Effects of An Individualized Pulmonary Rehabilitation Program in Post-COVID Fibrosis: A Case Report
DOI:
https://doi.org/10.12974/2312-5470.2023.09.02Keywords:
COVID-19, Post-COVID fibrosis, Rehabilitation, Case reportAbstract
Long COVID-19 Syndrome, in addition to symptoms such as chronic cough, exertional dyspnea and fatigue, pulmonary fibrosis is presented as specific respiratory system problems. Post-COVID fibrosis is characterized by radiographic abnormalities consistent with pulmonary fibrosis. Patients with post-COVID fibrosis may benefit from pulmonary rehabilitation programs. This case report aimed to investigate the effects of an individualized pulmonary rehabilitation (PR) program on selected clinical parameters in a 46-year-old male who was diagnosed with post-COVID fibrosis. Spirometry and diffusion tests were investigated. Six-minute walk and shuttle walk tests for exercise capacity, hand-held dynamometer for quadriceps muscle strength, mMrc dyspnea scale for dyspnea, Fatigue Severity Scale for fatigue and London Chest Activity of Daily Living for activities of daily living were evaluated. An individualized PR program included breathing exercises, single-leg cycle training (for the right leg, 10 to 30 min) and bilateral neuromuscular electrical stimulation for quadriceps muscles (30 min) was prescribed 3 days a week for 8 weeks. Small but promising improvements were observed in FEV1, FVC, FEV1/FVC, DLCO, 6MWD, shuttle walk tests walking distance and time, quadriceps muscle strength, mMRC and FSS scores. PR program combined with antifibrotic therapy has the potential to improve respiratory functions, exercise capacity, muscle strength, dyspnea, fatigue, and participation in ADL in patient with post-COVID fibrosis.
References
Dennis A, Wamil M, Alberts J, Oben J, Cuthbertson DJ, Wootton D, et al. Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: A prospective, community-based study. BMJ Open. 2021; 11(3): e048391. https://doi.org/10.1136/bmjopen-2020-048391 DOI: https://doi.org/10.1136/bmjopen-2020-048391
Humphreys H, Kilby L, Kudiersky N, Copeland R. Long COVID and the role of physical activity: a qualitative study. BMJ Open. 2021; 11(3): e047632. https://doi.org/10.1136/bmjopen-2020-047632 DOI: https://doi.org/10.1136/bmjopen-2020-047632
Venkatesan P. NICE guideline on long COVID. Lancet Respir Med. 2021; 9(2): 129. https://doi.org/10.1016/S2213-2600(21)00031-X DOI: https://doi.org/10.1016/S2213-2600(21)00031-X
Rai DK, Sharma P, Kumar R. Post covid 19 pulmonary fibrosis. Is it real threat? Indian J Tuberc. 2020; 68(3): 330-3. https://doi.org/10.1016/j.ijtb.2020.11.003 DOI: https://doi.org/10.1016/j.ijtb.2020.11.003
Funke-Chambour M, Bridevaux PO, Clarenbach CF, Soccal PM, Nicod LP, Von Garnier C. Swiss Recommendations for the Follow-Up and Treatment of Pulmonary Long COVID. Respiration. 2021; 100(8): 826-41. https://doi.org/10.1159/000517255 DOI: https://doi.org/10.1159/000517255
Lechowicz K, Drożdżal S, Machaj F, Rosik J, Szostak B, Zegan-Barańska M, et al. COVID-19: The potential treatment of pulmonary fibrosis associated with SARS-CoV-2 infection. J Clin Med. 2020; 9(6): 1917. https://doi.org/10.3390/jcm9061917 DOI: https://doi.org/10.3390/jcm9061917
Cheng L, Tan B, Yin Y, Wang S, Jia L, Warner G, et al. Short- and long-term effects of pulmonary rehabilitation for idiopathic pulmonary fibrosis: a systematic review and meta-analysis. Clin Rehabil. 2018; 32(10): 1299-307. https://doi.org/10.1177/0269215518779122 DOI: https://doi.org/10.1177/0269215518779122
Choi K, Kim M, Lee SM, Kim J. Exercise-based pulmonary rehabilitation for a post-COVID-19 pulmonary fibrosis patient: A case report. Medicine (Baltimore). 2021; 24: 100(47): e27980. https://doi.org/10.1097/MD.0000000000027980 DOI: https://doi.org/10.1097/MD.0000000000027980
Lee AL, Holland AE. Time to adapt exercise training regimens in pulmonary rehabilitation--a review of the literature. Int J Chron Obstruct Pulmon Dis. 2014; 10(9): 1275-88. https://doi.org/10.2147/COPD.S54925 DOI: https://doi.org/10.2147/COPD.S54925
Jones S, Man WD, Gao W, Higginson IJ, Wilcock A, Maddocks M. Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev. 2016; 10(10): CD009419. https://doi.org/10.1002/14651858.CD009419.pub3 DOI: https://doi.org/10.1002/14651858.CD009419.pub3
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111-117. https://doi.org/10.1164/ajrccm.166.1.at1102 DOI: https://doi.org/10.1164/ajrccm.166.1.at1102
Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992; 47: 1019-1024. https://doi.org/10.1136/thx.47.12.1019 DOI: https://doi.org/10.1136/thx.47.12.1019
Revill SM, Morgan MD, Singh SJ, Williams J, Hardman AE. The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease. Thorax 1999; 54: 213-222. https://doi.org/10.1136/thx.54.3.213 DOI: https://doi.org/10.1136/thx.54.3.213
Bestall JC, Paul EA, Garrod R, Garnham R, Jones, PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) Dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999; 54(7): 581-586. https://doi.org/10.1136/thx.54.7.581 DOI: https://doi.org/10.1136/thx.54.7.581
Dittner AJ, Wessely SC, Brown RG. The assessment of fatigue: a practical guide for clinicians and researchers. J Psychosom Res. 2004; 56, 157-70. https://doi.org/10.1016/S0022-3999(03)00371-4 DOI: https://doi.org/10.1016/S0022-3999(03)00371-4
Garrod, R., Bestall, J.C., Paul, E.A., Wedzicha, J.A., Jones, P.W. Development and validation of a standardized measure of activity of daily living in patients with severe COPD: the London Chest Activity of Daily Living scale (LCAD). Respir Med. 2000; 94, 589-596. https://doi.org/10.1053/rmed.2000.0786 DOI: https://doi.org/10.1053/rmed.2000.0786
Akar O, Günay E, Sarinc Ulasli S, Ulasli AM, Kacar E, Sariaydin M et al. Efficacy of neuromuscular electrical stimulation in patients with COPD followed in intensive care unit. Clin Respir J. 2017; 11, 743-750. https://doi.org/10.1111/crj.12411 DOI: https://doi.org/10.1111/crj.12411
Pezzuto A, Tonini G, Tammaro A, Laviano A, Salerno G, Ciccozzi M. A COPD Patient Who Developed Pulmonary Fibrosis Following COVID-19: A Case Study. Global Journal of Respiratory Care. 2021; 7, 35-40. https://doi.org/10.12974/2312-5470.2021.07.06 DOI: https://doi.org/10.12974/2312-5470.2021.07.06
LI J. Rehabilitation management of patients with COVID-19: Lessons learned from the first experience in China. Eur J Phys Rehabil Med. 2020; 56(3): 335-8. https://doi.org/10.23736/S1973-9087.20.06292-9 DOI: https://doi.org/10.23736/S1973-9087.20.06292-9
Agostini F, Mangone M, Ruiu P, Paolucci T, Santilli V, Bernetti A. Rehabilitation settings during and after COVID-19: An overview of recommendations. J Rehabil Med. 2021; 53(1): jrm00141. https://doi.org/10.2340/16501977-2776 DOI: https://doi.org/10.2340/16501977-2776
Paneroni M, Simonelli C, Saleri M, Bertacchini L, Venturelli M, Troosters T, et al. Muscle Strength and Physical Performance in Patients without Previous Disabilities Recovering from COVID-19 Pneumonia. Am J Phys Med Rehabil. 2021; 100(2): 105-9. https://doi.org/10.1097/PHM.0000000000001641 DOI: https://doi.org/10.1097/PHM.0000000000001641
American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009; 41(3): 687-708. https://doi.org/10.1249/MSS.0b013e3181915670 DOI: https://doi.org/10.1249/MSS.0b013e3181915670
