Clinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease

Tackling pulmonary fibrosis risks in post-COVID-19: cutting-edge treatments

INTRODUCTION

Pulmonary fibrosis (PF) post-COVID-19 has been identified as an important complication of Long-COVID, especially in patients with severe respiratory symptoms. High-resolution computed tomography (HRCT) is the main tool for detecting fibrotic lesions in patients with PF post-COVID-19.

AREAS COVERED

We conducted a systematic review with the following objectives: (1) to summarize the incidence and disease burden of post‑COVID‑19 pulmonary fibrosis, (2) to provide information on available therapies and drugs for its management, (3) to comprehensively evaluate the initial treatment efficacy of these drugs, and (4) to identify the limitations and challenges associated with current treatment approaches.

EXPERT OPINION

Cutting-edge treatments for PF post-COVID-19 are focused on the complex and multifactorial nature of the disease progreession during Long COVID, which involves chronic inflammation, fibroblast activation, and excessive extracellular matrix deposition leading to stiffening and fibrosis of lung tissue. While traditional antifibrotic drugs with nintedanid and pirfenidone are being used, novel therapies with anti-interleukines, mesenchymal stem cells, and Rho-kinase inhibitors promise the new treatment approaches for patients with PF post-COVID-19. Further research and clinical trials are needed to determine the most effective strategies for managing this complex condition, with the goal of improving patient outcomes and quality of life.

TB survivors: why curing TB is sometimes not enough

It is now well understood that the effect of TB does not always end when a patient completes a successful course of treatment. Successful treatment is by definition a microbiological cure, but people may continue to suffer the consequences of TB for months or years after treatment. For example, ongoing health challenges can present in the form of post-TB lung disease (PTLD), and there is a high incidence of TB-related symptoms associated with disability in other domains. We discuss an article in this issue of the Journal that explores the experiences of adult TB survivors, which further expands our understanding of this condition.

Viewpoint on WHO implementation guidance on tuberculosis infection prevention and control

Transmission continues to drive the tuberculosis (TB) and drug-resistant TB epidemics, making infection control an essential component for public health agencies worldwide [1–3]. Transmission of TB is complex, influenced by factors linked to patient behaviour, the form of disease, the exposed individual, the microbe and the environment [3–6]. Each year, more than 10 million people develop TB, more than 80% of whom have pulmonary disease and more than 60% are bacteriologically positive [1].

This viewpoint describes key aspects for TB infection prevention and control, and also covers areas of paramount interest for clinicians, such as when to admit or discharge infectious patients and presenting relevant country examples https://bit.ly/3YcyJxj

2022 TB programme review in Pakistan: strengthening governance, with better patient diagnosis and treatment

BACKGROUND

In Pakistan, 84% of healthcare is provided by the private sector. We conducted an epidemiological and programme review for TB to document progress and guide further efforts.

METHODS

Surveillance and data systems were assessed before analysing epidemiological data. We reviewed the programme at federal, provincial and peripheral levels and compiled national data along with WHO estimates to describe the evolution of epidemiological and programme indicators.

RESULTS

In 2021, of the estimated number of TB cases, 55% of overall cases and 18% of drug-resistant cases were diagnosed and treated respectively. The contribution of the private sector in case detection increased from 30% in 2017 to 40% by 2021. For newly diagnosed pulmonary TB cases, the overall proportion of confirmed cases was 52%. In 2021, testing for rifampicin resistance among confirmed cases was 66% for new and 84% for previously treated patients. The treatment success rate exceeded 90% for drug susceptible TB. The main challenges identified were a funding gap (60% in 2021-2023), fragmented electronic systems for data collection and suboptimal coordination among provinces.

CONCLUSIONS

The main challenges prevent further progress in controlling TB. By addressing these, Pakistan could improve coverage of interventions, including diagnosis and treatment. Bacteriological confirmation using recommended diagnostics also requires further optimisation.

Standards for clinical trials for treating TB

BACKGROUND: The value, speed of completion and robustness of the evidence generated by TB treatment trials could be improved by implementing standards for best practice.METHODS: A global panel of experts participated in a Delphi process, using a 7-point Likert scale to score and revise draft standards until consensus was reached.RESULTS: Eleven standards were defined: Standard 1, high quality data on TB regimens are essential to inform clinical and programmatic management; Standard 2, the research questions addressed by TB trials should be relevant to affected communities, who should be included in all trial stages; Standard 3, trials should make every effort to be as inclusive as possible; Standard 4, the most efficient trial designs should be considered to improve the evidence base as quickly and cost effectively as possible, without compromising quality; Standard 5, trial governance should be in line with accepted good clinical practice; Standard 6, trials should investigate and report strategies that promote optimal engagement in care; Standard 7, where possible, TB trials should include pharmacokinetic and pharmacodynamic components; Standard 8, outcomes should include frequency of disease recurrence and post-treatment sequelae; Standard 9, TB trials should aim to harmonise key outcomes and data structures across studies; Standard 10, TB trials should include biobanking; Standard 11, treatment trials should invest in capacity strengthening of local trial and TB programme staff.CONCLUSION: These standards should improve the efficiency and effectiveness of evidence generation, as well as the translation of research into policy and practice.