Respiratory sequelae of COVID-19: pulmonary and extrapulmonary origins, and approaches to clinical care and rehabilitation.

Although the exact prevalence of post-COVID-19 condition (also known as long COVID) is unknown, more than a third of patients with COVID-19 develop symptoms that persist for more than 3 months after SARS-CoV-2 infection. These sequelae are highly heterogeneous in nature and adversely affect multiple biological systems, although breathlessness is a frequently cited symptom. Specific pulmonary sequelae, including pulmonary fibrosis and thromboembolic disease, need careful assessment and might require particular investigations and treatments. COVID-19 outcomes in people with pre-existing respiratory conditions vary according to the nature and severity of the respiratory disease and how well it is controlled. Extrapulmonary complications such as reduced exercise tolerance and frailty might contribute to breathlessness in post-COVID-19 condition. Non-pharmacological therapeutic options, including adapted pulmonary rehabilitation programmes and physiotherapy techniques for breathing management, might help to attenuate breathlessness in people with post-COVID-19 condition. Further research is needed to understand the origins and course of respiratory symptoms and to develop effective therapeutic and rehabilitative strategies.
Competing Interests: Declaration of interests SJS has received project funding from the UK National Institute for Health Research (NIHR), UK Research and Innovation, the Department of Health and Social Care, and Actegy. She has received funding for a doctoral training programme from the Wellcome Trust, and reports funding for presentations from GSK, the UK Ministry of Justice, Cipla, and Sherbourne Gibbs. SJS is the American Thoracic Society Pulmonary Rehabilitation Assembly Chair, clinical lead for the Royal College of Physicians Pulmonary Rehabilitation Accreditation Scheme, clinical lead for the National Asthma and COPD Audit Programme for Pulmonary Rehabilitation, and is on the National Institute for Health and Care Excellence expert advisory panel for long COVID. CEB has received funding to his institution for consultancy and investigator roles from GSK, AstraZeneca, Genentech, Roche, Sanofi, Regeneron, Boehringer Ingelheim, Chiesi, Mologic, and 4DPharma. RAE reports research funding from the NIHR, UKRI, and the Wolfson Foundation. She has received payment for a consultancy role from AstraZeneca, for invited lectures from Boehringer Ingelheim, and for conference attendance from Chiesi. RAE is secretary of the European Respiratory Society Group 01.02 Rehabilitation and Chronic Care. RGJ has received grants to his institution from AstraZeneca, Biogen, Galecto, GSK, Nordic Biosciences, RedX, and Pilant. He reports consultancy fees from AstraZeneca, Brainomix, Bristol Myers Squibb, Chiesi, Cohbar, Daewoong, GSK, Pliant, Resolution Therapeutics, Roche, and Veracyte, and lecture fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Roche, and PatientMPower. RGJ is on data safety monitoring boards for Boehringer Ingelheim, Galapagos, and Vicore, and is on the advisory board of NuMedii. RGJ is the current president of Action for Pulmonary Fibrosis. MT has received funding from MorphogenIX and Jansen for taking part in advisory boards and has received support from GSK and Jansen to travel and attend meetings. All other authors declare no competing interests.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)