Postcovid bronchoobstructive syndrome in the practice of a general practitioner and a pulmonologist: a large-scale study

Abstract

It is hard to make a conclusion about relationship between Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and Bronchoobstructive Syndrome (BOS) in the postcovid period based on the literature. The aim. To determine the optimal treatment approaches by conducting a comprehensive assessment of clinical, laboratory and functional parameters, taking into account the risk factors for the development of BOS. Methods. 10,456 patients with Coronavirus Disease-19 (COVID-19) were examined, and 7,459 patients were randomized into 2 groups with a newly diagnosed BOS. Group 1 (n = 3,245) was prescribed beclomethasone/formoterol (BDP/FORM) as Maintenance And Reliever Therapy (MART). Group 2 (n = 4,252) was prescribed budesonide suspension (BUD) and salbutamol solution (SAL). The study assessed severity of COVID-19, presence of atopy and frequency of acute respiratory viral infections (SARS) in the medical history, spirometric parameters, blood eosinophils, Asthma Control Questionnaire-5 (ACQ-5) score, use of pro re nata medications, and adverse events. Results. Patients who had mild COVID-19 were diagnosed with BOS at weeks 8 – 24 (73.3%), while patients with moderate or severe COVID-19 were diagnosed at week 4 (54.9%). Virus-induced BOS (VI BOS) was diagnosed in 71.8% of the cases. 13% of the patients with BOS in postcovid period were diagnosed with asthma. Conclusion. The incidence of BOS is significantly higher in patients with atopy and history of frequent SARS who had moderate or severe COVID-19. A fixed combination of extrafine BDP/FORM as MART was superior to nebulized BUD + SALM in the treatment of VI BOS.