Pulmonary Fibrosis Caused by Severe COVID-19 Infection: Discharge May Not Be The End of Treatment.

Since December 2019, COVID-19 caused by SARS-CoV-2 infection has been spread rapidly in the world. Beside acute respiratory distress syndrome found in acute phase of infection, there is also pulmonary fibrosis as a chronic complication due to COVID-19. With the global pandemic of COVID-19, more and more autopsy and puncture histopathological results have been published.Until now there is no specific therapy to handle post-inflammatory pulmonary fibrosis due to COVID-19 infection. Several studies are ongoing to determine an effective treatment for this chronic complication. While ARDS appears to be the main cause of pulmonary fibrosis in COVID-19, the pathogenesis of ARDS caused by SARS-CoV-2 is different from the typical ARDS. Some therapies may be considered for reducing the fibrosis process in lung after COVI-19 infection namely pirfenidone, nintedanib and mesenchymal stem cells. Many patients are still recovering spontaneously in the first six weeks after acute COVID-19 infection and do not generally require fast-track entry into a pulmonary rehabilitation programme. However, those who have significantly persistent respiratory illness may need to be supported by pulmonary rehabilitation. Multidisciplinary intervention based on personalized evaluation and treatment which includes exercise training, education and behavioral modification can be given to improve the physical and psychological condition of patients with post-COVID pulmonary fibrosis.