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Authors
Advisor(s)
Abstract(s)
Introdução: A pandemia da COVID-19, iniciada em 2020, veio abalar o mundo ao
introduzir uma panóplia de desafios relacionados não só com a coordenação dos serviços
de saúde, como também com o bem-estar e vida diária das populações. A COVID-19
manifesta-se através de uma variedade de sinais e sintomas, tais como febre, tosse,
dificuldade respiratória, fadiga, diarreia, entre outros. Um sintoma em particular é a
perda de olfato (englobando hiposmia e anosmia), cuja duração pode ser de algumas
semanas ou persistir por um período mais alargado, estabelecendo-se, deste modo, uma
perturbação olfativa de longa duração. O treino olfativo é um método demonstrado
cientificamente eficaz na abordagem à disfunção do olfato persistente após uma infeção
viral. Porém, não existe, atualmente, um tratamento estabelecido na gestão de doentes
com disfunção de olfato de longa duração na sequência da COVID-19.
Objetivos: Determinar a aplicabilidade e segurança de diferentes abordagens
terapêuticas em doentes com disfunção do olfato de longa duração no contexto pósCOVID-19, constatando potenciais tratamentos eficazes nestes casos.
Metodologia: Foi realizada uma pesquisa na base de dados PubMed/MEDLINE de
artigos científicos publicados em inglês de 2023, sendo estes um avanço da evidência
científica relativamente a uma revisão sistemática publicada em 2022 de tema idêntico
à presente revisão, a qual também foi utilizada. Utilizaram-se as palavras-chave
Intervention AND covid-19 pandemic AND smell dysfunction AND anosmia AND
hyposmia. Os principais outcomes investigados foram a eficácia de diversas
metodologias perante doentes com disfunção do olfato persistente em consequência da
COVID-19, bem como a sua segurança e possíveis eventos adversos.
Resultados: Na presente revisão foram incluídos 12 artigos científicos que estudaram
a eficácia do treino olfativo (juntamente com a toma oral de vitamina A e o uso de
corticosteroide nasal), bloqueio do gânglio estrelado, administração de insulina e agentes
quelantes intranasais, injeção de plasma rico em plaquetas (PRP) nas fendas olfativas,
aplicação de corticosteroides sistémicos em conjunto com irrigação nasal e
palmitoiletanolamida (PEA) com luteolina, tendo-se constatado resultados promissores
em todas estas abordagens.
Conclusão: O bloqueio do gânglio estrelado, a administração de insulina e quelantes
intranasais e de PRP nas fendas olfativas têm potencial para se tornarem linhas de
tratamento nos doentes com disfunção do olfato de longa duração no contexto da COVID-19. O mesmo se verifica para o uso de corticosteroides e irrigação nasal. Porém,
dada a atual evidência científica, a sua aplicabilidade na clínica não deve ser imediata.
Recomenda-se a realização de randomized controlled trials (RCT) com metodologias
mais rigorosas e robustas e que permitam introduzir, com mais segurança e de forma
definitiva, os métodos referidos como abordagens terapêuticas na situação descrita.
Assim, preconiza-se o treino olfativo, de preferência ao início da manhã ou da tarde,
juntamente com a toma de vitamina A ou a toma única diária de PEA coultramicronizada com luteolina (um-PEA-LUT), na tentativa de tratar esta disfunção.
Simultaneamente, considera-se importante a adoção de uma dieta saudável, a prática de
atividade física regular e a cessação tabágica (se aplicável).
Introduction: The COVID-19 pandemic, which began in 2020, shook the world by introducing a range of challenges related not only to the coordination of health services, but also to the well-being and daily lives of populations. COVID-19 manifests itself through a variety of signs and symptoms, such as fever, cough, difficulty breathing, fatigue, diarrhea, among others. A particular symptom is the loss of smell (including hyposmia and anosmia), which can last for a few weeks or persist for a longer period, thus establishing a long-lasting olfactory disorder. Olfactory training is a method that has been scientifically proven to be effective in addressing persistent smell dysfunction after a viral infection. However, there is currently no established treatment for the management of patients with long-term smell dysfunction following COVID-19. Objectives: To determine the applicability and safety of different therapeutic approaches in patients with long-term smell dysfunction in the post-COVID-19 context, identifying potential effective treatments in these cases. Methodology: A search was carried out in the PubMed/MEDLINE database of scientific articles published in English from 2023, which are an advance in scientific evidence in relation to a systematic review published in 2022 on an identical topic to the present review, which was also used. The keywords Intervention AND covid-19 pandemic AND smell dysfunction AND anosmia AND hyposmia were used. The main outcomes investigated were the effectiveness of different methodologies for patients with persistent smell dysfunction as a result of COVID-19, as well as their safety and possible adverse events. Results: The present review included 12 scientific articles that studied the effectiveness of olfactory training (along with oral vitamin A and the use of nasal corticosteroids), stellate ganglion block, administration of insulin and intranasal chelating agents and plasma injection rich in platelets (PRP) in the olfactory clefts, with promising results having been observed in all these approaches. Conclusion: Stellate ganglion blockade, administration of insulin and intranasal chelators and PRP in the olfactory clefts have the potential to become lines of treatment in patients with long-term smell dysfunction in the context of COVID-19. The same applies to the use of corticosteroids. However, given the current scientific evidence, its applicability in the clinic should not be immediate. It is recommended to carry out RCTs with more rigorous and robust methodologies that allow the introduction, more safely and definitively, of the methods referred to as therapeutic approaches in the situation described. Therefore, olfactory training is recommended, preferably early in the morning or afternoon, together with the intake of vitamin A or a single daily dose of um-PEA-LUT, in an attempt to treat this dysfunction. At the same time, it is considered important to adopt a healthy diet, practice regular physical activity and stop smoking (if applicable).
Introduction: The COVID-19 pandemic, which began in 2020, shook the world by introducing a range of challenges related not only to the coordination of health services, but also to the well-being and daily lives of populations. COVID-19 manifests itself through a variety of signs and symptoms, such as fever, cough, difficulty breathing, fatigue, diarrhea, among others. A particular symptom is the loss of smell (including hyposmia and anosmia), which can last for a few weeks or persist for a longer period, thus establishing a long-lasting olfactory disorder. Olfactory training is a method that has been scientifically proven to be effective in addressing persistent smell dysfunction after a viral infection. However, there is currently no established treatment for the management of patients with long-term smell dysfunction following COVID-19. Objectives: To determine the applicability and safety of different therapeutic approaches in patients with long-term smell dysfunction in the post-COVID-19 context, identifying potential effective treatments in these cases. Methodology: A search was carried out in the PubMed/MEDLINE database of scientific articles published in English from 2023, which are an advance in scientific evidence in relation to a systematic review published in 2022 on an identical topic to the present review, which was also used. The keywords Intervention AND covid-19 pandemic AND smell dysfunction AND anosmia AND hyposmia were used. The main outcomes investigated were the effectiveness of different methodologies for patients with persistent smell dysfunction as a result of COVID-19, as well as their safety and possible adverse events. Results: The present review included 12 scientific articles that studied the effectiveness of olfactory training (along with oral vitamin A and the use of nasal corticosteroids), stellate ganglion block, administration of insulin and intranasal chelating agents and plasma injection rich in platelets (PRP) in the olfactory clefts, with promising results having been observed in all these approaches. Conclusion: Stellate ganglion blockade, administration of insulin and intranasal chelators and PRP in the olfactory clefts have the potential to become lines of treatment in patients with long-term smell dysfunction in the context of COVID-19. The same applies to the use of corticosteroids. However, given the current scientific evidence, its applicability in the clinic should not be immediate. It is recommended to carry out RCTs with more rigorous and robust methodologies that allow the introduction, more safely and definitively, of the methods referred to as therapeutic approaches in the situation described. Therefore, olfactory training is recommended, preferably early in the morning or afternoon, together with the intake of vitamin A or a single daily dose of um-PEA-LUT, in an attempt to treat this dysfunction. At the same time, it is considered important to adopt a healthy diet, practice regular physical activity and stop smoking (if applicable).
Description
Keywords
Anosmia Disfunção do Olfato Hiposmia Intervenção Pandemia Covid-19