Journal Article

SARS-CoV-2 organising pneumonia: ‘Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?’

Kanne, Jeffrey P, Kory, Pierre

2020

Overview

Reviews of COVID-19 CT imaging along with postmortem lung biopsies and autopsies indicate that the majority of patients with COVID-19 pulmonary involvement have secondary organising pneumonia (OP) or its histological variant, acute fibrinous and organising pneumonia, both well-known complications of viral infections. Further, many publications on COVID-19 have debated the puzzling clinical characteristics of ‘silent hypoxemia’, ‘happy hypoxemics’ and ‘atypical ARDS’, all features consistent with OP. The recent announcement that RECOVERY, a randomised controlled trial comparing dexamethasone to placebo in COVID-19, was terminated early due to excess deaths in the control group further suggests patients present with OP given that corticosteroid therapy is the first-line treatment. Although RECOVERY along with other cohort studies report positive effects with corticosteroids on morbidity and mortality of COVID-19, treatment approaches could be made more effective given that secondary OP often requires prolonged duration and/or careful and monitored tapering of corticosteroid dose, with ‘pulse’ doses needed for the well-described fulminant subtype. Increasing recognition of this diagnosis will thus lead to more appropriate and effective treatment strategies in COVID-19, which may lead to a further reduction of need for ventilatory support and improved survival.

• Publisher: British Thoracic Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Betacoronavirus / Biopsy / Coronavirus Infections - complications / Coronavirus Infections - drug therapy / Coronavirus Infections - physiopathology / Coronaviruses / COVID-19 / Cryptogenic Organizing Pneumonia - diagnosis / Cryptogenic Organizing Pneumonia - drug therapy / Cryptogenic Organizing Pneumonia - etiology / Cryptogenic Organizing Pneumonia - physiopathology / Dexamethasone - therapeutic use / Diagnostic Errors / Edema / Fibroblasts / Glucocorticoids - therapeutic use / Humans / Hypoxia - etiology / Hypoxia - physiopathology / imaging/CT MRI etc / Immunomodulators / Lung - diagnostic imaging / Lung - pathology / Lung - physiopathology / Lung Diseases, Interstitial - diagnosis / Lung Diseases, Interstitial - drug therapy / Lung Diseases, Interstitial - etiology / Lung Diseases, Interstitial - physiopathology / Mortality / Pandemics / Perspective / Pneumonia / Pneumonia, Viral - complications / Pneumonia, Viral - drug therapy / Pneumonia, Viral - physiopathology / Proteins / rare lung diseases / Respiratory diseases / SARS-CoV-2 / Severe acute respiratory syndrome coronavirus 2 / Tomography, X-Ray Computed / viral infection