Respiratory complications are more common in elderly patients, especially in those
with a history of respiratory disorders. Additionally, before the coronavirus disease
2019 (COVID-19) outbreak, respiratory diseases (e.g., chronic obstructive pulmonary
disease) and pulmonary complications due to lower respiratory infections were some
of the leading causes of death in the elderly population.[1] Thus, there is a rising concern in long-term symptoms due to the severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) infection, mainly in frail elderly people with
respiratory pathologies and comorbidities.[2]
[3]
[4]
Recently, the term “Long COVID” had being introduced to describe the long-term symptoms
of the SARS-CoV-2 infection in patients recovered and discharged from hospital.[5] The SARS-CoV-2 virus interact with angiotensin-converting enzyme 2 negatively affecting
the vascular endothelium and leading to systemic injury.[6] Amidst, the respiratory system is directly lesioned by COVID-19, which may require
health strategies for elderly patients with preexisting respiratory diseases, mainly
in low-income and middle-income countries due to limited resources. Additionally,
SARS-CoV-2 infection severity and mortality has been clearly related to vulnerability
due to age-related accumulation of deficits, rather than chronological age itself.[3]
[4] In this scenario, the need of research support is a necessary step to understand,
in an international and interdisciplinary perspective, the long-term symptoms of COVID-19
in this population to manage and preserve their health lifelong. Thus, we performed
a literature review on PUBMED database until December 16, 2021 using keywords and
Medical Subject Headings terms related to “postacute COVID-19 syndrome” and “respiratory
system,” of which the main findings were summarized in the paragraph below.
Emergent data suggested that 1 to 3 months after discharge, patients still had radiologic
abnormalities consistent with pulmonary dysfunction (e.g., interstitial thickening
and fibrosis), decreased diffusion capacity for carbon monoxide, and diminished respiratory
muscle strength.[7]
[8]
[9]
[10] In addition, it was observed airflow obstruction, as well as reduced lung volume
measurements (total lung capacity, forced vital capacity, and forced expiratory volume
in one second) after more than 1 month postdischarge or more than 2 months postadmission.[11]
With the abovementioned symptoms, this leads to concerns about the elderly population
with vulnerability due to a history of preexisting respiratory diseases. Frailty is
a complex condition characterized by declining function across several homeostatic
systems leading to increased vulnerability to stressors and risk of adverse health
outcomes with age.[12]
[13]
[14] At the beginning of COVID-19 pandemic era, initial reports from Wuhan revealed that
most cases of COVID-19 have occurred in people aged 60 or above.[15] Additional reports from Italy and the United Kingdom, which are among the most hit
countries in Europe, have confirmed the high risk of death in older adults, particularly
in those with preexisting diseases (e.g., cardiovascular and respiratory diseases).[16]
[17]
[18] SARS-CoV-2 is a novel virus, which means there is still much that the medical and
wider research community do not know. Thus, well-conducted long-term research is needed
to follow-up discharged patients with symptoms from “long COVID” to treat sequelae
in the vulnerable population, taking into account frailty assessment and the history
of comorbidities.[5]
[14]
[19]
We hope this Letter encourage future researches to identify and manage long-term complications
due to COVID-19 infection and support elderly patients with vulnerability due to preexisting
comorbidities, mainly in the respiratory system.
