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Post-COVID Respiratory Sequelae in COPD: Mucus Plugging, Infectious Complications, and Risk-Stratified Follow-Up.
Florina Cristiana Lucaciu1,2,3, Norbert Wellmann1,2,4, Ana Maria Mihai1,2,3
1Doctoral School, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Journal of Clinical Medicine
|May 4, 2026
Summary
Patients with chronic obstructive pulmonary disease (COPD) face increased risks from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, including mucus plugs and secondary infections. Careful monitoring post-discharge is crucial for managing respiratory sequelae.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Critical Care
Background:
- Chronic obstructive pulmonary disease (COPD) involves mucus dysfunction, inflammation, and impaired immunity.
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exacerbates these underlying lung conditions.
- Understanding the interplay between COPD and COVID-19 is critical for patient outcomes.
Purpose of the Study:
- To review the impact of SARS-CoV-2 infection in COPD patients.
- To synthesize evidence on respiratory sequelae and complications.
- To identify critical periods for intervention.
Main Methods:
- Focused narrative review of clinical, experimental, and consensus evidence (2020-2025).
- Qualitative synthesis prioritizing cohort studies, meta-analyses, and mechanism-focused studies.
- Focused on outcomes related to mucus obstruction, infections, sepsis, and exacerbations.
Main Results:
- Mucus plugs are common in COPD (41-67%) and linked to poor outcomes.
- Secondary bacterial infections (14-18%) and sepsis are significant concerns, especially in severe COVID-19.
- Increased risk of COPD exacerbations post-discharge, peaking within 30 days of severe disease.
- Persistent dyspnea and reduced diffusing capacity for carbon monoxide (DLCO) indicate ARDS-related injury.
Conclusions:
- Post-COVID respiratory sequelae in COPD result from mucus, immune, and infectious complications.
- The first month after hospital discharge is critical for risk stratification and follow-up.
- Targeted interventions are needed to mitigate long-term respiratory decline.
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