Administration of Erdosteine After Severe Course of COVID-19 in the Early Period After Patient Discharge From Medical Facility

Quality of Life After Severe COVID-19

Since the beginning of the COVID-19 pandemic, relatively little attention has been given to the health-related quality of life of patients post-discharge from medical facilities where they were treated for severe COVID-19. A significant group of these patients may suffer from ongoing or recurrent symptoms (such as exertional/rest dyspnea, cough, fatigue, or asthenia), persisting lung function impairment, and psychological or psychosocial problems after discharge.

Therefore, studies were conducted in real clinical practice aimed at evaluating health-related quality of life, particularly focusing on dyspnea, in patients who experienced severe COVID-19 in the first days after their discharge.

Study Results

Santus et al. enrolled patients in an observational study after discharge from the intensive care unit of Luigi Sacco University Hospital in Milan, Italy, from April 1 to June 30, 2020. Their reason for hospitalization was severe COVID-19 pneumonia with respiratory failure. In addition to ventilatory support in the form of conventional oxygen therapy and continuous positive airway pressure (CPAP), they received pharmacotherapy available at that time for COVID-19 patients (e.g., hydroxychloroquine, lopinavir/ritonavir, tocilizumab, or antibiotics). Following discharge, they were prescribed erdosteine 300 mg twice daily for 15 days in addition to their usual chronic disease therapy.

At discharge and 15 days post-discharge, patients completed four health-related quality of life assessments: the SGRQ (St George’s Respiratory Questionnaire) focusing on disease symptoms, activity limitation, and social and emotional impact of the disease; the mMRC (modified Medical Research Council) questionnaire regarding the impact of dyspnea on daily activities; the Borg scale assessing perceived physical exertion; and a visual analogue scale (VAS) rating resting dyspnea.

The study included 20 patients with an average age of 55 years, mostly men (85%). Cardiovascular comorbidities (mainly arterial hypertension) were recorded in 60% of participants, and chronic respiratory diseases (bronchial asthma or chronic obstructive pulmonary disease) in 20%. Upon discharge, all but three patients had completed hospitalization therapy. The exception concerned three patients who were continued on thromboprophylaxis with low molecular weight heparins due to elevated D-dimer levels. Post-discharge, patients continued their usual chronic disease treatments.

In the overall average SGRQ score, a reduction from 25.5 (standard deviation [SD] 15.5) to 16.9 (SD 13.2; p < 0.01) was observed, with 65% of patients achieving a clinically significant score change of ≥ 4 points. Significant reductions were noted across all questionnaire domains (all comparisons, p < 0.01). For VAS scores assessing resting dyspnea, a significant reduction in the average value from 1.6 (SD 1.7) to 1.4 (SD 2.5; p < 0.01) was found. The mMRC questionnaire also showed a significant reduction, indicating less impact of dyspnea on daily activities. A clinically significant score change of ≥ 1 point was achieved by 30% of patients. The Borg scale revealed an increase in average score from 12.8 (SD 4.2) to 14.3 (SD 2.4; p < 0.01).

Fresh Data on Improved Quality of Life

Feshchenko et al. followed up on these findings with a recent study evaluating 38 patients, comparing the efficacy of erdosteine against a control group not receiving the treatment for 30 days post-discharge from medical facilities where they were hospitalized with COVID-19 pneumonia. The active therapy group consisted of 26 patients taking erdosteine 300 mg twice daily, while 12 formed the control group without active treatment.

At discharge and 30 days post-discharge, patients again completed two health-related quality of life questionnaires, SGRQ, and mMRC. Discharge scores for both groups were similar. However, after 30 days, the erdosteine group's scores showed a significant improvement. The SGRQ total score significantly dropped from 29.30 ± 3.90 to 15.40 ± 1.60 (the control group saw a nonsignificant drop from 25.18 ± 4.90 to 18.20 ± 1.70). The mMRC score for the treated group significantly decreased from 1.83 ± 0.14 to 1.46 ± 0.11, whereas the control group's score dropped from 1.85 ± 0.16 to 1.58 ± 0.39, which was not statistically significant.

Conclusion

In patients with a history of severe COVID-19, those who received erdosteine 300 mg twice daily in addition to their usual chronic disease therapy within 15 days post-discharge showed a significant improvement in health-related quality of life and dyspnea during rest and daily activities.

This conclusion is supported by a controlled study comparing erdosteine administration with a control group without active treatment. Erdosteine use in patients discharged from hospitals after severe COVID-19 reduced dyspnea and improved quality of life.

Therefore, according to data from available studies, treatment with this mucomodulatory substance may effectively aid recovery from pneumonia associated with COVID-19 infection.

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Sources:
1. Santus P., Tursi F., Croce G. et al. Changes in quality of life and dyspnoea after hospitalization in COVID-19 patients discharged at home. Multidiscip Respir Med 2020; 15 (1): 713, doi: 10.4081/mrm.2020.713.
2. Feshchenko Y. I., Ostrovskyy M. M., Varunkiv O. I., Horovenko N. H. Improved quality of life and dyspnea with erdosteine in COVID-19 patients after hospital discharge. Minerva Respir Med 2022 Feb 10, doi: 10.23736/S2784-8477.22.01992-1.