Increased Risk of Pulmonary Fibrosis in Critically Ill COVID-19 Patients | Pharmacy Times

Post-COVID Lung Damage: New Study Reveals Fibrosis Risks

October 4, 2025

A new examination has revealed that a substantial proportion of individuals hospitalized with severe Coronavirus Disease 2019 (COVID-19) pneumonia and requiring mechanical ventilation exhibit signs of lung scarring, known as pulmonary fibrosis. The retrospective study, conducted across nine hospitals in South Korea, underscores the need for vigilant monitoring and potentially new therapeutic strategies to address this emerging long-term health challenge.

Pulmonary fibrosis – a serious lung condition. Pulmonary fibrosis can cause breathing difficulties and requires careful medical attention”>

Pulmonary fibrosis can be a serious complication following a severe bout of COVID-19.

Pulmonary fibrosis, a condition where lung tissue becomes damaged and scarred, severely impairs breathing and has no known cure. Initial findings indicate approximately 75% of critically ill Covid-19 patients demonstrated these fibrotic changes on chest Computed Tomography (CT) scans. This finding adds to the growing understanding of ‘long COVID’ and its diverse, long-lasting effects.

The Scope of the problem

Researchers analyzed data from 125 patients who underwent mechanical ventilation due to COVID-19 pneumonia between February 2020 and October 2021.The analysis categorized patients into those exhibiting pulmonary fibrosis and those without.Results showed that 54 patients-43.2% of the group-displayed two or more indicators of lung scarring, while 7 patients-5.6%-showed three or more.

Commonly observed features included traction bronchiectasis or bronchiolectasis, affecting 60.8% of patients, followed by architectural distortion or parenchymal bands (44.8%), reticulation (18.4%), and, less frequently, honeycomb patterns (0.8%).

Steroid Treatment and Outcomes

The vast majority of patients – 94.4%, or 118 out of 125 – received systemic steroid treatment during their hospitalization, and 74.7% also received antiviral therapies. Surprisingly, the dosage of steroids administered did not considerably differ between those who developed pulmonary fibrosis and those who did not. Similarly, ventilator settings and other supportive care measures were comparable between the groups.

22 patients (17.6%) died during their hospital stay, while 89 (71.2%) experienced one or more complications. Interestingly, when pulmonary fibrosis was defined by the presence of two or more fibrotic changes, mortality rates were notably lower in patients *with* fibrosis (9.3%) compared to those without (23.9%). A similar trend was observed for patients with three or more changes (0% vs 18.6%).

Identifying Risk Factors

Statistical analysis revealed certain factors were associated with a *reduced* risk of developing pulmonary fibrosis. Higher heart rate, higher sequential Organ Failure Assessment (SOFA) scores, and higher daily doses of steroids were all linked to a lower likelihood of lung scarring. Conversely, factors previously suspected-such as age, gender, smoking history, and C-reactive protein levels-did not demonstrate a significant association in this study.

“Our findings suggest that a higher daily dose of steroids may play a critical role in mitigating fibrotic progression,” the researchers concluded. “Further research is needed to determine the optimal timing, dosage, and duration of corticosteroid therapy, particularly in patients with severe COVID-19, to improve clinical outcomes and prevent long-term pulmonary sequelae.”

Understanding Pulmonary Fibrosis

Pulmonary fibrosis isn’t exclusive to post-COVID conditions. It can arise from various causes, including environmental exposures, autoimmune diseases, and genetic predisposition. Symptoms frequently enough include shortness of breath, a persistent dry cough, fatigue, and unexplained weight loss. Early diagnosis is crucial, though challenging, as symptoms can mimic other respiratory illnesses.

Condition	Key Characteristics	Potential Causes
Idiopathic Pulmonary Fibrosis (IPF)	Progressive scarring of the lungs with unknown cause.	Genetic factors, environmental exposures.
Post-COVID Pulmonary Fibrosis	Lung scarring following severe COVID-19 infection.	Severe COVID-19 infection,inflammatory response.

Did You Know? The prognosis for pulmonary fibrosis varies considerably depending on the underlying cause and the extent of lung damage.

Ongoing research is exploring potential therapies to slow the progression of lung scarring and improve the quality of life for those affected.

Frequently Asked Questions about Pulmonary Fibrosis & COVID-19

• What is pulmonary fibrosis? Pulmonary fibrosis is a lung disease characterized by the scarring and thickening of lung tissue, making it challenging to breathe.
• Is pulmonary fibrosis a common complication of COVID-19? While studies vary, a significant percentage of patients hospitalized with severe COVID-19, especially those requiring ventilation, have shown signs of pulmonary fibrosis.
• What are the symptoms of pulmonary fibrosis? common symptoms include shortness of breath,a persistent dry cough,fatigue,and unexplained weight loss.
• Can steroids prevent pulmonary fibrosis after COVID-19? Research suggests higher doses of steroids *may* be protective, but optimal dosing strategies are still under investigation.
• How is pulmonary fibrosis diagnosed? Diagnosis typically involves a combination of physical examination, imaging tests (like CT scans), and sometimes a lung biopsy.
• Are there any effective treatments for pulmonary fibrosis? treatments focus on managing symptoms and slowing disease progression, but there’s currently no cure.
• What can I do to protect my lungs from long-term COVID-19 effects? vaccination, early treatment of COVID-19, and avoiding smoking are crucial steps.

Do you have concerns about potential long-term lung effects from a COVID-19 infection? Share your thoughts in the comments below.

What are the key differences between idiopathic and secondary pulmonary fibrosis, and how dose COVID-19 relate to the latter?

Increased Risk of Pulmonary Fibrosis in Critically Ill COVID-19 Patients

Understanding the Link Between COVID-19 and lung Damage

Critically ill patients who contracted COVID-19 exhibit a significantly heightened risk of developing pulmonary fibrosis, even after the acute infection subsides. This isn’t simply lingering lung damage; it’s a basic change in lung tissue structure. Understanding this connection is crucial for proactive monitoring and potential intervention. The severity of initial COVID-19 illness, particularly the need for mechanical ventilation, appears to be a strong predictor of this long-term complication. Terms like “post-COVID fibrosis,” “COVID-19 lung damage,” and “acute respiratory distress syndrome (ARDS) complications” are increasingly relevant in pulmonary care.

What is pulmonary Fibrosis?

Pulmonary fibrosis is a chronic and progressive lung disease characterized by the scarring of lung tissue. This scarring thickens and stiffens the lungs, making it challenging to breathe. Unlike conditions like COPD, which primarily involve airway obstruction, pulmonary fibrosis affects the lung tissue itself.

Hear’s a breakdown of key aspects:

* Scarring: The core issue is the excessive buildup of scar tissue (fibrosis).

* Reduced Lung Capacity: Scarring reduces the lungs’ ability to expand and contract efficiently.

* Oxygen Exchange impairment: Thickened lung tissue hinders the transfer of oxygen into the bloodstream.

* Progressive Nature: Pulmonary fibrosis typically worsens over time, leading to increasing shortness of breath and reduced quality of life.

* Idiopathic vs. Secondary: Pulmonary fibrosis can be idiopathic (cause unknown) or secondary to another condition, like COVID-19.

How COVID-19 Contributes to Fibrosis Progress

The mechanisms by which COVID-19 leads to pulmonary fibrosis are complex and still under investigation. However, several key factors are believed to play a role:

* Cytokine Storm: The intense inflammatory response (cytokine storm) characteristic of severe COVID-19 can cause significant lung injury.

* Acute Respiratory Distress Syndrome (ARDS): Many critically ill COVID-19 patients develop ARDS, a severe form of lung failure that often leads to fibrosis. ARDS and subsequent mechanical ventilation are major risk factors.

* Endothelial Dysfunction: COVID-19 can damage the endothelial cells lining blood vessels in the lungs, contributing to inflammation and fibrosis.

* Transforming Growth Factor-beta (TGF-β) Activation: TGF-β is a key signaling molecule involved in fibrosis. COVID-19 infection can trigger its overactivation.

* Viral Persistence: while less common, persistent viral presence in lung tissue may contribute to ongoing inflammation and fibrosis.

Identifying Patients at High Risk

Early identification of patients at risk is paramount. Several factors increase the likelihood of developing post-COVID pulmonary fibrosis:

1. Severity of Initial infection: Patients requiring ICU admission, mechanical ventilation, or experiencing ARDS are at significantly higher risk.
2. prolonged Ventilation: The longer a patient is on a ventilator, the greater the risk of lung injury and fibrosis.Ventilator-induced lung injury (VILI) is a serious concern.
3. Pre-existing Lung Conditions: Individuals with pre-existing lung diseases (COPD, asthma, interstitial lung disease) may be more susceptible.
4. Age: Older adults are generally at higher risk due to age-related decline in lung function and immune response.
5. Comorbidities: Conditions like diabetes, cardiovascular disease, and obesity can exacerbate lung injury and increase fibrosis risk.

Diagnostic Tools and Monitoring

Detecting pulmonary fibrosis early requires a combination of clinical assessment and diagnostic testing.

* High-Resolution Computed Tomography (HRCT): HRCT scans are the gold standard for identifying and assessing the extent of lung fibrosis.Look for characteristic patterns like reticular opacities, honeycombing, and traction bronchiectasis.

* Pulmonary Function Tests (PFTs): PFTs measure lung capacity and airflow, helping to identify restrictive lung disease patterns consistent with fibrosis. Specifically, reduced forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) are common findings.

* Six-Minute Walk Test (6MWT): This assesses exercise capacity and can detect subtle declines in lung function.

* Blood Biomarkers: Research is ongoing to identify reliable blood biomarkers for early detection of fibrosis, such as KL-6 and surfactant protein D (SP-D).

* Regular Follow-up: Patients with a history of severe COVID-19 should undergo regular pulmonary follow-up, including HRCT scans and PFTs, for at least one year post-infection.

Management and Treatment strategies

Currently, there is no cure for pulmonary fibrosis. Though, several strategies can definitely help manage symptoms and slow disease progression.

* Antifibrotic Medications: Drugs like pirfenidone and nintedanib, approved for idiopathic pulmonary fibrosis, are being investigated for their potential to slow the progression of post-COVID fibrosis.

* Corticosteroids: May be used