Health Tips

Compared to last year, we now understand COVID-19 better. While most people recovered fully from COVID-19, some may not be so lucky—they either die or suffer from its complications even after being discharged from the hospital. Among the post-COVID-19 complications, a condition known as organizing pneumonia (OP) is seen among moderate to severe COVID-19 patients. 

What’s organizing pneumonia (OP) in COVID-19?

(A) A CT-scan image of an organizing pneumonia case 6 days after onset of symptoms of COVID-19. (B) CT-scan image of the lung 2 weeks after discharge suggesting mild lung fibrosis. Source: Kory P, Kanne J. SARS-CoV-2 organising pneumonia: ‘Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?’ [Internet]. 2021 [cited 15 August 2021]. Available from: http://dx.doi.org/10.1136/bmjresp-2020-000724 via Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license

Organizing pneumonia (OP) is a inflammatory disease in lung which may occur from:

• Direct lung injury from the COVID-19 virus itself

• Cytokine release syndrome (CRS) caused by COVID-19. This is a hypothesis whereby COVID-19 causes a huge derangement in a person’s immune system, which then leads to inflammation in the lung such as OP or organ damage such as in the kidneys.

People who develop organizing pneumonia after COVID-19 may experience shortness of breath, cough and/or chest pain. 

At the moment, doctors would diagnose post-COVID-19 OP via computed tomographic (CT) scan. Good news about post-COVID-19 OP is that most cases are not severe and have high chances of recovery with medical treatment. 

Treatment of organizing pneumonia (OP) after COVID-19

The treatment of organizing pneumonia (OP) is important to prevent the condition from progressing into lung fibrosis, in which the lung tissue becomes damaged and scarred. It’s incurable.

Currently, corticosteroids (commonly known as ‘steroid’ among the general public) are primarily used to treat OP after COVID-19. This is not the first time corticosteroids are being used in treating inflammatory lung diseases— they have always been used in the treatment of severe asthma and severe community-acquired pneumonia cases. Corticosteroids have also been frequently used in treating severe COVID-19 in the hospital.

The most commonly used corticosteroids for treating OP after COVID-19 is prednisolone:

• The prednisolone treatment is usually started at a dose of 0.5-1mg/kg/day, with a maximum dose of 60mg/day,

• Lower doses of prednisolone may be considered in elderly, patients with poorly controlled diabetes and immunocompromised individuals (Reasons: see side effects of steroids below)

• The duration of treatment varies between 1 to 3 months.

• Your doctor may prescribe a tapering regimen of prednisolone to you, i.e. you will be asked to reduce the dose of your prednisolone by 5mg every 5 days (or a week) until your next follow-up visit with the doctor. Such gradual reduction of doses is called tapering regimen, and it is important to prevent an adverse effect called hypothalamic-pituitary-adrenal axis (HPA) suppression. HPA suppression may lead to nausea, vomiting, abdominal pain, weakness, lethargy or even coma. 

Adverse effects of corticosteroids

As useful as corticosteroids are, they come with many side effects; those side effects can take place in many organs. Side effects range from those that are not necessarily serious but are unpleasant to patients (eg, Cushingoid appearance) to those that are life-threatening (eg, serious infections). 

Skin and appearance: 

• Skin thinning

• Purpura (Purple or red discolored spots on skin; occurs when small blood vessels in the skin burst, causing blood to pool under the skin)

Steroid purpura. Image credit to © DermNet New Zealand via Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand)

• Weight gain

• Cushingoid appearance, also known as ‘moon face’ (facial puffiness)

Gastrointestinal related:

• Gastric pain/ulcer, which the risk can be further increased if steroid is taken with nonsteroidal anti-inflammatory painkillers, such as ibuprofen, diclofenac and naproxen. This is why you should always take prednisolone with food to reduce stomach discomfort, as well as avoid taking steroids with other painkillers at the same time.

Metabolic effects:

• Higher blood sugar level, which can complicate the treatment of diabetes if steroids are taken concurrently for other accompanying medical conditions. Therefore, if you have diabetes, make sure you follow your diabetic treatment strictly. You may also increase the dose of your insulin injection under the supervision of a healthcare professional.

Others:

• Lower immunity, which leads to higher risk of infection

• Cataract

• Osteoporosis, a condition that is characterized by reduced bone strength and higher risk of bone fracture.

Despite these potential adverse effects of steroid medications, you should not stop taking your steroid medication unless requested by your healthcare professional. If a doctor prescribes you steroids, you should also strictly follow the doctor’s or pharmacist’s instructions on how to take them. The reason that they are aware of the side effects of steroids medication but still prescribe you with steroids is because your medical condition may call for it, and the benefits of starting a steroid therapy outweighs the potential side effects you may experience. Talk to your healthcare professional on how to handle or prevent these side effects, and do not stop taking your steroid therapy without your healthcare professional’s advice.

A word from DOC2US

If you have any enquiries related to COVID-19 and its vaccines, you can consult our COVID-19 Task Force, which consists of professional doctors and healthcare professionals, for FREE! 

You can access free COVID-19 virtual health advisory by downloading the DOC2US app or go to https://web.doc2us.com/. Alternatively, go to MySejahtera app> Digital Health> Virtual Health Advisory, and click on DOC2US.

For more information about COVID-19 vaccination programme in Malaysia, visit https://www.vaksincovid.gov.my/

Disclaimer: COVID-19 is a novel disease. The information and scientific evidence of the disease, treatment and vaccines are changing as we speak. Some content of this article may be outdated in the future. We encourage you to always speak to a healthcare professional you trust for the latest updates on COVID-19, its treatment and vaccines.

Read more:

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Does the brand of COVID-19 vaccines matter?

Should you receive Covid-19 vaccine if you have a drug allergy?

Side effects of Covid-19 vaccine: should you be worried? 

What you need to know about the COVID-19 vaccine

Should pregnant women take COVID-19 vaccine?

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Please adhere to your COVID-19 vaccination appointment, here's why

How is COVID-19 patient being treated in the hospital?

Are the COVID-19 vaccines effective against the variants?

References

1. Vadász I, Husain-Syed F, Dorfmüller P, Roller F, Tello K, Hecker M et al. Severe organising pneumonia following COVID-19 [Internet]. 2021 [cited 15 August 2021]. Available from: http://dx.doi.org/10.1136/thoraxjnl-2020-216088

2. Pogatchnik B, Swenson K, Sharifi H, Bedi H, Berry G, Guo H. Radiology–Pathology Correlation Demonstrating Organizing Pneumonia in a Patient Who Recovered from COVID-19. American Journal of Respiratory and Critical Care Medicine [Internet]. 2020 [cited 15 August 2021];202(4):598-599. Available from: https://doi.org/10.1164/rccm.202004-1278IM

3. Parra Gordo M, Buitrago Weiland G, Grau García M, Arenaza Choperena G. Radiologic aspects of COVID-19 pneumonia: Outcomes and thoracic complications. Radiología (English Edition) [Internet]. 2021 [cited 15 August 2021];63(1):74-88. Available from: https://www.elsevier.es/en-revista-radiologia-english-edition--419-articulo-radiologic-aspects-covid-19-pneumonia-outcomes-S2173510721000136

Cover image credit: Photo by CDC on Unsplash

Written by

Ms Joyce Toh