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

IOWA CITY – Damage to the small airways in the lungs is an after-effect of COVID-19 that can 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 know UI Post-COVID Clinic performed CT scans of patients previously infected with coronavirus and uncovered physical changes in the small airways – which may explain persistent breathing problems associated with long-distance COVID-19.

And these symptoms appear in patients regardless of the severity of their COVID-19 disease.

“Many people who had mild illness (from COVID-19) are usually people who are healthy and do not have many risk factors. Despite that, they still have the same results as someone who had developed a serious illness,” he said. Dr. Alejandro Comellas, Lung Physician 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 research group across the country that confirms that long-distance covid is a common and long-lasting consequence for those who have been infected with COVID-19.

Disease detected in 40 percent of long-distance patients

Researchers examined 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 following a COVID-19 infection.

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

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

However, researchers found that many of the post-COVID patients experienced a disease that caused air to get trapped in the small airways in the lungs, 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 minor respiratory illnesses, were detected in about 40 percent of patients in the study, Comellas said.

Comellas said it is unclear if this was caused by inflammation or fibrosis or permanent scarring of the lung. There are treatment options for inflammation, but treatments for fibrosis are limited.

These symptoms were also not related to the severity of a patient’s COVID-19 disease. The study showed that patients who had a mild coronavirus disease experienced the same symptoms as those who were seriously ill.

“It tells us that even if you think you want a mild illness, you can still have the same problems as someone who ended up in the intensive care unit in terms of minor respiratory illnesses,” Comellas said.

Among the 100 people surveyed, 67 never required hospitalization for COVID-19, according to researchers. Seventeen patients were hospitalized due to coronavirus infection, and 16 were hospitalized in intensive care.

Study results showed that the amount of air trapped in the lungs was greater for patients who were hospitalized compared to those who did not need hospitalization.

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

Researchers are working to determine if air entrapment in a patient’s lungs is a permanent disease or if it is something that will go away over time. Comellas said the UI Post-COVID Clinic will continue its research on the subject in the coming months to make that decision.

Disease is not seen in patients with three shots

The latest research from UI’s Post-COVID Clinic is among a growing body of scientific evidence on long-distance 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 require hospitalization later developed some form of long-distance covid. Another study out of the University of Washington estimated that the frequency among outpatients was 33 percent.

There has been anecdotal evidence from patients and providers around this phenomenon for several months, but Comellas said its key researchers reveal objective, systematic results to determine what happens to these patients.

In addition, the study further highlights the importance of vaccination not only to prevent serious illness but also to prevent long-term symptoms after infection.

Comellas said providers at the Post-COVID clinic do not see any long-distance patients receiving 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 booster dose seek treatment for long-distance covid symptoms.

“Vaccination is so important in so many aspects of acute illness, impact on society and even when thinking of post-COVID,” he said.

The Post-COVID Clinic also plans to conduct research into the potential neurological symptoms – such as brain fog or memory problems – reported in long-distance patients, Comellas said.

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