Screening for and Treatment of Epstein—Barr Virus Infection Reactivation as Rehabilitation Tool in Uncontrolled Asthma Patients Who Have Had COVID-19

Objective — to evaluate the frequency of the reactivation of Epstein—Barr virus (EBV) infection among patients with uncontrolled asthma who have had COVID-19 and to determine its treatment effectiveness as a rehabilitation tool. Materials and methods. The study included 25 uncontrolled asthma patients with post-COVID syndrome. For all patients, we determined the presence of active EBV infection by polymerase chain reaction of saliva and nasopharyngeal samples. For the treatment of uncontrolled asthma patients with post-COVID syndrome and reactivation of EBV infection acyclovir 400 mg 4 times a day for 20 days, proteflazid 15 drops twice daily for 2 months, decametoxin 0.02 % solution nebulizer therapy for 10 days were prescribed. Before and after the therapy, the patients completed the Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ-7). In addition, we performed spirometry and the 6-Minute Walk Test (6MWT) to assess the treatment efficacy. Results and discussion. Reactivation of EBV infection was detected in 19 (76.0 ± 8.5) % of patients with uncontrolled bronchial asthma who have had COVID-19. For these 19 patient we prescribed therapy as listed in materials and methods. Under the treatment, there was a decrease in the severity of respiratory symptoms and an improvement in the control of bronchial asthma symptoms. After two months of treatment, the patients had a statistically significant enhancement in the control of asthma symptoms: ACT increased from (11.8 ± 0.7) to (19.3 ± 0.7) points, ACQ-7 decreased from (2.6 ± 0.1) to (1.1 ± 0.1) points with clinically important and statistical significance (p < 0.05). The pulmonary function, namely the vital and forced vital capacity and the bronchial patency (forced expiratory volume in the first second) improved under the study treatment. The small airways obstruction (mid-expiratory flow) decreased with a statistically significant difference. There was a physical exercise tolerance improvement by the 6MWT. Conclusions. Reactivation of EBV infection is often (76 %) complication of COVID-19. The use of acyclovir, proteflazid and topical decametoxin therapy for these patients allows improving in asthma control according to the ACT and ACQ-7 questionnaires. With the improvement of the pulmonary function test, the exercise tolerance of the patients became better. Screening for and treatment of EBV infection reactivation is a possible rehabilitation element in uncontrolled asthma patients who have had COVID-19.