Do you use prednisone in the management of patients with persistent respiratory symptoms following acute COVID-19 infection?

No, unless I note bronchial hyperresponsiveness on follow-up Pulmonary function tests (PFTs).

What I've noted is a significantly high percentage of undiagnosed asthmatics who come into the light because of a more severe clinical course from covid. Use anti-fibrotics occasionally for fibrosis depending on pattern and severity.

It's a good question but not a simple yes/no. Many persistent post-COVID symptoms after the acute phases are often due to superimposed bacterial infection. Application of steroids after the acute COVID phase may be harmful in this case.

If I have ruled out infection, have a low procalcitonin level, and elevated CRP/Ferritin that are persistent after the initial round of Prednisone, I think it is reasonable to try another course of steroids to prevent longer-term fibrotic sequelae.

However, I wou...

I have seen a lot of patients with significant pulmonary symptoms after having severe coronavirus infections. Typically, these are patients who have been hospitalized, and in some cases, a patient who spent time on mechanical ventilators. I do a high-resolution CT scan, looking for post-inflammatory pulmonary fibrosis. If I find it, and they have restrictive physiology on pulmonary function testing, I give them a trial of corticosteroids. I typically treat them for about three months and reasses...

I agree with Dr. @Dr. First Last in that I don't typically use systemic steroids. I see a younger population and I don't really see the typical fibrotic changes on CT and decreased DLCO. My typical workup is full PFTs, CXR, basic labs and a TTE (mainly aimed at ruling out other causes for their symptoms). If they have significant coughing and wheezing, I will usually do a MCCT if they have normal spirometry. I am surprised by how much asthma I see (10-20% is a rough estimate) that was either unm...