Post–COVID-19 Interstitial Lung Disease Emerges as Ongoing Clinical Challenge

Post–COVID-19 interstitial lung disease (ILD) has emerged as a significant long-term complication of SARS-CoV-2 infection, with variable clinical trajectories and no established treatment guidelines, according to a narrative review examining recent research and clinical recommendations from 2020 to 2025. The findings underscore the need for vigilance in monitoring patients with persistent respiratory symptoms after acute infection.

The review defines post–COVID-19 ILD as a chronic condition characterized by sustained respiratory symptoms, radiologic abnormalities, and impaired lung function following COVID-19. Diagnosis relies on medical history, pulmonary function testing, and imaging—particularly high-resolution computed tomography (HRCT). In select cases, lung biopsy, including cryobiopsy or video-assisted thoracoscopic surgery, may be required to clarify histologic patterns.

Fibrotic lung injury is described as a consequence of acute viral damage, potentially amplified by persistent inflammation and dysregulated tissue repair. Risk factors for post–COVID-19 ILD include severe acute illness, advanced age, male sex, and smoking history. The authors note that the “clinical course and prognosis of post-COVID-19 ILD is uncertain,” with some patients experiencing improvement or stability, while others progress to worsening lung function.

Treatment strategies remain heterogeneous. The review highlights corticosteroids, antifibrotic agents—including newer agents such as nerandomilast—oxygen therapy, pulmonary rehabilitation, smoking cessation, and vaccination as components of current management approaches. However, standardized guidelines are lacking. The authors state that “treatment of post-COVID-19 ILD is not presently defined by guidelines,” emphasizing the need for individualized care.

They conclude that “ILD represents a significant long-term complication of COVID-19 infection” and call for further investigation into pathophysiology and management.

Reference
Carbone RG, Nagoti S, Monselise A, Wille KM, Puppo F, Shah PL. COVID-19 and interstitial lung disease. Medicina. 2026; 62(1):22. https://doi.org/10.3390/medicina62010022