What to Know About Pulmonary Fibrosis and COVID-19

Pulmonary fibrosis is a lung disease in which tissue deep in the lungs becomes scarred, making the tissue thick and stiff, which causes shortness of breath and makes it harder for your blood to get enough oxygen.

The exact causes of pulmonary fibrosis are often unknown, but some of the risk factors for pulmonary fibrosis are the same for severe illness from COVID-19. There is evidence to show that pulmonary fibrosis increases risk and susceptibility to COVID-19, and vice versa, though time will tell how prevalent COVID-19-induced pulmonary fibrosis is.

Pulmonary Fibrosis and COVID-19 Risk

Researchers have demonstrated that having pulmonary fibrosis increases your risk and susceptibility to COVID-19 infection.

This isn’t surprising considering pulmonary fibrosis and severe cases of COVID-19 share a few common risk factors, including:

• Increasing age
• Male sex
• Comorbidities such as diabetes and hypertension

Given that pulmonary fibrosis debilitates lung function, it makes sense that pulmonary fibrosis would only increase the risk of having a severe case of COVID-19. Understandably so, these overlapping risk factors are cause for concern when it comes to mitigating a double attack on the lungs, should you become exposed to COVID-19.

Knowing this, it is important to understand the options for reducing your risk of exposure to COVID-19. Though you cannot immediately ameliorate underlying conditions that put you at increased risk, you can take immediate steps to reduce the chances of being exposed, including following public health advice, which has essentially become the golden rule of the pandemic:

• Wear a mask
• Social distance
• Wash your hands
• Get a vaccine

Inversely, people recovering from severe COVID-19 are at serious risk of developing pulmonary fibrosis. Research has shown that characteristics of COVID-19 include:

• Acute lung injury
• Attempted repair via fibroproliferation (connective tissue accumulation)
• Lung remodeling

This increases the risk of pulmonary fibrosis, clearly demonstrating the two-way relationship between COVID-19 and pulmonary fibrosis, which calls for specific considerations in how they interact.

Scientists cannot yet fully know the prevalence of post-COVID pulmonary fibrosis, but so far the data show a high rate of fibrotic lung function abnormalities in people who are discharged from the hospital after having COVID-19.

This emphasizes the importance of COVID-19 prevention and treatment to improve the prognosis of lung health among people who are at higher risk of serious illness and complications from COVID-19. Knowing that there is a two-way relationship between the conditions presents unique considerations for mitigating further lung complications.

Complications of Pulmonary Fibrosis and COVID-19

Viral infections may worsen existing fibrosis. COVID-19 is likely to complicate matters on top of pulmonary fibrosis since COVID-19 often leads to respiratory distress.

Some symptoms of pulmonary fibrosis and COVID-19 overlap, such as:

• Difficulty breathing and dry cough
• Fatigue

However, unintended weight loss as well as clubbing of the tips of fingers and toes are unique to pulmonary fibrosis and can therefore help you distinguish between what is a product of existing pulmonary fibrosis or that of COVID-19.

It is hard to say whether and to what extent COVID-19 will impact daily life. Only time will tell how COVID-19 affects lung function, especially in those with lung health issues, and what can be learned about mitigating further fibrosis post-COVID-19.

But there is good news: Scientists have suggested that the complications caused by COVID-19 could be hindered early on. And though there is no cure for pulmonary fibrosis nor COVID-19 at the moment, antifibrotic therapy can serve as treatments for both conditions.

Pulmonary Fibrosis Treatments and COVID-19

Antifibrotic drugs, including Nintedanib and Pirfenidone, are commonly prescribed to help slow the decline in lung function due to pulmonary fibrosis.

Other therapies such as spironolactone and fibrinolytic agents have also been shown to have some positive results in the treatment of COVID-19-related pulmonary fibrosis, though there is no hard and fast answer on how good they are, thus requiring more research trials.

Nonetheless, the fact that available antifibrotic drugs are shown to be helpful in not only treating pulmonary fibrosis but also preventing severe illness from COVID-19 is great news as it improves prognosis on both fronts, especially in terms of curbing further fibrosis.

In addition, the fact that antifibrotic drugs can be used for dual purposes—treating pulmonary fibrosis and COVID-19—shows there is little to worry about in terms of treatment interactions. In fact, researchers have suggested antifibrotic intervention should be done in the first week of ARDS onset in order for it to be more effective in preventing progression to pulmonary fibrosis.

This can be taken as a good sign. What is already in place for treating pulmonary fibrosis has the added benefit of preventing severe illness from COVID-19. In light of the potential complications of COVID-19 and pulmonary fibrosis, there is evidence to show that symptoms can be managed.

Frequently Asked Questions

Should I get a COVID-19 vaccine if I have pulmonary fibroisis?

Yes. According to the Centers for Disease Control and Prevention (CDC), most people with underlying medical conditions can still get the vaccine.

If you are eligible to receive the vaccine, you should proceed in getting vaccinated, as the currently authorized vaccines are effective in reducing the severity and spread of COVID-19.

When you go to get your vaccine, it is important to tell the person administering the vaccine about all of your allergies and health conditions. Doing so helps them help you better.

If you still have questions or concerns, it is best to talk to your healthcare provider for their advice.

What about my pulmonary fibrosis therapies/treatments?

It depends on the type of treatment/therapy you receive.

If you are a lung transplant recipient, there are unique considerations when it comes to preventing COVID-19. A recent study shows that you may not gain sufficient immunity after the first dose of the COVID-19 mRNA vaccine (such as Pfizer and Moderna).

In other words, you might not be as protected as the general population. Therefore, it is important that you and your household members remain vigilant about the measures we know are effective in stopping the spread, including social distancing, mask-wearing, and handwashing.

All things considered, it is best to talk to your healthcare provider or pulmonologist if you have specific questions or concerns about your treatment.

Does pulmonary fibrosis increase the chances of having serious complications from COVID-19?

Both COVID-19 and pulmonary fibrosis impact the lungs and can make it hard to breathe. And pulmonary fibrosis is a known complication of COVID-19. Thus, there is some added complication of having both.

We are still learning from the science about how to treat COVID-19 and ameliorate complications. Nonetheless, prevention remains paramount to reducing your risk of coronavirus infection and the potential for it to worsen existing fibrosis.

How to Stay Safe

There are a few simple things to keep in mind to stay safe during the pandemic.  

The first thing is to follow the standard public health guidance from the CDC, which has been shown to be effective in reducing your risk:

• Wear a mask that fits snugly and covers your nose and mouth.
• Stay six feet apart from people you don’t live with.
• Get a COVID-19 vaccine when you can.
• Avoid crowds and poorly ventilated places.
• Wash your hands often with soap and water, and use hand sanitizer if soap and water are not available.

Another thing is to minimize trips out to places that may be crowded, such as shopping centers or grocery stores, and stock up on necessities when you do go out.

You may even consider asking a household member, neighbor, or close friend/family member to run errands for you. Be sure to ask them to practice social distancing and mask-wearing, too, when they go out on your behalf. That way you are both safer. 

Finally, if you are seeing your healthcare provider regularly for treatment, ask them if some or all of your appointments can be done via telehealth. This would also be a good opportunity to ask them their advice for staying safe given your personal history and condition.

In sum, it can be scary to have a medical condition during a pandemic, especially as we are counting on each other to stop the spread. However, you can take matters into your own hands by following the basic precautionary principles offered here.

A Word From Verywell

As COVID-19 research is ongoing, and we do not yet know how long the pandemic will last, it is understandable if you are feeling anxious for yourself or a loved one.

We have learned from the research that pulmonary fibrosis does increase risk and susceptibility to contracting COVID-19, but we are also seeing that some treatments for pulmonary fibrosis are protective against severe illness from COVID-19 and may even prevent worsening fibrosis post-infection.

Furthermore, we know that the public health guidance that everyone is encouraged to follow—regardless of health status—works in slowing the spread. So, although it is only natural to have some concerns for someone (maybe yourself) with pulmonary fibrosis during this time, it is good to keep in mind that you are not alone.

You have a community: About 100,000 people in the United States are affected by pulmonary fibrosis, with 30,000 to 40,000 new cases diagnosed each year—and this will likely increase due to the pandemic.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.