Abstract

Background: Post-Acute Sequelae of COVID-19 (PASC) appears like a chameleon in various forms and degrees of expression. Individual therapeutic approaches are needed to achieve complete remissions.  Recently, our research group reported on diagnostic possibilities for the objectification of PASC-associated dyspnea using spiroergometry, computed tomography and bronchoscopy. Hereby, we were able to establish analogies to the diagnosis "Interstitial pneumonia with autoimmune features" (IPAF). Treatment with prednisolone or azithromycin was able to improve symptom burden and performance. However, in elite sports, this improvement is often not sufficient to return to the top of the world.

Objectives: The aim of this follow-up study was to verify whether therapy-resistant bronchiolitis can be successfully treated by bronchial thermoplasty and, via this, close the gap back to top performance.

Methods: We prospectively recruited previously healthy athletes from elite sports with persistent exertional dyspnea after previous SARS-CoV-2 infection who met diagnostic criteria for IPAF, and who had a persistent obstructive breathing pattern with dynamic hyperinflation on spiroergometry after therapy with prednisolone or azithromycin.

Results: Complete remission of the obstructive breathing pattern and significant improvement in exercise capacity and VO2max were achieved after completion of 3 sessions of bronchial thermoplasty.

Conclusion: In PASC patients the use of bronchial thermoplasty may lead to complete remission of PASC-associated pulmonary limitations in case of persistent bronchiolitis.