Post Covid Respiratory Follow Up

 

The aim of this document is provide guidance on the follow up of patients with confirmed or suspected Covid 19 infection.

The respiratory rationale for follow up is to exclude complications of Covid infection (post infective fibrosis and thromboembolic disease) as well as excluding an underlying respiratory condition that may have been masked by Covid infection.

There may be a number of patients with persistent symptoms and no underlying respiratory condition or complication of Covid infection.  There is helpful self-care advice for this group of patients via https://www.yourcovidrecovery.nhs.uk/

 

Confirmed Covid-19 and abnormal CXR

Patients with confirmed Covid pneumonia and abnormal CXR should have a repeat CXR at 12 weeks (not 6 weeks as viral/covid pneumonitis takes longer to settle on CXR) to ensure resolution of Covid pneumonia changes.

If CXR changes have resolved and symptoms have returned to baseline then no further follow up required

If significant CXR improvement with minor residual change firstly assess patient symptoms.  If clinically improving repeat a CXR at another 12 weeks to ensure stable/resolving change.  If ongoing significant breathlessness to baseline – refer for respiratory assessment.

If no significant CXR improvement for CT thorax and respiratory referral

 

Confirmed Covid-19 and normal CXR or no CXR performed

No routine follow up.  Patient advice to seek medical assessment if symptoms have not significantly improved or returned to baseline at 3 months.  Direct to NHS advice https://www.yourcovidrecovery.nhs.uk/

 

Suspected Covid 19 or confirmed Covid 19 and persistent symptoms

Advise symptoms may persist for 3+ months and reassure if within this timeframe and no concerns regarding alternative diagnosis or worsening/significant symptoms

If persistent symptoms of breathlessness at 3 months perform:

CXR

Spirometry (if able)

Walk test to monitor oxygen saturations

D-dimer (if positive consider discussion with acute GP)

If above normal patient unlikely to have significant respiratory complication and can reassure with advice for rehabilitation and cardio-respiratory exercise.

If above abnormal or ongoing significant concern = Refer respiratory - Consider requesting HRCT chest (or if d-dimer positive CTPA) and echocardiogram and at time of referral to aid assessment in respiratory clinic

If Post Covid Syndrome (>12 weeks of symptoms) then please see referral guideline: 
https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/primary_care_clinical_referral_criteria/coronavirus/long_covid

 

Author.

Dr Ben Soar (RCHT)

Dr Matthew Berry (RCHT)

Update November 2021 – Dr Madeleine Attridge – GP sifter