COVID-19 and People Living with Pulmonary Fibrosis

People with pulmonary fibrosis are not at a higher risk of contracting COVID-19. However, as per the CDC (Centers for Disease Control and Prevention), people with respiratory diseases including pulmonary fibrosis are at a higher risk for developing more serious complications from COVID-19 illness if they do get infected, and should seek care as soon as symptoms start.

Common symptoms of COVID-19 begin 2 to 14 days after exposure. While symptoms may vary from few or no symptoms to severe breathing difficulty, more common symptoms include:

• Fever (Temperature over 100.4^o F)
• Tiredness
• Worsening cough
• Increased shortness of breath
• Body ache, headache

Get medical attention immediately if you have:

• More difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face
• Increased oxygen requirement

Since people with pulmonary fibrosis may be more likely to show symptoms and to have a more severe infection than others, they should take extra precautions as advised by the CDC to protect themselves and reduce the risk of being exposed to COVID-19.

Recommendations suggested by the CDC include:

1. Wash your hands often and with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, and after blowing your nose, coughing, or sneezing.
   1. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol.
2. Avoid close contact with people who are sick, distancing yourself by at least six feet.
3. Avoid touching your eyes, nose and mouth.
4. Stay at home if you are sick.
5. Cover your cough and sneeze with a tissue, then throw the tissue in the trash.
6. Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
7. Facemasks should be used by people who show symptoms of COVID-19 to reduce the spread of the disease to others.
8. Avoid non-essential travel

In addition to the general preventive measures listed above, patients with pulmonary fibrosis should: 

1. Stock up on necessary medications and supplies that can last for a few weeks.
2. Avoid crowds and non-essential travel.
3. Stay at home as much as possible.

Advice for family members and caregivers

Family members and caregivers of people with chronic diseases such as pulmonary fibrosis should take appropriate precautions and take extra care to avoid bringing COVID-19 home. They should constantly monitor patients and stock medicines and other necessary supplies that can last for several weeks. Storing extra non-perishable food can help minimize trips to the grocery store.  

People who show symptoms of COVID-19 should avoid visiting their family members in nursing homes or other places until the self-isolation period is complete.

Additional recommendations from PF NOW! for staying healthy and safe 

1. Exercise: It is important to do aerobic, strengthening and breathing exercises to strengthen lung function. Exercising improves lung capacity and shortness of breath. Certain breathing exercises such as diaphragmatic or belly breathing help strengthen your most powerful breathing muscle, while helping clear excess mucus from your lungs. This is particularly important in keeping infections at bay.
2. Maintain a healthy diet: Health and diet go hand in hand. Eating a variety of foods that are high in vitamins and antioxidants such as fresh fruits, vegetables, nuts and fish can help fight infection, inflammation and help reduce cellular damage. Here is a link to a video on 6 superfoods for lung health.
3. Continue taking your daily supplements: Systemic enzyme supplements are a safe and natural way to support your body’s immunity. They have been used for decades to help fight infection and maintain healthy levels of inflammation. Supplementation with vitamins C, B6, D and E may also have protective effects.
4. Drink plenty of water: Getting enough water is as important for the lungs as it is for the rest of the body. Staying hydrated through out the day helps maintain a healthy mucosal lining which helps your lungs function better.
5. Get enough sleep: A good night’s sleep allows your body to rejuvenate and improve its ability to absorb oxygen and fight off viruses.
6. Stop smoking: Smoking increases your susceptibility to infections such as pneumonia, increases the length and severity of an illness and depletes your body of protective antioxidants.  
7. Get your yearly flu shot: A flu shot will not protect you against a corona virus infection but will indirectly help in the fight against COVID-19 by relieving pressure on healthcare providers
8. Monitor your blood oxygen levels: If you have a pulse oximeter, monitor your oxygen saturation levels 1-2 times a day. Maintain a log of the results for any medical provider to review, in case your blood oxygen levels fluctuate or start to drop. 

Some common questions you may have as a caregiver or a person with Pulmonary Fibrosis

Do I need to wear a facemask?

Face masks can filter out respiratory droplets potentially carrying the virus. However, those with pulmonary fibrosis should only wear face masks when necessary as they may make breathing more difficult. Please discuss with your physician regarding where and when you should use a facemask. 

Is it safe to continue my routine clinic visits?

The risk of in-person clinic appointments depends on the spread of COVID-19 in your area and in the particular clinic.  If you have concerns about it, you should discuss your specific situation and risks with your care center.  For routine follow up appointments, you may be rescheduled.  For the most up-to-date information on COVID-19, we recommend visiting the CDC Travel Information and CDC Coronavirus Disease 2019 webpage. If you have a fever or worsened cough and shortness of breath, you should alert your physician before arriving to a clinic/hospital for an appointment.

Is it safe to continue my pulmonary rehabilitation program?

As per CDC guidelines, patients should avoid crowds and stay at home as much as possible, especially those at a higher risk.  We recommend discussing the risks of participating in pulmonary rehab sessions with your pulmonary rehab team and physician.  Home exercise programs may be preferable during the COVID-19 pandemic. Several online resources are available to assist patients with exercise training and your pulmonary rehab team can guide you as to which is appropriate for you.

Is pulmonary function testing (PFT) or spirometry during the COVID-19 pandemic safe?

Patients have expressed concerns about whether they can become infected with COVID-19 via spirometry testing.  If you have a fever or increased cough and shortness of breath, it is very important for you to alert your physician before arriving to a clinic/hospital for testing. If you have concerns about routine testing, you should discuss any questions with the testing center and your physician.  For non-urgent, routine testing during the COVID-19 pandemic, some centers are opting to reschedule to a later date.    

I am currently on the waiting list for a lung transplant. What are the implications if the virus remains active for some time?

Patients on the waiting list for a lung transplant should maintain contact with their transplant center. According to the American Society of Transplantation, the risk of acquiring COVID-19 from an organ donor is low. However, transplant surgery may be delayed due to the threat of exposure in the hospital and the current strain on medical personnel and resources. While you wait, you must continue to take all the precautions you can to remain in your best health possible. 

What precautions can I take as a lung transplant recipient? 

If you have received a lung transplant, you are taking medication that compromises your immune status. It is very important for you to stay near your home and with those you live until the outbreak subsides. If you take a walk around the block, be sure to keep a distance of six feet between yourself and other people. Ask family members or neighbors for help with getting groceries and essentials. Ask your transplant team on advice regarding using a mask.

Is there a treatment for COVID-19?

There are currently no vaccines available for human coronaviruses including COVID-19. This makes the prevention and containment of the virus very important. Oxygen therapy is the treatment intervention for patients with severe disease. Mechanical ventilation may be necessary in cases of respiratory failure. The FDA has issued emergency authorization of a few drugs for corona virus care. 

Several vaccine and treatment clinical studies are ongoing. For a list of clinical trials on Covid-19, please visit: https://clinicaltrials.gov/ct2/results?cond=&term=covid-19&cntry=&state=&city=&dist=

COVID-19 is an emerging, rapidly evolving situation:

Get the latest public health information from CDC: https://www.coronavirus.gov.

Get the latest research information from NIH: https://www.nih.gov/coronavirus

We urge you to take the recommendations for avoiding COVID-19 infection seriously. 

To connect with people in the PF NOW! community:

Join our online forum, and attend our virtual support groups on Zoom.

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