COVID-19 Patients with Pulmonary Fibrotic Tissue: Clinical Pharmacological Rational of Antifibrotic Therapy
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COVID-19
COVID-19 Patients with Pulmonary Fibrotic Tissue: Clinical Pharmacological Rational of Antifibrotic Therapy Antonio Vitiello 1 & Chiara Pelliccia 2 & Francesco Ferrara 1 Accepted: 24 August 2020 # Springer Nature Switzerland AG 2020
Abstract In December 2019, the first data emerged from Wuhan, China, of a serious acute respiratory disease caused by a new coronavirus, SARS-CoV-2 (COVID-19). In a short time, the health emergency became a global pandemic. To date, there are about 18.8 million infected people and about 700,000 deaths. There are currently no effective vaccines, and treatments are mostly experimental. The symptoms associated with COVID-19 are different, ranging from mild upper respiratory tract symptoms to severe acute respiratory distress syndrome (SARS). Data from previous coronavirus outbreaks such as SARS-CoV (2003 outbreak) and emerging epidemiological data from the current global COVID-19 pandemic suggest that there could be substantial tissue fibrotic consequences following SARS-CoV-2 infection, responsible for severe and in some cases fatal lung lesions. Some data show that even patients cured of viral infection have lung fibrotic tissue residues responsible for incorrect respiratory function even after healing. The role of antifibrotic drug therapy in patients with ongoing SARS-CoV-2 infection or in patients cured of residual pulmonary fibrosis is still to be defined and unclear; the scientific rationale for initiating, continuing, or discontinuing therapy is poorly defined. In this article, we describe the advantages of antifibrotic therapy in patients with ongoing SARS-CoV-2 viral infection to prevent the worsening and aggravation of the clinical situation, and the advantages it could have in the role of preventing pulmonary fibrosis after SARS-CoV-2 infection, and in accelerating the complete healing process. Keywords Fibrotic . Pulmonary . Covid-19 . Infection . Pirfenidone
SARS-CoV-2 Clinical Aspects The new coronavirus SARS-CoV-2 (COVID-19) is responsible for the current global pandemic, representing a health challenge with few precedents in human history. At the time of writing this manuscript, COVID-19 infected 6.42 million people and caused about 700,000 deaths [1]. SARS-CoV-2 infection can have a completely asymptomatic or mildly symptomatic course, but in some cases, it can also cause systemic hyperinflammation, pulmonary fibrosis and scarring with lung collapse, multi-organ dysfunction, and patient death [2]. To date, no effective or antiviral vaccines Topical Collection on COVID-19 * Francesco Ferrara [email protected] 1
Usl Umbria 1, Perugia, Italy
2
Usl Umbria 2, Terni, Italy
against SARS-CoV-2 are available, treatments are mostly experimental, so it is very important to know the advantages of current therapeutic solutions to decrease the aggressiveness of the viral infection, avoiding serious complications and consequent patient death. The most serious phases of viral infection are characterized by a sudden and excessive release of proinflammatory me
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