Marcus, and other smart people. What are you thoughts on a post COVID course of prednisone for people with lingering dyspnea with exertion, fatigue, cough, etc. Possibly +/- some flovent? Or just flovent alone?

Seeing some young, otherwise healthy folks, that aren't able to perform like they used to several weeks post recovery. A quick literature search yields primarily small scale studies and anecdotal cases for a post-viral syndrome course of prednisone, but it's largely positive.

Do you have a typical course? One med over another? Any clinical utility in PFTs before trying a prednisone course? Can't imagine it would change management. Maybe for academic purposes. Also, PFTs are very hard to come by right now.

Following this. Seeing the same thing in relatively healthy middle aged people. Post COVID care is a complete unknown now. Getting echo routinely on these pts? I feel like we overuse steroids (in general) and am very reluctant to try it empirically without some evidence.
Seems like all effort (appropriately) has been on inpts. Hopefully med schools are setting up post COVID clinics and getting some useful data for us.

Have seen handful of post ICU covid pts. Ones with severe hypoxia during acute illness. All have fibrosis and residual dyspnea. No major obstruction on PFTs. Mainly restriction. We don't know how to manage these pts yet, if at all. Don't think steroids play a role unless there is obstructive component to airflow.

I ran this by the Infectious Disease people I most closely work with. My COVID patient numbers are much smaller than what Marcus Aurelius and others have seen, but I have seen it in some of the patients I have seen, as well as in at least one personal friend who had it. Normal CXRs. The I.D. guys say some will definitely seem to respond to steroid tapers (if no diabetes, HTN, contraindications, etc.) and that some will respond really nicely to steam inhalations. Obviously, as with so many things with COVID, there isn't a lot of evidence-based medicine yet.
Edit: one of them thinks it is probably normal post viral reactive bronchitis or bronchospasm, the other thinks it has to do with persistent microthrombotic events that don't show up on CXR or CT scan. Who knows? MA probably has opinions on this.

Yes - in the acute and sub-acute setting I am using steroids - systemic and inhaled. My post above is referring to f/us weeks out in the office. With residual dyspnea on exertion and dry coughing.

All I know is when I had Covid, the prednisone made my symptoms improve within 24 hours of taking it

To all the doctors in this thread. I tested positive for covid 3 months ago and still have lingering symptoms. I've taken Zithromax, predinosone, and nothing has worked. Symptoms (feverish feeling, muscle aches, stuffy nose, ear ache) keep coming back every 2-3 weeks. I'm starting to take a multivitamin + zinc to see if that helps at all.

Anything else you folks would recommend to help get rid of this? I've seen a Facebook group of covid survivors that claim to have experienced symptoms 3-6 months after testing positive. It's just so strange this covid.

By the way I'm a 35 year old male, in good health, and no underlying conditions.