Dr. Alejandro Comellas (foreground) is heading up a clinic at the University of Iowa Hospitals and Clinics with Dr. Joseph Zabner (left) and Dr. Raul Villacreses for patients after they have been infected with COVID-19. (The Gazette)

IOWA CITY — Damage to the small airways in the lungs is an aftermath of COVID-19 that may cause long-lasting side effects, even for those who did not have a serious illness, according to a new study from the University of Iowa.

Researchers at the UI Post-COVID Clinic conducted CT scans of patients previously infected by the coronavirus and uncovered physical changes in the small airways — which may explain ongoing breathing problems associated with long-haul COVID-19.

And these symptoms are appearing in patients regardless of the severity of their COVID-19 illness.

“A lot of people who had mild disease (from COVID-19) are usually people who are healthy and don’t have a lot of risk factors. Despite that, they still have the same findings as somebody who had developed a severe illness,” said Dr. Alejandro Comellas, pulmonologist at the University of Iowa Hospitals and Clinics and head of the Post-COVID Clinic.

This study, published in the journal Radiology earlier this month, is among a growing body of research nationwide solidifying that long-haul COVID is a common and long-lasting consequence for those who have been infected by COVID-19.

Disease detected in 40 percent of long-haul patients

Researchers studied CT lung scans of 100 patients at the Post-COVID Clinic, an Iowa City-based specialized clinic established in June 2020 to treat and study patients experiencing complications after a COVID-19 infection.

These scans were then compared with scans taken before March 2020 of 106 healthy patients who had never been infected by COVID-19, Comellas said.

Researchers used specialized lung scans, called expiratory CT scans, that took imagines of patients’ lungs as they inhaled and exhaled. When someone exhales completely, he or she should be able to expel all of the air out of the lungs.

However, researchers found that many of the post-COVID patients were experiencing a disease that caused air to be trapped in the small airways in the lungs, which is similar to what people with asthma or chronic obstructive pulmonary disease, or COPD, experience. As a result, these patients experience wheezing or shortness of breath.

These persistent symptoms, described as small airways disease, was detected in about 40 percent of the patients in the study, Comellas said.

Comellas said it’s unclear whether this was caused by inflammation or fibrosis, or permanent scarring, of the lung. There are treatment options for inflammation, but therapies for fibrosis are limited.

These symptoms also had no correlation with the severity of a patient’s COVID-19 illness. The study found patients who had a mild illness with the coronavirus were experiencing the same symptoms as those who were seriously ill.

“It tells us even if you think you’re going to have a mild disease, you could still be having the same problems as someone who ended up in the ICU in regards to small airway disease,” Comellas said.

Among the 100 individuals studied, 67 never required hospitalization for COVID-19, according to researchers. Seventeen patients were hospitalized because of coronavirus infection and 16 were admitted into intensive care.

Study findings did show the amount of air trapped in the lungs was greater for patients who were hospitalized when compared with those who did not require hospitalization.

The small airways disease appears to be a long-lasting condition for these long-haul patients, Comellas said. Researchers detected air trapped in the lungs of nine patients who took a expiratory CT scan more than six months after their COVID-19 diagnosis.

Researchers are working to determine whether air trapping in patient’s lungs is a permanent malady, or whether it’s something that will go away over time. Comellas said the UI Post-COVID Clinic will be continuing its research on the subject in the coming months to make that determination.

Disease not appearing in patients with three shots

The latest research from UI’s Post-COVID Clinic is among a growing body of scientific evidence on long-haul COVID nationwide.

One recent study from the University of California estimated that as many as 27 percent of patients who had COVID-19 but did not need hospitalization later developed some form of long-haul COVID. Another study out of the University of Washington estimated the rate among outpatients was 33 percent.

There’s been anecdotal evidence from patients and providers around this phenomenon for several months, but Comellas said its important researchers uncover objective, systematic findings to determine what’s happening to these patients.

In addition, the study further highlights the importance of vaccination in not just preventing serious illness, but also in preventing long-term symptoms following infection.

Comellas said providers at the Post-COVID Clinic are not seeing any long-haul patients who received two doses from the primary vaccine series as well as a booster shot. They have seen patients who received the first two shots, but not the booster dose, seek care for long-haul COVID symptoms.

“Vaccination is so important in so many aspects for acute illness, the affect on the community and even when thinking about post-COVID,” he said.

The Post-COVID Clinic also plans to conduct research on the potential neurological symptoms — such as brain fog or memory issues — reported in long-haul patients, Comellas said.

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