵

Clinical implications in the U.S.:

There are no clade 1 Mpox cases reported in the U.S., and clade 2 is circulating at low levels.

1. Prevention considerations
   • Enhanced contact and respiratory precautions
   • Vaccination is recommended for high-risk groups per the Centers for Disease Control and Prevention (CDC) guidelines
   • Early recognition of the disease and any respiratory symptoms
   • Timely isolation measures and disinfection to prevent transmission
2. Management approaches
   • Supportive care for respiratory symptoms
   • Isolation of infected persons
   • Monitoring for respiratory deterioration
   • Specific antiviral therapy (tecovirimat) or immunoglobulin therapy when indicated⁶

Integrated care approaches with multidisciplinary management

Effective management of post-COVID lung conditions and new emerging diseases such as Mpox-related lung conditions require collaboration between:

• Pulmonologists, frontline health care workers, public health leaders and CDC
• Infectious disease specialists and infection prevention teams
• Physical therapy, occupational therapy and cardio-pulmonary rehabilitation experts
• Primary care physicians and providers for ongoing vigilance and care coordination

Patient education

• Recognition of warning signs and teaching infection prevention practices
• Self-monitoring strategies and increasing awareness of emerging diseases
• Adherence to follow-up care plans and prevention of further episodes
• The importance of following vaccination protocols in preventing viral spread^7,8

Future directions

• Ongoing research into the long-term impacts of post-COVID lung conditions
• Development of new therapeutic options, prevention strategies and increased access to resources
• Longitudinal studies on outcomes and recovery of post COVID patients and respiratory viral illnesses
• Enhanced education regarding new and emerging respiratory viruses

Managing post-COVID lung conditions requires a systematic, multi-disciplinary patient-centered approach. Continued vigilance, appropriate preventive measures, and evidenced-based vaccination and management strategies remain essential.
 

References

1. Nalbandian A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.
2. Raghu G, Wilson KC. COVID-19 interstitial pneumonia: monitoring the clinical course in survivors. Lancet Respir Med. 2020 Aug 3;8(9):839-842.
3. Singh SJ, et al. British Thoracic Society survey of rehabilitation to support recovery of the post-COVID-19 population. BMJ Open. 2020 Dec 2;10(12):e040213.
4. Public Health Strategies for Mpox. Mpox. Published 2024. Public Health Strategies for Mpox | Mpox | CDC
5. Beeson A, et al. Mpox respiratory transmission: the state of the evidence. The Lancet Microbe. 2023 April;4(4):e277-e283.
6. Huang Y, et al. Monkeypox: A clinical update for paediatricians. J Paediatr Child Health. 2022 Sep;58(9):1532-1538.
7. Wu X, et al. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalization: a prospective study. Lancet Respir Med. 2021 May 5;9(7):747-754.
8. Maqbool K, et al. Role of vaccination in patients with human monkeypox virus and its cardiovascular manifestations. Ann Med Surg (Lond). 2024 Jan 4;86(3):1506-1516.