COVID-19 OUTCOMES: DRUG TREATMENT OPTIONS
Background. Since December 2019 there has been a rapid spread of the COVID-19 pandemic across most of the world. This has determined the enormous burden on the global economy. The burden of the new coronavirus infection is determined not only by the costs directly related to the treatment of the acute phase of the disease, but also by the successful rehabilitation of patients after COVID-19, risk reduction and timely management of adverse outcomes for optimal patient recovery. Aim. The aim of the study was to analyze the adverse outcomes of COVID-19 and to estimate the possibility of their correction and prevention. Material and methods. We analyzed the PubMed database for 2020-2021 using the keywords «COVID-19, pulmonary outcomes and treatment», as well as the online meetings of chief pulmonologists of the Volga Federal District (VFD) in April 2021, where we heard about the regional experience in prevention and correction of COVID-19 adverse outcomes. Results and discussion. More and more publications are appearing on the so-called «postdrome» after COVID-19. Postdrome problems are becoming increasingly important as more and more treated patients are discharged from hospitals. To date, there are already over 103 million COVID-19 survivors. In patients with severe or critical manifestations of the disease, widespread and progressive endothelial thrombosis with diffuse microvascular thrombosis is increasingly evident as the final stage of the proinflammatory cytokine storm. Adequate anticoagulant therapy primarily using heparins with direct antiviral activity, preventing venous thromboembolism, being used for pulmonary thrombosis, is relevant in the prevention of adverse outcomes. Many authors note long-lasting residual changes on lung CT after the acute phase of COVID-19. At the same time, unlike post-inflammatory pneumosclerosis in the outcome of bacterial pneumonias, these changes can often regress within 6-12 months after a viral infection. Along with the effects of optimal anticoagulant therapy in the prevention of adverse COVID-19 outcomes, the available literature discusses the possibility of different regimens of glucocorticosteroid therapy. At the expert council of pulmonology specialists of the Volga Federal District the regional experience of using a domestic drug bovgialuronidase azoximer (Longidase) with official indications for treatment of fibrosis was covered in the therapeutic complex of patients with severe forms of COVID-19. Conclusion. Accumulating the evidence base of different ways of prevention and correction of residual changes in COVID-19 patients, which significantly deteriorate patients’ ability to work as well as their quality of life, can be considered one of the main priorities of modern COVID-19 medicine.