Pulmonary complications due to COVID-19 – a literature review
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Department of Pulmonology, Faculty of Public Health, University of Warmia and Mazury in Olsztyn, Poland
Submission date: 2021-03-23
Final revision date: 2021-04-22
Acceptance date: 2021-04-22
Online publication date: 2021-09-24
Corresponding author
Anna Maria Romaszko-Wojtowicz   

Department of Pulmonology, Faculty of Public Health, University of Warmia and Mazury in Olsztyn, Jagiellońska 78, 10-357 Olsztyn, Poland.
Pol. Ann. Med. 2021;28(2):244-249
irst cases of a disease called coronavirus disease 2019 (COVID-19), caused by a novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of the coronavirus family, were detected in December 2019. The disease is manifested by a variety of symptoms and can run a different course: from oligosymptomatic or asymptomatic to the development of acute respiratory failure and even death.

The aim of this paper is to provide critical analysis of the potential pulmonary complications after COVID-19 infection.

Material and methods:
We have provided the systematic literature review based on which we have discussed the pathophysiology of COVID-19, its outcomes, risk factors and pulmonary complications.

Results and discussion:
The organs that are most often affected by a SARS-CoV-2 infection are the lungs. An infection with this virus can lead to a severe respiratory tract illness, both in the acute phase and as a complication after a relatively mild case. There are numerous observations of patients convalescing from COVID-19 who suffer from the interstitial pulmonary disease with fibrosis. There are also reported cases of spontaneous pneumothorax after COVID-19.

It should be borne in mind that other late complications may appear with time.

None declared.
None declared.
Van der Hoek L. Human coronaviruses: What do they cause? Antivir Ther. 2007;12(4 Pt B):651–658.
Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health. 2020;25(3):278-280.
Coronaviridae Study Group of the International Committee on Taxonomy of V. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–544.
To KK, Tsang OT, Leung WS, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020;20(5):565–574.
Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720.
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475–481.
Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: Early experience and forecast during an emergency response. JAMA. 2020;323(16):1545–1546.
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062.
Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. JAMA. 2020;323(14):1335.
Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985.
Arentz M, Yim E, Klaff L, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. 2020;323(16):1612–1614.
World Health Organization. Coronavirus disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update. Accessed 12.02.2021.
Bellani G, Laffey JG, Pham T, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016;315(8):788–800.
de Luis Cabezón N, Sánchez Castro I, Bengoetxea Uriarte UX, Rodrigo Casanova MP, García Peña JM, Aguilera Celorrio L. Acute respiratory distress syndrome: A review of the berlin definition [in Spanish]. Rev Esp Anestesiol Reanim. 2014;61(6):319–327.
Matthay MA, Aldrich JM, Gotts JE. Treatment for severe acute respiratory distress syndrome from COVID-19. Lancet Respir Med. 2020;8(5):433–434.
Tay MZ, Poh CM, Renia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020;20(6):363–374.
Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020;130(5):2620–2629.
Huang D, Lian X, Song F, et al. Clinical features of severe patients infected with 2019 novel coronavirus: a systematic review and meta-analysis. Ann Transl Med. 2020;8(9):576.
Zhang J, Hao Y, Ou W, et al. Serum interleukin-6 is an indicator for severity in 901 patients with SARS-CoV-2 infection: a cohort study. J Transl Med. 2020;18(1):1–8.
Ackermann M, Verleden SE, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med. 2020;383(2):120–128.
Magro C, Mulvey JJ, Berlin D, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res. 2020;220:1–13.
Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020;46(6):1089–1098.
Klok F, Kruip M, van der Meer N, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145–147.
Group RC, Horby P, Lim WS, et al. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med. 2021;384(8):693–704.
van Dongen CM, Janssen MT, van der Horst RP, et al. Unusually rapid development of pulmonary hypertension and right ventricular failure after COVID-19 Pneumonia. Eur J Case Rep Intern Med. 2020;7(7):001784.
Dicpinigaitis PV. Effect of viral upper respiratory tract infection on cough reflex sensitivity. J Thorac Dis. 2014;6(Suppl 7):S708–S711.
Vasarmidi E, Tsitoura E, Spandidos DA, Tzanakis N, Antoniou KM. Pulmonary fibrosis in the aftermath of the COVID-19 era (Review). Exp Ther Med. 2020;20(3):2557–2560.
Richeldi L, Collard HR, Jones MG. Idiopathic pulmonary fibrosis. Lancet. 2017;389(10082):1941–1952.
Wong KT, Antonio GE, Hui DS, et al. Severe acute respiratory syndrome: thin-section computed tomography features, temporal changes, and clinicoradiologic correlation during the convalescent period. J Comput Assist Tomogr. 2004;28(6):790–795.
Marvisi M, Ferrozzi F, Balzarini L, Mancini C, Ramponi S, Uccelli M. First report on clinical and radiological features of COVID-19 pneumonitis in a Caucasian population: Factors predicting fibrotic evolution. Int J Infect Dis. 2020;99:485–488.
Huang Y, Tan C, Wu J, et al. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir Res. 2020;21(1):163.
Das KM, Lee EY, Singh R, et al. Follow-up chest radiographic findings in patients with MERS-CoV after recovery. Indian J Radiol Imaging. 2017;27(3):342–349.
Desai SR, Wells AU, Rubens MB, Evans TW, Hansell DM. Acute respiratory distress syndrome: CT abnormalities at long-term follow-up. Radiology. 1999;210(1):29–35.
Liu W, Tao ZW, Wang L, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl). 2020;133(9):1032–1038.
González-Rubio J, Navarro-López C, López-Nájera E, et al. A Systematic review and meta-analysis of hospitalised current smokers and COVID-19. Int J Environ Res Public Health. 2020;17(20):7394.
Patanavanich R, Glantz SA. Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: A systematic review and meta-analysis. BMC Public Health. 2021;21:1554.
Thillai M, Patvardhan C, Swietlik EM, et al. Functional respiratory imaging identifies redistribution of pulmonary blood flow in patients with COVID-19. Thorax. 2021;76(2):182–184.
de Perrot M, Granton J, Fadel E. Pulmonary hypertension after pulmonary emboli: an underrecognized condition. CMAJ. 2006;174(12):1706.
Iba T, Levy JH, Connors JM, Warkentin TE, Thachil J, Levi M. The unique characteristics of COVID-19 coagulopathy. Crit Care. 2020;24(1):360.
Daher A, Balfanz P, Cornelissen C, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae. Respir Med. 2020;174:106197.
Poissy J, Goutay J, Caplan M, et al. Pulmonary embolism in patients with COVID-19: Awareness of an increased prevalence. Circulation. 2020;142(2):184–186.
Vieillard-Baron A, Schmitt JM, Augarde R, et al. Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis. Crit Care Med. 2001;29(8):1551–1555.
Repesse X, Charron C, Vieillard-Baron A. Acute respiratory distress syndrome: the heart side of the moon. Curr Opin Crit Care. 2016;22(1):38–44.
Avellanas Chavala ML. Pulmonary arterial hypertension and COVID-19. Med Intensiva. 2020;44(9):577–579. doi: 10.1016/j.medin.2020.05.005.
Light RW. Management of spontaneous pneumothorax. Am Rev Respir Dis. 1993;148(1):245–248.
Costumbrado J, Ghassemzadeh S. Spontaneous Pneumothorax. Treasure Island (FL): StatPearls Publ.; 2021. Accessed: 16.09.2021.
Wong K, Kim DH, Iakovou A, et al. Pneumothorax in COVID-19 acute respiratory distress syndrome: Case series. Cureus. 2020;12(11):e11749.
Yamaya T, Baba T, Hagiwara E, et al. Pneumothorax in a COVID-19 pneumonia patient without underlying risk factors. Intern Med. 2020;59(22):2921–2925.
Chen X, Zhang G, Tang Y, Peng Z, Pan H. The coronavirus diseases 2019 (COVID-19) pneumonia with spontaneous pneumothorax: a case report. BMC Infect Dis. 2020;20(1):662.
Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338(6):347–354.
Sun R, Liu H, Wang X. Mediastinal Emphysema, Giant Bulla, and Pneumothorax Developed during the Course of COVID-19 Pneumonia. Korean J Radiol. 2020;21(5):541–544.
Wichmann D. Autopsy findings and venous thromboembolism in patients with COVID-19. Ann Intern Med. 2020;173(12):1030.
Fox SE, Akmatbekov A, Harbert JL, Li G, Quincy Brown J, Vander Heide RS. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Med. 2020;8(7):681–686.
Liu K, Zeng Y, Xie P, et al. COVID-19 with cystic features on computed tomography: A case report. Medicine (Baltimore). 2020;99(18):e20175.
Dicpinigaitis PV, Canning BJ. Is there (will there be) a post-COVID-19 chronic cough? Lung. 2020;198(6):863–865.
Alhakeem A, Khan MM, Al Soub H, Yousaf Z. Case report: COVID-19-associated bilateral spontaneous pneumothorax – a literature review. Am J Trop Med Hyg. 2020;103(3):1162–1165.
Vazzana N, Ognibene S, Dipaola F. Pneumomediastinum and subcutaneous emphysema after noninvasive ventilation in a COVID-19 patient. Adv Respir Med. 2020;88(5):466–467.
Gorospe L, Ayala-Carbonero A, Urena-Vacas A, et al. Spontaneous pneumomediastinum in patients with COVID-19: A case series of four patients. Arch Bronconeumol. 2020;56(11):754–756.
Murayama S, Gibo S. Spontaneous pneumomediastinum and Macklin effect: Overview and appearance on computed tomography. World J Radiol. 2014;6(11):850–854.
Grabala J, Grabala M, Onichimowski D, Grabala P. The basics of application of medical ultrasonography in the diagnosis of acute respiratory failure. Pol Ann Med. 2017;24(1):104–109.
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