Bronchopulmonary system within the confines of post-COVID-19 syndrome: literature review

The purpose of this review is to describe the available scientific data on the post-COVID-19 syndrome, formulate the main approaches to classification, determine the potential mechanisms of its pathogenesis, as well as determine the mechanisms of the occurrence of bronchopulmonary system pathology within the framework of the post-COVID-19 syndrome. It is known that long-term persistence of COVID-19 symptoms significantly reduces the quality of life of patients through the direct or indirect effect of the SARS-CoV-2 virus on a number of organs and systems. The review examines in detail the possible pathogenetic mechanisms of the post-COVID-19 syndrome, describes and studies the most common consequences of acute COVID-19, taking into account the severity of the disease, including diseases of the respiratory system, in particular interstitial and broncho-obstructive diseases. Particular attention is paid to the above problems in order to describe and structure the available scientific data on lung diseases within the framework of the post-COVID-19 syndrome. It should be noted, however, that there are very few studies on pathogenesis of changes in the bronchopulmonary system in the post-COVID-19 period. The bulk of them affect only individual manifestations of diseases of the respiratory system, in particular cough and shortness of breath, and are not aimed at determining causeand-effect relationships and the relationship of these symptoms to a specific nosology. Taking into consideration the continued high incidence of COVID-19, there is no doubt that additional studies of bronchopulmonary manifestations of post-COVID-19 syndrome should be conducted. Information from the databases PubMed, eLibrary, Scopus, Jstor was used as literary sources.

1. World Health Organization (2020). Novel coronavirus (2019-nCoV): situation report, 1. Geneva: World Health Organization; 2020. 5 p. Available at: https://apps.who.int/iris/handle/10665/330760

2. World Health Organization (2020). Novel coronavirus (2019-nCoV): situation report, 22. Geneva: World Health Organization; 2020. 7 p. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200211-sitrep-22-ncov.pdf?sfvrsn=fb6d49b1_2

3. Cucinotta D., Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157– 160. doi: 10.23750/abm.v91i1.9397

4. Wu Z., McGoogan J.M. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242. doi: 10.1001/jama.2020.2648

5. Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y., Zhang L., Fan G., Xu J., Gu X., Cheng Z., … Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S01406736(20)30183-5

6. The prevalence of long COVID symptoms and COVID-19 complications [exhibit on the Internet]. Office for National Statistics. 2020. Available at: https://www.ons.gov.uk/news/statementsandletters/theprevalenceoflongcovidsymptomsandcovid19complications

7. Blomberg B., Mohn K.G., Brokstad K.A., Zhou F., Linchausen D.W., Hansen B.A., Lartey S., Onyango T.B., Kuwelker K., Sævik M., … Langeland N. Long COVID in a prospective cohort of home-isolated patients. Nat. Med. 2021;27(9):1607–1613. doi: 10.1038/s41591-021-01433-3

8. Huang C., Huang L., Wang Y., Li X., Ren L., Gu X., Kang L., Guo L., Liu M., Zhou X., … Cao B. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220– 232. doi: 10.1016/S0140-6736(20)32656-8

9. Ceban F., Ling S., Lui L.M.W., Lee Y., Gill H., Teopiz K.M., Rodrigues N.B., Subramaniapillai M., di Vincenzo J.D., Cao B., … McIntyre R.S. Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis. Brain Behav. Immun. 2022;101:93–135. doi: 10.1016/j.bbi.2021.12.020

10. Troyer E.A., Kohn J.N., Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav. Immun. 2020;87:34–39. doi: 10.1016/j.bbi.2020.04.027

11. Mehandru S., Merad M. Pathological sequelae of long-haul COVID. Nat. Immunol. 2022;23(2):194–202. doi: 10.1038/s41590-021-01104-y

12. Jimeno-Almazán A., Pallarés J.G., Buendía- Romero Á., Martínez-Cava A., Franco-López F., Sánchez-Alcaraz Martínez B.J., Bernal-Morel E., CourelIbáñez J. Post-COVID-19 syndrome and the potential benefits of exercise. Int. J. Environ. Res. Public Health. 2021;18(10):5329. doi: 10.3390/ijerph18105329

13. Gebremeskel S., Schanin J., Coyle K.M., Butuci M., Luu T., Brock E.C., Xu A., Wong A., Leung J., Korver W., … Youngblood B.A. Mast cell and eosinophil activation are associated with COVID-19 and TLR-mediated viral inflammation: implications for an anti-siglec-8 antibody. Front. Immunol. 2021;12:650331. doi: 10.3389/fimmu.2021.650331

14. Phetsouphanh C., Darley D.R., Wilson D.B., Howe A., Munier C.M.L., Patel S.K., Juno J.A., Burrell L.M., Kent S.J., Dore G.J., Kelleher A.D., Matthews G.V. Immunological dysfunction persists for 8 months following initial mild-to-moderate SARSCoV-2 infection. Nat. Immunol. 2022;23(2):210–216. doi: 10.1038/s41590-021-01113-x

15. Needham D.M., Davidson J., Cohen H., Hopkins R.O., Weinert C., Wunsch H., Zawistowski C., Bemis-Dougherty A., Berney S.C., Bienvenu O.J., … Harvey M.A. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit. Care Med. 2012;40(2):502– 509. doi: 10.1097/CCM.0b013e318232da75

16. Carfì A., Bernabei R., Landi F.; Gemelli Against COVID-19 PostAcute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324(6):603–605. doi: 10.1001/jama.2020.12603

17. Halpin S.J., McIvor C., Whyatt G., Adams A., Harvey O., McLean L., Walshaw C., Kemp S., Corrado J., Singh R., … Sivan M. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J. Med. Virol. 2021;93(2):1013–1022. doi: 10.1002/jmv.26368

18. Garrigues E., Janvier P., Kherabi Y., Le Bot A., Hamon A., Gouze H., Doucet L., Berkani S., Oliosi E., Mallart E., … Nguyen Y. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J. Infect. 2020;81(6):4–6. doi: 10.1016/j.jinf.2020.08.029

19. Aiyegbusi O.L., Hughes S.E., Turner G., Rivera S.C., McMullan C., Chandan J.S., Haroon S., Price G., Davies E.H., Nirantharakumar K., … TLC Study Group. Symptoms, complications and management of long COVID: a review. J. R. Soc. Med. 2021;114(9):428–442. doi: 10.1177/01410768211032850

20. Tenforde M.W., Kim S.S., Lindsell C.J., Billig Rose E., Shapiro N.I., Files D.C., Gibbs K.W., Erickson H.L., Steingrub J.S., Smithline H.A., … IVY Network Investigators. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a Multistate Health Care Systems Network – United States, March-June 2020. MMWR Morb. Mortal. Wkly. Rep. 2020;69(30):993–998. doi: 10.15585/mmwr.mm6930e1

21. Marjenberg Z., Leng S., Tascini C., Garg M., Misso K., Seblain C.E.G., Shaikh N. Risk of long COVID main symptoms after SARS-CoV-2 infection: a systematic review and meta-analysis. Sci. Rep. 2023;13(1):15332. doi: 10.1038/s41598-023-42321-9

22. Kanne J.P., Little B.P., Schulte J.J., Haramati A., Haramati L.B. Long-term lung abnormalities associated with COVID-19 pneumonia. Radiology. 2023;306(2):e221806. doi: 10.1148/radiol.221806

23. Drazen J.M., Wijsenbeek M., Cottin V. Spectrum of fibrotic lung diseases. N. Engl. J. Med. 2020;383(10):958–968. doi: 10.1056/NEJMra2005230

24. Huang W.J., Tang X.X. Virus infection induced pulmonary fibrosis. J. Transl. Med. 2021;19(1):496. doi: 10.1186/s12967-021-03159-9

25. Han X., Fan Y., Alwalid O., Li N., Jia X., Yuan M., Li Y., Cao Y., Gu J., Wu H., Shi H. Six-month follow-up chest CT findings after severe COVID-19 pneumonia. Radiology. 2021;299(1):E177–E186. doi: 10.1148/radiol.2021203153

26. Li X., Shen C., Wang L., Majumder S., Zhang D., Deen M.J., Li Y., Qing L., Zhang Y., Chen C., … Liu Y. Pulmonary fibrosis and its related factors in discharged patients with new corona virus pneumonia: a cohort study. Respir. Res. 2021;22(1):203. doi: 10.1186/s12931-021-01798-6

27. Guler S.A., Ebner L., Aubry-Beigelman C., Bridevaux P.O., Brutsche M., Clarenbach C., Garzoni C., Geiser T.K., Lenoir A., Mancinetti M., … Funke-Chambour M. Pulmonary function and radiological features 4 months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study. Eur. Respir. J. 2021;57(4):2003690. doi: 10.1183/13993003.03690-2020

28. Oronsky B., Larson C., Hammond T.C., Oronsky A., Kesari S., Lybeck M., Reid T.R. A review of persistent post-COVID syndrome (PPCS). Clin. Rev. Allergy Immunol. 2023;64(1):66–74. doi: 10.1007/s12016-021-08848-3

29. Michalski J.E., Kurche J.S., Schwartz D.A. From ARDS to pulmonary fibrosis: the next phase of the COVID-19 pandemic? Transl. Res. 2022;241:13– 24. doi: 10.1016/j.trsl.2021.09.001

30. Bharat A., Querrey M., Markov N.S., Kim S., Kurihara C., Garza-Castillon R., Manerikar A., Shilatifard A., Tomic R., Politanska Y., … Budinger G.R.S. Lung transplantation for patients with severe COVID-19. Sci. Transl. Med. 2020;12(574):eabe4282. doi: 10.1126/scitranslmed.abe4282

31. Song W.J., Hui C.K.M., Hull J.H., Birring S.S., McGarvey L., Mazzone S.B., Chung K.F. Confronting COVID-19-associated cough and the post-COVID syndrome: role of viral neurotropism, neuroinflammation, and neuroimmune responses. Lancet Respir. Med. 2021;9(5):533–544. doi: 10.1016/S22132600(21)00125-9

32. Al-Shamrani A., Al-Shamrani K., Al-Otaibi M., Alenazi A., Aldosaimani H., Aldhalaan Z., Alalkami H., Yousef A.A., Kobeisy S., Alharbi S. Residual cough and asthma-like symptoms post-COVID-19 in children. Children (Basel). 2023;10(6):1031. doi: 10.3390/children10061031

33. Lee J.H., Yim J.J., Park J. Pulmonary function and chest computed tomography abnormalities 6-12 months after recovery from COVID-19: a systematic review and meta-analysis. Respir. Res. 2022;23(1):233. doi: 10.1186/s12931-022-02163-x

34. Mora N., Fina F., Méndez-Boo L., Cantenys R., Benítez M., Moreno N., Balló E., Hermosilla E., Fàbregas M., Guiriguet C., … Medina M. “Decline and uneven recovery from 7 common long-term conditions managed in the Catalan primary care after two pandemic years: an observational retrospective population-based study using primary care electronic health records”. BMC Prim. Care. 2023;24(1):9. doi: 10.1186/s12875-022-01935-0

35. Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G., Belenkov Yu.N., Konradi A.O., Lopatin Yu.M., Rebrov A.P., Tereshchenko S.N., Chesnikova A.I., Hayrapetyan H.G., …, Yausheva E.Yu. Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2021;26(10):4708. [In Russian]. doi: 10.15829/15604071-2021-4708

36. Gencer A., Caliskaner Ozturk B., Borekci S., Gemicioglu B. Bronchodilator reversibility testing in long-term cough and dyspnea after COVID-19 viral infection: a trigger for asthma? J. Asthma. 2023;60(6):1221– 1226. doi: 10.1080/02770903.2022.2139719

37. Laorden D., Domínguez-Ortega J., Carpio C., Barranco P., Villamañán E., Romero D., Quirce S., Álvarez-Sala R.; ASMA@COVIDHULP group. Long COVID outcomes in an asthmatic cohort and its implications for asthma control. Respir. Med. 2023;207:107092. doi: 10.1016/j.rmed.2022.107092

38. Richardson S., Hirsch J.S., Narasimhan M., Crawford J.M., McGinn T., Davidson K.W.; the Northwell COVID-19 Research Consortium; Barnaby D.P., Becker L.B., Chelico J.D., … Zanos T.P. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052–2059. doi: 10.1001/jama.2020.6775

39. Wu X., Liu X., Zhou Y., Yu H., Li R., Zhan Q., Ni F., Fang S., Lu Y., Ding X., … Wang Y. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. Lancet Respir. Med. 2021;9(7):747– 754. doi: 10.1016/S2213-2600(21)00174-0

40. Steinbeis F., Thibeault C., Doellinger F., Ring R.M., Mittermaier M., Ruwwe-Glösenkamp C., Alius F., Knape P., Meyer H.J., Lippert L.J., … Zoller T. Severity of respiratory failure and computed chest tomography in acute COVID-19 correlates with pulmonary function and respiratory symptoms after infection with SARS-CoV-2: An observational longitudinal study over 12 months. Respir. Med. 2022;191:106709. doi: 10.1016/j.rmed.2021.106709