Hyperbaric oxygen therapy as a method of pulmonary rehabilitation for patients with long-term respiratory outcomes of COVID-19 in combination with chronic obstructive pulmonary disease

Background. The respiratory system is the main target of SARS-CoV-2 infection. In a series of studies among patients with a history of chronic obstructive pulmonary disease, severe complications during COVID-19 were observed more often than in patients with bronchial asthma and patients without bronchial obstructive pathology. There is a need to find new methods of pulmonary rehabilitation to prevent the deterioration and exacerbation of chronic bronchial obstructive pathology in patients with long-term respiratory outcomes of COVID-19. One such promising method of pulmonary rehabilitation is hyperbaric oxygenation – the therapeutic use of gas mixtures with increased partial pressure of medical oxygen. The article discusses the application of hyperbaric oxygen therapy in pulmonary rehabilitation for patients with chronic obstructive bronchial diseases, such as bronchial asthma and chronic obstructive pulmonary disease, as well as those who have recovered from COVID-19 associated with pneumonia, at least three months prior to inclusion in the study.

Materials and methods. The main group consisted of 23 patients who underwent a 10-day course of hyperbaric oxygen therapy, while the comparison group included 20 patients who did not receive hyperbaric oxygen therapy. The average scores of the dyspnea index on the mMRS scale, laboratory markers of inflammation (complete blood count, C-reactive protein, ferritin), spirometric parameters, DLco, and CT patterns were measured at the beginning of the study and three months later.

Results. The patients in the main group demonstrated a statistically significant improvement in exercise tolerance (the average mMRS score decreased from 2.4 ± 0.6 to 1.8 ± 0.4 points, p = 0.002), as well as a reduction in laboratory markers of inflammation (the average C-reactive protein levels decreased from 6.9 ± 3.9 to 4.3 ± 2.5 mg/ml and ferritin from 436 ± 22 to 427 ± 17 ng/ml, p < 0.001). The average FEV1 value in the main group increased from 84.17 ± 5 to 91.11 ± 5% of the predicted values (p < 0.001). No similar changes were observed in the comparison group. Chest CT scans showed that in the main group, reticular changes almost halved, and signs of organizing pneumonia disappeared three months after hyperbaric oxygen therapy. Statistically significant differences were noted in the overall lung involvement on CT in both groups (in the main group – from 29.7 ± 19.2 to 2.7 ± 1.8%, p < 0.001; in the comparison group – from 27.4 ± 20.8% to 21.5 ± 9.5%, p < 0.001).

Conclusion. Thus, the hyperbaric oxygen therapy method proved to be effective in treating the long-term respiratory consequences of COVID-19. Patients showed improved exercise tolerance, reduced manifestations of bronchial obstruction, and a decrease in systemicinflammatory response three months after hyperbaric oxygen therapy, while lung changes on CT resolved more rapidly.

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