The Management of Pulmonary Fibrosis in COVID-19

Cleopas Martin Rumende, Erwin C Susanto, Truely P Sitorus


Pulmonary fibrosis due to COVID-19 is recognized as sequel of ARDS characterized by failed alveolar re-epithelization, fibroblast activation, excessive collagen deposition and other extracellular matrix components that disrupt the normal lung architecture. There are risk factor for pulmonary fibrosis namely advanced age, severe ARDS infection, mechanical ventilation due to ventilator-induced lung injury, smoking and chronic alcoholism. Diagnosis of post-COVID pulmonary fibrosis can be made by clinical symptoms and characteristic finding from lung CT scan. To date, there is no definitive treatment for post-inflammatory pulmonary fibrosis after COVID-19 infection, however some of antifibrotic therapies may be considered. Beside medical treatment, pulmonary rehabilitation program and long-term oxygen treatment should be included as part of comprehensive treatment for pulmonary fibrosis due to COVID-19.


pulmonary fibrosis; COVID-19


Rai DK, Sharma P, Kumar R. Post COVID-19 pulmonary fibrosis is it reversible? Indian J Tuberculosis. https://doi.otg/10.1016/j.ijb.2020.11.003.

Ojo AS, Balogun SA, Williams OT, Ojo OS. Pulmonary fibrosis in COVID-19 survivors: Predictive factors and risk reduction strategies. Pulmonary Medicine.

Udwadia ZF, Koul PA, Richeldi L. Post COVID-19 lung fibrosis: the tsunami that will follow the earthquake. Indian Chest Society. http://doi:10.4103/lungindia.lungindia_818_20.

McDonald LT. Healing after COVID-19: are survivors at risk for pulmonary fibrosis? Am J Physiol Lung Cell Mol Physiol. 2021:320:L257-65.

Zhang C, Wu Z, Li JW, et al. Discharge may not be the end of treatment: Pay attention to pulmonary fibrosis caused by severe COVID-19. J Med Virol. 2021;93: 1378-86.

Lechowicz K, Drozdzal S, Machaj F, et al. COVID-19: The potential treatment of pulmonary fibrosis associated with SARS-CoV-2 infection. J Clin Med. 2020;9:2-20.

Kwee TC, Kwee RM. Chest CT scan in COVID-19: what the radiologist needs to know.

Al Mamun SM, Jahan R, Islam QT, Nazrin T, Shajalal K. Rationale of using common antifibrotic therapy in post COVID pulmonary fibrosis. J Medicine. 2021; 22:46-50.

Seifirad S. Pirfenidone: A novel hypothetical treatment for COVID-19.

George PM, Wells AU, Jenkins RG. Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy.

Vitiello A, Pelliccia C, Ferrara F. COVID-19 patients with pulmonary fibrotic tissue: clinical pharmacological rational of antifibrotic therapy. SN Comphrehensive Clinical Medicine. 2020;2:1709-12.

Clinical management of COVID-19: Living guidance. WHO/2019-nCoV/clinical/2021.1.

Qin H, Zhao A. Mesenchymal stem cell therapy for acute respiratory distress syndrome: from basic to clinics. Protein Cell. 2020;11:707-22.

Li Z, Niu S, Guo B, et al. Stem cell therapy for COVID-19, ARDS and pulmonary fibrosis. Cell Proliferation. 2020;53:e12939.

Can A, Coskun H. The rationale of using mesenchymal stem cells in patients with COVID-19-related acute respiratory distress syndrome: What to expect. Stem Cells Transl Med. 2020;1–16.

Esquivel D, Mishra R, Soni P, et al. Stem cells therapy as a possible therapeutic option in treating COVID-19 patients. Stem Cell Rev and Rep. 2020;17:144-52.

Li C, Zhao H, Wang B. Challenges for Mesenchymal Stem Cell-Based Therapy for COVID-19. Drug Design, Development and Therapy. 2020;14:3995–4001.

Shetty R, Murugeswari P, Chakrabarty K, et al. Stem cell therapy in coronavirus disease 2019: current evidence and future potential. Cytotherapy.

Eiro N, Cabrera JR, Fraile M, Costa L, Vizoso FJ. The Coronavirus pandemic (SARS-CoV-2): New problems demand new solutions, the alternative of mesenchymal (stem) stromal cells. Front Cell Dev Biol. Doi: 10.3389/fcell. 2020.00645.

Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. Management of post-acute COVID-19 in primary care. BMJ. 2020;370:3026.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.