Administration of Erdosteine after Severe COVID-19 in the Early Period after Discharging Patients from the Healthcare Facility

Quality of Life in Patients after Severe COVID-19

Since the onset of the COVID-19 pandemic, relatively little attention has been paid to health-related quality of life in patients after discharge from a healthcare facility where they were hospitalized due to severe COVID-19. A significant group of patients might suffer from ongoing or recurrent symptoms (such as exertional/rest dyspnea, cough, fatigue, or asthenia), persistent lung function impairment, and psychological or psychosocial issues after discharge.

Therefore, studies were conducted in real clinical practice aiming to evaluate health-related quality of life, particularly focusing on dyspnea, in patients after severe COVID-19 in the first days post-discharge.

Study Results

Santus et al. included patients in an open 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 hospitalization was due to coronavirus pneumonia with severe respiratory failure, where, in addition to ventilation support in the form of conventional oxygen therapy and CPAP, they were given pharmacotherapy available at the time for COVID-19 patients (such as hydroxychloroquine, lopinavir/ritonavir, tocilizumab, or antibiotics). Upon discharge from the healthcare facility, they were prescribed erdosteine at a dose of 300 mg twice daily for 15 days, in addition to their usual chronic disease therapy.

At discharge and 15 days post-discharge, patients filled out four assessments focusing on health-related quality of life — the SGRQ questionnaire (St George's Respiratory Questionnaire) assessing disease symptoms, activity limitations, and the social and emotional impact of the disease, the mMRC questionnaire (modified Medical Research Council) regarding the impact of dyspnea on daily activities, the Borg scale evaluating exertional dyspnea, and a visual analog scale (VAS) score assessing resting dyspnea.

A total of 20 patients were included in the study, with an average age of 55 years, and the majority were men (85%). Cardiovascular comorbidities were recorded in 60% of participants (most commonly arterial hypertension), and 20% had a positive history of chronic respiratory disease such as bronchial asthma or chronic obstructive pulmonary disease. After discharge, ongoing treatment during hospitalization was discontinued for all but three persons. The mentioned trio, representing an exception, was prescribed continued thromboprophylaxis with low-molecular-weight heparins due to elevated D-dimer levels. Post-discharge, patients continued their usual chronic disease therapy.

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

Feshchenko et al. published a recent study in response to these findings, which evaluated the effectiveness of erdosteine in 38 patients compared to a control group without treatment for 30 days post-discharge from the healthcare facility where these patients were hospitalized for coronavirus pneumonia. Active therapy with erdosteine at a dose of 300 mg twice daily was undertaken by 26 subjects, while another 12 represented the control group without active treatment.

At discharge and 30 days post-discharge, patients filled out two questionnaires focusing on health-related quality of life, like in the previous study, the SGRQ and mMRC. At discharge, the scores in the individual questionnaires were similar for both groups. However, 30 days post-discharge, a significant improvement was observed in both questionnaire systems only among patients taking erdosteine. The SGRQ showed a significant decrease in the total score from an initial value of 29.30 ± 3.90 to 15.40 ± 1.60 (in the control group, there was a non-significant decrease from 25.18 ± 4.90 to 18.20 ± 1.70). In the mMRC questionnaire, a significant decrease was observed in the treated group from an initial value of 1.83 ± 0.14 to 1.46 ± 0.11, while in the control group, there was a decrease from 1.85 ± 0.16 to 1.58 ± 0.39, which was not statistically significant.

Conclusion

Patients with a history of severe COVID-19, who were given erdosteine at a dose of 300 mg twice daily in addition to their usual chronic disease therapy after being discharged from the healthcare facility, experienced significant improvements in health-related quality of life parameters and dyspnea at rest and during daily activities over 15 days. A similar conclusion was reached by another study, which evaluated the administration of erdosteine at a dose of 300 mg twice daily compared to a group without active treatment for 30 days post-discharge.

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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.