Recovery After Pneumonia: Stages and Methods of Rehabilitation

Pneumonia is an acute infectious and inflammatory disease affecting the lungs, primarily caused by bacteria and/or viruses, less often by fungi and parasites.

Since 2019, the emergence of a new strain of coronavirus has become a significant public health issue, leading to a global pandemic. The course of coronavirus infection is highly variable, ranging from the complete absence of symptoms to severe pneumonia with respiratory failure.

After pneumonia, patients often experience a prolonged recovery process, attributed to the recovery of lung function, stabilization of metabolic processes, and strengthening of immunity.

Rehabilitation goal for patients recovering from COVID-19:

• Improvement of breathing;
• Alleviation of anxiety and depression;
• Resolving associated complications;
• Preservation of pre-existing functions and improvement of health.

Rehabilitation efforts aim at preventing secondary pathologies such as neuropathy, myopathy, joint dysfunctions, and lung fibrosis. Timely and well-planned medical rehabilitation can significantly reduce the likelihood of complications, improve quality of life, and decrease the frequency of disease recurrences.

Stages of medical rehabilitation for patients after pneumonia

• First stage: early rehabilitation in intensive care units. At this stage, a comprehensive set of medical rehabilitation measures is provided in intensive care units, as well as in infectious and therapeutic departments if there are no contraindications.
• Second stage: early rehabilitation in specialized inpatient medical rehabilitation departments designed for patients with somatic diseases.
• Third stage: organizing rehabilitation programs in day hospital departments, outpatient rehabilitation centers, and at home using telemedicine solutions. It is recommended for patients with somatic diseases who have sufficient rehabilitation potential. To achieve the greatest therapeutic effect, it is recommended to perform a set of exercises three times a week: twice under the supervision of specialists and once independently at home.

Symptoms of pneumonia in the post-infection period

After discharge, many patients treated for COVID-19 pneumonia may continue to experience symptoms for up to 180 days. The most common symptoms are fatigue (42.4%) and dyspnea (37.3%).

Studies indicate that COVID-19 has a significant impact on the psycho-emotional state of patients. For example, in addition to insomnia after discharge, approximately 20% of patients experienced depression and anxiety.

Loss of taste and smell often occurs in the early stage of the disease and resolves within four weeks, but a small portion of patients may continue to experience these symptoms for a longer duration.

After pneumonia, many patients continue to experience the consequences in the form of functional impairments of the respiratory system:

• Decreased vital lung capacity;
• Impairment of ventilation-perfusion ratio;
• Presence of residual infiltrates or fibrotic changes on X-ray or computed tomography;
• Increased airway reactivity and predisposition to recurrent respiratory infections.

Rehabilitation planning after pneumonia

Recovery after pneumonia is a multi-stage process that must be adapted to the severity of pneumonia, the patient’s age, and the presence of chronic diseases.

The best results are achieved with comprehensive rehabilitation consisting of medication, electrotherapy/restorative therapy, pulmonary rehabilitation, nutrition, lifestyle changes, and psychological support. This positively affects the quality of life and reduces the risk of developing complications.

Before planning rehabilitation, any symptoms that may affect its safety are assessed by a clinician.

Key symptoms include:

• Respiratory symptoms: dyspnea, cough;
• Cardiovascular symptoms: feelings of tightness and/or discomfort in the chest, palpitations;
• General symptoms: fatigue, weakness, fever;
• Neurological symptoms: headache, loss of concentration, memory problems, sleep disturbances, dizziness, tinnitus;
• Gastrointestinal symptoms: abdominal pain or discomfort, nausea, diarrhea, anorexia, and decreased appetite;
• Musculoskeletal symptoms: joint pain, muscle pain;
• Psychological symptoms: depression, anxiety.

Then, a recovery plan will be developed together with the patient.

Methods of recovery and restorative therapy for the lungs after pneumonia

Medication therapy

Medical therapy during the recovery period includes continuing the use of medications aimed at normalizing bronchial patency and reducing the inflammatory process:

• Mucolytics (ambroxol, acetylcysteine), promoting easier mucus clearance;
• Vitamins and immunomodulators, providing support to the body’s defenses.

Electrotherapy/restorative therapy

Electrotherapy/restorative therapy promotes improved microcirculation, reduction of inflammation, and recovery of respiratory function:

• Inhalations with medicinal solutions (saline, mineral water) for moisturizing the airways and easing secretion clearance;
• UHF therapy for reducing inflammation, improving blood circulation, and stimulating regeneration processes in lung tissues;
• Electrophoresis with medications is a method of delivering active substances through the skin using an electric field, providing a localized therapeutic effect;
• Chest massage with postural drainage and vibration is a technique promoting bronchial expansion, improving bronchopulmonary drainage, and enhancing cough reflex efficiency.

Pulmonary rehabilitation

Pulmonary rehabilitation is a program aimed at improving the lung condition after pneumonia and strengthening the patient’s emotional well-being:

• Breathing exercises: exercises on deep diaphragmatic breathing, pursed-lip breathing, and exercises for cough stimulation;
• Postural drainage: positioning the patient in various positions (including tilting and turning the torso) to facilitate mucus evacuation from the lower airways using gravity;
• Saturation control (oxygen saturation level in the blood) during physical exercises.

An exercise program should include:

• Endurance training (bicycle and treadmill);
• Gymnastics (a combination of exercises to improve strength, coordination, range of motion, and balance);
• Walking indoors and outdoors;
• Strength training.

To determine the appropriate level of load during any physical exercise, it is optimal to use the result of the 6-minute walk test or conduct an individual trial walk outdoors.

Regularly performing these procedures promotes the restoration of normal lung ventilation, reduces residual phenomena, and increases the overall functional capacity of the respiratory system.

Nutrition and lifestyle

Balanced nutrition plays an important role in the recovery process after pneumonia.

Recommendations:

• Increase the intake of protein-rich foods for tissue regeneration support;
• Consume foods that contain the necessary amount of nutrients, such as vitamins A, E, C, D, B group vitamins, omega-3 fatty acids, and minerals (iron, copper, selenium, zinc, and magnesium), as they help strengthen the immune system;
• Ensure adequate fluid intake for thinning the mucus and facilitating its removal;
• Avoid excessive fatty, salty, smoked, and difficult-to-digest foods;
• Quit harmful habits. Smoking suppresses the function of the ciliated epithelium, increases inflammation, and slows recovery. Complete refusal of nicotine, as well as limiting alcohol consumption, promotes faster recovery of the respiratory system;
• Physical activity: start with light exercises such as walking and breathing exercises, gradually progressing to more complex and active workouts.

Psychological support

Psychological support is an essential part of rehabilitation after a severe illness, which may be accompanied by anxiety, fear, apathy, or depression.

It is necessary to provide the patient with emotional and psychological assistance:

• Regular consultations with a psychologist or psychotherapist, both offline and online using digital and social media;
• Training in relaxation methods, breathing exercises, and stress management.

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Prevention of recurrences

To reduce the risk of recurrent pneumonia attacks, it is important to follow these preventive measures:

• Scheduled vaccination against influenza and pneumococcal infection (especially for patients with two or more chronic diseases, primarily those over 50 years old);
• Treatment of acute respiratory diseases immediately upon detection;
• Balanced and rational nutrition ensuring the intake of all macronutrients and micronutrients, especially vitamin D, which is significant in the development of viral infections;
• Systematic control of associated chronic pathologies;
• Regular medical examinations for early disease detection.

Recovery from pneumonia of any origin is a prolonged process, with timelines varying among different patients. The duration of rehabilitation depends on age, individual body characteristics, and the presence of chronic co-morbidities.

A significant portion of patients with COVID-19 pneumonia continue to experience symptoms for 3–6 months after hospital discharge. The most common complaints are fatigue, dyspnea on physical exertion, insomnia, and anxiety. Dyspnea during physical activity is associated with persistent changes identified in instrumental lung examinations and changes in lung diffusion capacity.

Thanks to the introduction of new technologies that allow physicians to monitor patient health after discharge, adherence to the rehabilitation program significantly increases. For instance, telerehabilitation can help avoid a break in medical care after the discharge of patients who have had pneumonia from the hospital.