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LETTER TO THE EDITOR
Ahead of print publication  

COVID-19 lung injury and high altitude pulmonary edema


1 Private Academic Practice, Bangkok, Thailand
2 Dr. DY Patil University, Pune, Maharashtra, India

Date of Submission01-Jul-2020
Date of Decision01-Aug-2020
Date of Acceptance15-Aug-2020

Correspondence Address:
Beuy Joob,
Private Academic Practice, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_367_20



How to cite this URL:
Joob B, Wiwanitkit V. COVID-19 lung injury and high altitude pulmonary edema. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Nov 30]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=310597



Dear Sir,

The COVID-19 lung injury is an important problem in the present crisis of COVID-19 pandemic. An interrelationship between COVID-19 and high altitude pulmonary edema (HAPE) is very interesting.[1],[2] There are many differences between lung problems in COVID-19 and HAPE although there are some clinical similarities. The objective of this short article is to discuss about the possibility that HAPE and COVID-19 pneumonia might present as comorbidities.

In general, the management of pneumonia in COVID-19 is based on clinical findings. COVID-19 lung disease and HAPE are two different diseases with different pathogeneses, but there are similarities of dyspnea, hypoxemia, and infiltrates on chest imaging in some cases.[3]

Regarding pathophysiology, hypoxic pulmonary vasoconstriction, and elevated pulmonary artery pressure are the main cause of HAPE whereas inflammatory process due to lung invasion of the pathogen and host immune response is the main pathogenesis of COVID-19 pneumonia.[3],[4] In severe COVID-19, pulmonary capillary leak syndrome might occur and it can lead to the pulmonary edema.[5] It is possible that each lung problem can present with an abnormal chest X-ray finding. Both conditions might present with pulmonary edema. The similarities might imply that there is a common clinical problem in both COVID-19 and HAPE. Nevertheless, due to different pathophysiological processes, it does not mean that the same management is effective in all cases.[6] For HAPE, supplemental oxygen or compression therapy is the main recommended treatment and it can lead to a dramatic improvement. For COVID-19 pneumonia, the management of inflammation is an important therapeutic focus. Without control of inflammation, there will be no success in the management of lung problem.[6] Nevertheless, an additional oxygen therapy might be applied to the patients with COVID-19 pneumonia who does not respond to anti-inflammation therapy.

We would like to share ideas on interrelationship between COVID-19 lung injury and HAPE. According to a recent reports from Nepal, the patients had no HAPE-like pattern.[7],[8] Those patients had no pulmonary edema but multifocal patchy lung infiltration. This is additional evidence showing lack of association between COVID-19 lung Injury and HAPE. Clinically, there are various forms of lung disorders in COVID-19. A concurrence between COVID-19 and other lung disorder is possible. There is a chance that COVID-19 might co-present with HAPE. Co-existence between COVID-19 and HAPE is an interesting issue for further research. Conclusively, a take away message is if there is a suspicion of concurrent occurrence of HAPE and COVID-19 Pneumonia, a good interpretation on clinical/laboratory findings will be required. For case management, COVID-19 might be likely if there a history of a risk contact and if there is a history of exposure to high altitude injury, HAPE should be considered. Nevertheless, in setting that high altitude injury is a common problem, it is necessary to consider for a possible concurrence in the present COVID-19 pandemic. For management of the case, the oxygen therapy might be given and if there is a good response, the HAPE is likely. To have a COVID-19 test should be parallel performed. During waiting the result and using oxygen therapy, if there is still no clinical improvement, the use of anti-inflammatory treatment for managing possible COVID-19 lung problem should be considered.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Luks AM, Freer L, Grissom CK, McIntosh SE, Schoene RB, Swenson ER, et al. COVID-19 Lung injury is not high altitude pulmonary edema. High Alt Med Biol 2020;21:192-3.  Back to cited text no. 1
    
2.
Brugger H, Basnyat B, Ellerton J, Hefti U, Strapazzon G, Zafren K. Letter to the Editor: COVID-19 Lung injury is different from high altitude pulmonary edema. High Alt Med Biol 2020;21:204-5.  Back to cited text no. 2
    
3.
Luks AM, Swenson ER. COVID-19 lung injury and high altitude pulmonary edema: A false equation with dangerous implications. Ann Am Thorac Soc 2020;7:918-21.  Back to cited text no. 3
    
4.
Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol 2020;215:108427.  Back to cited text no. 4
    
5.
Bahloul M, Ketata W, Lahyeni D, Mayoufi H, Kotti A, Smaoui F, et al. Pulmonary capillary leak syndrome following COVID-19 virus infection. J Med Virol 2020; [Doi: 10.1002/jmv. 26152].  Back to cited text no. 5
    
6.
Archer SL, Sharp WW, Weir EK. Differentiating COVID-19 pneumonia from acute respiratory distress syndrome and high altitude pulmonary edema: Therapeutic implications. Circulation 2020;142:101-4.  Back to cited text no. 6
    
7.
Pun SB, Mandal S, Bhandari L, Jha S, Rajbhandari S, Mishra AK, et al. Understanding COVID-19 in Nepal. J Nepal Health Res Counc 2020;18:126-7.  Back to cited text no. 7
    
8.
Shrestha R, Shrestha S, Khanal P, Kc B. Nepal's first case of COVID-19 and public health response. J Travel Med 2020;27:taaa024.  Back to cited text no. 8
    




 

 
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