Acute respiratory distress in relation to COVID-19 and beyond

Charles Pilette, Grégory Reychler, Nicolas Audag, Anne-Claire Latiers, Stéphanie Quennery, William Poncin, Gimbada Mwenge, Giuseppe Liistro, Charlotte Smetcoren, Frank Aboubakar, Sophie Gohy, Silvia Berardis, Antoine Froidure Published in the journal : February 2021 Category : Pneumology

Summary :

In 2020, COVID-19 mobilized pulmology experts along with other colleagues specializing in infectious diseases, emergency physicians, as well as intensivists. This occurred within a concerted effort, especially with the aim to reach a consensus in managing the infectious and inflammatory diseases at Cliniques Universitaires Saint-Luc. The physiotherapy team was mobilized from the very first hours of the pandemic; they were indeed involved in optimizing respiratory care for these patients. Original work and the "field" experience of our physicians and physiotherapists turned out to be instrumental in clarifying essential concerns. These latter included the best interface for delivering high-flow oxygen therapy, as well as the usefulness of supplying positive pressure continuous positive airway pressure (CPAP) to numerous patients with severely hypoxemic SARS-CoV-2 pneumonia, in addition to defining the most appropriate aerosol therapy in this pandemic context.

The follow-up of chronic respiratory disease-affected patients represented another challenge. Indeed, we were obliged to implement alternative methods, including teleconsultations, which particularly applied to the first CONIV-19 wave. Nevertheless, the year 2020 witnessed the arrival on the European market of targeted cystic fibrosis therapies as well as self-injectable biologics for severe Type 2 asthma, along with the multidisciplinary management of the ever-increasing number of cases suffering from diffuse interstitial pathologies. Notably, our department distinguished itself through original COVID-19 studies that were conducted in respiratory disease (cystic fibrosis, severe asthma patients) patient cohorts. Another distinctive feature pertaining to our department was the shedding light on the aging mechanisms involved in certain genetic pulmonary fibrosis forms, as well as on telomere length regulation, the latter being a risk factor for COVID-19 severity. Lastly, while lung cancers remain at the top of the "serial killer" list, these gloomy statistics are likely to change in the near future, owing to the progress made in molecular biology. This progress enables us today, and will do it even more tomorrow, to initiate and implement a personalized medicine management for certain cancer types.

These clinical and research transfer activities clearly demonstrate the pulmologists’ desire to work at the patient's bedside, in an effort to offer him the most appropriate specific care, in line with our academic hospital’s missions. This latter includes an active contribution to further developing medical and scientific knowledge in this field. Notably, this issue is at the heart of the 2020 news.

Key Words

Pneumonia to SARS-CoV-2 pneumonia, chronic respiratory diseases, lung cancer, targeted therapies, pulmonary rehabilitation, positive pressure ventilation, high-flow oxygenotherapy