Post-COVID Sequelae: From Lung Disease to Long Disease

COVID-19 can have both an acute phase and post-acute phase of illness termed post-COVID sequelae, or "long Covid." In this case, a 66-year-old woman with a past medical history of reactive airway disease was admitted for shortness of breath twice. The first episode occurred in the setting of active COVID-19 infection. However, the second episode took place seven weeks later in the absence of COVID-19 as evidenced by a rapid antigen test. It is unclear why she re-developed shortness of breath after being discharged symptom-free from her initial admission. After treatment with prednisone, albuterol, and ipratropium she experienced symptomatic relief yet again and outpatient pulmonary function testing demonstrated a mildly obstructive pattern reversed with an inhaled bronchodilator. She has remained symptom-free since finishing an outpatient prednisone course. It is possible she developed post-COVID sequelae resembling an acute asthma exacerbation. Though the exact mechanism of post-COVID sequelae is not known, it is thought to be due to a combination of immune activation, dysregulation, and suppression. It is an important presentation for internists to know given the prevalence of COVID-19.