Pulmonary fibrosis secondary to COVID-19: a narrative review

Expert Rev Respir Med. 2021 Jun;15(6):791-803. doi: 10.1080/17476348.2021.1916472. Epub 2021 Apr 27.


Introduction: Coronavirus disease 2019 (COVID-19) is still increasing worldwide, and as a result, the number of patients with pulmonary fibrosis secondary to COVID-19 will expand over time. Risk factors, histopathological characterization, pathophysiology, prevalence, and management of post-COVID-19 pulmonary fibrosis are poorly understood, and few studies have addressed these issues.Areas covered:This article reviews the current evidence regarding post-COVID-19 pulmonary fibrosis, with an emphasis on the potential risk factors, histopathology, pathophysiology, functional and tomographic features, and potential therapeutic modalities. A search on the issue was performed in the MEDLINE, Embase, and SciELO databases and the Cochrane library between 1 December 2019, and 25 January 2021. Studies were reviewed and relevant topics were incorporated into this narrative review. Expert opinion: Pulmonary sequelae may occur secondary to COVID-19, which needs to be included as a potential etiology in the current differential diagnosis of pulmonary fibrosis. Therefore, serial clinical, tomographic, and functional screening for pulmonary fibrosis is recommended after COVID-19, mainly in patients with pulmonary involvement in the acute phase of the disease. Further studies are necessary to determine the risk factors, markers, pathophysiology, and appropriate management of post-COVID-19 pulmonary fibrosis.

Keywords: Coronavirus; covid-19; ct-scan; interstitial lung disease; lung function; post-covid-19; pulmonary fibrosis; pulmonary sequelae.

Publication types

  • Review

MeSH terms

  • COVID-19 / complications*
  • COVID-19 / diagnosis
  • COVID-19 / pathology
  • COVID-19 / therapy
  • Databases, Factual
  • Diagnosis, Differential
  • Disease Progression
  • Humans
  • Lung / pathology
  • Lung / virology
  • Pulmonary Fibrosis / diagnosis
  • Pulmonary Fibrosis / etiology*
  • Pulmonary Fibrosis / pathology
  • Pulmonary Fibrosis / therapy
  • Risk Factors
  • SARS-CoV-2 / physiology
  • Severity of Illness Index
  • Tomography, X-Ray Computed / methods