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Updated: Sep 1, 2025

Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease
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Managing Post COVID-19 Patient with Breathlessness.

Yen Shen Wong1, Muhammad Amin Ibrahim1, Mohd Arif Mohd Zim1

  • 1Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia.

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This case highlights a chronic obstructive pulmonary disease (COPD) patient experiencing severe COVID-19, leading to organizing pneumonia and fibrosis. Early intervention and careful management of pre-existing conditions are crucial for recovery.

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Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Radiology

Background:

  • Chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD), may increase the severity of coronavirus disease 2019 (COVID-19) infections.
  • This review focuses on a specific case of COPD exacerbation following COVID-19 and the diagnostic strategies employed.

Observation:

  • A 69-year-old male with GOLD D COPD and ischemic heart disease presented with severe COVID-19 requiring high-flow nasal cannula.
  • Initial CTPA revealed organizing pneumonia (OP) and emphysematous changes; treatment included baricitinib and methylprednisolone, followed by oral prednisolone and optimized COPD pharmacotherapy.
  • The patient was re-admitted with dyspnea and fever, showing increased reticulations and crazy paving on CTPA, indicative of interstitial pneumonia with COVID-19 OP and fibrosis progression.

Findings:

  • The patient's condition evolved from initial organizing pneumonia to interstitial pneumonia with fibrosis progression post-COVID-19.
  • Treatment involved corticosteroids and optimized COPD management, with a cautious approach to inhaled corticosteroids due to pneumonia and low eosinophil count.
  • Antibiotic therapy led to a positive response, and clinical and radiological improvements were noted at 3-month follow-up.

Implications:

  • Close monitoring of patients with pre-existing lung conditions post-COVID-19 is essential to detect and manage interstitial lung disease.
  • Optimizing management of underlying conditions like COPD is paramount in mitigating severe COVID-19 outcomes.
  • Caution is advised with corticosteroid inhalers in patients with recent pneumonia and low eosinophil counts.