Pulmonary Disorders and COVID-19

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]

Overview

Covid-19 infection is associated with pulmonary complications such as acute respiratory distress syndrome, pneumonia, pulmonary embolism, hypoxemia, superinfection, respiratory failure, and increased mortality in patients with an underlying pulmonary disease such as chronic obstructive pulmonary disease (COPD).

Complications

Pulmonary embolism

In May 2020, various autopsies studies revealed pulmonary embolism to be the common cause of death in these patients. These patients in their mid-70s had preexisting medical conditions such as cardiac diseases, hypertension, diabetes and obesity.These studies highlight the role of hypercoagulability as main contributor towards the fatality in these patients. Various studies have described Virchow's triad to be the main component of the hypercoagulable state in these patients.

Pathogenesis

As data on COVID-19 has been incomplete and evolving, the pathogenesis of pulmonary embolism has not yet been completely understood. Various contributors towards the pathogenesis of pulmonary embolism in these patients are listed as

• Endothelial cell injury : It has been proposed that endothelial cell contribute towards the inititation and propagation of ARDS by changing the vascular barrier permeability, increasing the chance of procagulative state that leads to endotheliitis and infiltration of inflammatory cells in the pulmonary vasculature.

Increased mortality in COPD patients

• According to a study conducted in China, having an underlying comorbidity such as chronic obstructive pulmonary disease (COPD) conferred a mortality hazard ratio of 2.681, even after adjusting for smoking status.