“There is no pulmonary rehabilitation in Poland”

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According to doctors, we will be dealing with the effects of the coronavirus pandemic for a long time to come. For many convalescents, recovery means long rehabilitation, incl. respiratory. Because it is the lungs that most often suffer from infection. We talk to prof. Paweł Śliwiński.

1. – Inflammation will leave a trace in the lung parenchyma in the form of post-inflammatory fibrosis of varying severity – explains the expert
2. Healers with pulmonary problems need rehabilitation – this, however, is a big problem in Poland
3. Prof. Śliwiński: – There is practically no such thing as pulmonary rehabilitation in Poland so far
4. Read the first part of the conversation HERE
5. You can find more such stories on the TvoiLokony home page

Monika Zieleniewska, MedTvoiLokony: What about patients who, for example, after a few months visit pneumonologists with pulmonary complications after COVID-19?

Prof. Paweł Śliwiński: If we control the pandemic and all the restrictions are loosened or eliminated, then we will remain as a society and as a health care provider with a huge problem of patients who have severely contracted COVID-19, this acute phase of the disease, and will enter the phase of a chronic disease, known as long COVID or COVID post. It is about a situation where the symptoms of the disease and its complications persist for weeks or even months. Whether it is also longer – this is not known yet, but it can be assumed that it is.

Severe COVID-19 disease with the involvement of a significant volume of the lung parenchyma (often in 80-90%) must have long-term consequences. Namely, like any inflammation, this one can heal completely. The changes we observe radiographically may resolve completely after some time, but no one should be surprised that the inflammation will leave a trace in the lung parenchyma in the form of post-inflammatory fibrosis of varying severity.

Are these changes permanent?

These are permanent changes. They can be compared to a scar on the skin after a deep cut or burn. This scar is basically for life, and the same thing happens in the lung parenchyma. I would like to add that the intensity of inflammation residues varies individually. These may be minor post-inflammatory changes, more or less numerous, which will not affect the functioning of the respiratory system in any way, but also the inflammation may be so intense that it will completely destroy the pulmonary parenchyma. It will lead to a permanent loss of lung volume, and this entails the possibility – either immediately or over the next few years – of developing respiratory failure and the need to breathe oxygen for the rest of your life.

So there is a lot of work for pneumologists?

It looks like a lot of work, because you probably know the term – pulmonary fibrosis. In extreme situations, inflammation can lead to fibrosis of the pulmonary parenchyma, which is no longer able to provide a person with proper gas exchange, i.e. proper oxygen uptake and carbon dioxide excretion, and entails respiratory failure. Such patients will certainly require at least oxygen therapy.

How do we deal with pulmonary fibrosis after COVID-19, are there any new methods?

There are no innovative methods. Here it is important to be clear and clear that we are all learning how to deal with complications from COVID-19.

First, there are clinical trials with various drugs designed to treat COVID-19, but no new drugs are available yet. There are also attempts to use drugs that we are currently using to treat other diseases that lead to pulmonary fibrosis, but currently there are few studies of this type and have not yet produced any conclusions. For now, some are trying, others are not trying to treat these patients with oral steroids. Attempts are being made to treat or prevent pulmonary fibrosis with traditional drugs, but there are also clinicians and scientists who believe that these changes may reverse spontaneously in many people. There is no clear position here. We learn, like in medicine, on the battlefield.

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Can such a sick person be rehabilitated?

You can and you must. It is worth noting, however, that so far there is practically no such thing as pulmonary rehabilitation in Poland. I hope that the tragedy that has hit us will slightly sober up the decision-makers and start paying attention to the great need for the development of respiratory rehabilitation, but not because COVID-19 happened to us, where there will be a lot of these rehabilitation, only at all. Because, for example, about 3 million people in Poland suffer from COPD. They have not had access to real pulmonary rehabilitation so far. While neurological, orthopedic or cardiological rehabilitation has been developed and is being developed, respiratory rehabilitation practically does not exist in Poland.

I hope that the pandemic will be a turning point for the decision-makers from the National Health Fund to recognize the fact that the rehabilitation of the respiratory system is as important as the rehabilitation of, for example, the musculoskeletal system. After all, no locomotor system will function if the human lungs are not functional.

I understand that this is not a matter of a lack of specialists, but rather of finances?

It is mainly a matter of a lack of organization, finance, equipment and a lack of awareness. Typically, rehabilitation is viewed as being active in relation to people with disabilities, be it after a heart attack or hip replacement. If a person’s disability is visible to the naked eye, then everyone will obviously recognize him as a disabled person. On the other hand, when we look at a person who has only the remnants of functional lung flesh, we usually do not treat him as a disabled person, because the lung defect is not visible. Our tragedy is the lack of awareness of the need for rehabilitation of pneumological patients. Not only people after COVID-19, but a huge number of patients who have always been in Poland and have never been properly rehabilitated.

So what should proper pulmonary rehabilitation look like?

There must be awareness among decision-makers that this is not about in-patient rehabilitation and the enormous costs associated with it, it is not about barracking tens of thousands of people in wards or sanatoriums, because most of them are able to use exercises on an outpatient basis; only this is not there. We create pilot programs, such as in Głuchołazy, for a lot of money, where nothing extraordinary is happening. Patients perform the same exercises that everyone else should have been doing for decades … No rehabilitation revolution has been introduced there. Patients have basic exercises that everyone should have, such as COPD or asthma, but nobody has done it so far. These people need to be improved by breathing.

Of course, rehabilitation should be comprehensive, so it should take into account not only breathing and physical exercises, but also nutrition and psychological care. Physiotherapists should be provided with working conditions and adequate financial conditions. Most importantly, these activities do not have to, or even cannot, be carried out in a hospital setting, as no one will ever provide enough beds for rehabilitation patients. The absolute majority of patients with respiratory diseases (including post-COVID-19) can and should undergo outpatient rehabilitation.

This may interest you:

1. One year after COVID-19. Every third patient has changes in the lungs
2. Pulmonary embolism can be a complication after COVID-19
3. What Happens to the Lungs After COVID-19? The doctors did not encounter such complications

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