PT  - JOURNAL ARTICLE
AU  - Pierre Kory
AU  - Jeffrey P Kanne
TI  - SARS-CoV-2 organising pneumonia: ‘Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?’
AID  - 10.1136/bmjresp-2020-000724
DP  - 2020 Sep 01
TA  - BMJ Open Respiratory Research
PG  - e000724
VI  - 7
IP  - 1
4099  - http://bmjopenrespres.bmj.com/content/7/1/e000724.short
4100  - http://bmjopenrespres.bmj.com/content/7/1/e000724.full
SO  - BMJ Open Resp Res2020 Sep 01; 7
AB  - Reviews of COVID-19 CT imaging along with postmortem lung biopsies and autopsies indicate that the majority of patients with COVID-19 pulmonary involvement have secondary organising pneumonia (OP) or its histological variant, acute fibrinous and organising pneumonia, both well-known complications of viral infections. Further, many publications on COVID-19 have debated the puzzling clinical characteristics of ‘silent hypoxemia’, ‘happy hypoxemics’ and ‘atypical ARDS’, all features consistent with OP. The recent announcement that RECOVERY, a randomised controlled trial comparing dexamethasone to placebo in COVID-19, was terminated early due to excess deaths in the control group further suggests patients present with OP given that corticosteroid therapy is the first-line treatment. Although RECOVERY along with other cohort studies report positive effects with corticosteroids on morbidity and mortality of COVID-19, treatment approaches could be made more effective given that secondary OP often requires prolonged duration and/or careful and monitored tapering of corticosteroid dose, with ‘pulse’ doses needed for the well-described fulminant subtype. Increasing recognition of this diagnosis will thus lead to more appropriate and effective treatment strategies in COVID-19, which may lead to a further reduction of need for ventilatory support and improved survival.