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Understanding and Managing Post-COVID-19 Organizing Pneumonia

Chung Chieh Yu*

The global impact of the rapid spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) since late 2019 has been substantial. COVID-19-related pneumonia has significantly contributed to the resulting fatalities. The most common findings of COVID-19 pneumonia in chest computed tomography scans include peripheral ground-glass opacities and consolidation, presenting in bilateral and multifocal distributions, which closely resemble to Organizing Pneumonia (OP). COVID-19-related OP is not uncommon and can mimic infectious pneumonia. The onset of OP following a COVID-19 varies, OP can occur from a few weeks to three months after COVID-19 infection. OP can be cryptogenic (COP) or secondary to various causes, with post COVID-19 OP classified as a secondary form of OP. Definitively diagnosis OP requires a lung biopsy, although acquiring sufficient tissue can pose challenges in real clinical practice. Rapid diagnostic tools can help exclude infectious pneumonia and assist promptly diagnosing OP, facilitating the initiation of steroid treatment. This is particularly critical for patients who are severely or critically ill. In cases of OP related to COVID-19, patients in the early phase should follow standard COVID-19 guidelines, receiving treatment with steroids, or a combination of anti-Interleukin-6 Inhibitors or Janus kinase inhibitors. On the other hand, late-onset cases are predominantly treated with corticosteroids, as observed in most case series and studies. For mild to moderate cases, treatment with a low dose of steroids and maintaining the steroid regimen for 8 Â ± 4 weeks can lead to favorable outcomes. The optimal steroid dosage and treatment duration for severe cases remain unclear. The dose and duration of systemic steroids for these severe patients should be tailored based on the severity of the disease and their responsiveness to treatment.