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Based on the American Journal of Case Reports e-ISSN 1941–5923, © Am J Case Rep, 2020; 21: e926779 DOI: 10.12659/AJCR.926779.
Authors: Scott A. Sigman, Soheila Mokmeli, Monica Monici, Mariana A. Vetrici
Team Physician, UMASS Lowell, Fellow of the World Society of Sports and Exercise Medicine, Fellow of the Royal College of Surgeons in Ireland, Chelmsford, MA, USA
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Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The presentation of COVID-19 includes dyspnea, lung edema, and pneumonia. Morbidity and mortality are associated with acute respiratory distress syndrome (ARDS) and cytokine storm. Hospitalized COVID-19 patients are classified as severe if they require intensive care unit (ICU) admission [1,2]. Here, we report the first case of the use of supportive or adjunctive photobiomodulation therapy (PBMT) in a patient with severe COVID-19 pneumonia.
Photobiomodulation Therapy (PBMT) is the best technical term for Low-Level Laser Therapy (LLLT). It is a light therapy using lasers or LEDs to improve tissue repair, reduce pain and inflammation wherever the beam is applied.
PBMT is an emerging alternative modality with demonstrated anti-inflammatory effects in pain management, lymphedema, wound healing, and musculoskeletal injuries. Additional terms for PBMT include low-level laser (or light) therapy (LLLT), cold laser, and photobiostimulation. The effects of PBMT differ from the thermal effects produced by the high-power lasers used in cosmetic and surgical procedures to destroy the tissue. PBMT is non-invasive, cost-effective, and has no known adverse effects.
Empirical use of PBMT in children, adults, and elderly patients with pneumonia, asthma, chronic bronchitis, or pulmonary fibrosis resulted in reduced chest pain and heaviness, normalization of respiratory function, shortened recovery times, and improved immunological and radiological parameters.
A 57-year-old African American man with a history of hypertension and asthma presented with shortness of breath, severe dehydration ´ renal failure. A physical examination revealed labored breathing, weakness, and fatigue. Chest X-rays demonstrated worsening bilateral lung infiltrates. The patient had been in the ICU for respiratory depression.
The diagnosis of SARS-CoV-2 was confirmed for this patient by reverse transcription-polymerase chain reaction by the nasopharyngeal swab. Patient consent was obtained for an FDA-guided and International Review Board-approved trial of laser treatment for COVID-19 (Lowell General Hospital Federal-wide Assurance number 0001427).
The patient was treated with an FDA-cleared Multiwave Locked System (MLS) Therapy Laser (ASA Laser, Italy.) The MLS laser utilizes a mobile scanner with 2 synchronized laser diodes, one in pulse mode (adjustable to 1–2000 Hz), emitting at 905 nm, and another in pulsed mode emitting at 808 nm. The 2 laser beams work simultaneously and synchronously. This laser is used in pain centers for the treatment of musculoskeletal pain and inflammation.
The patient tolerated all 4 daily treatments and noted significant improvement in breathing immediately after each treatment. Paroxysmal coughing spells resolved after the third treatment. Upon completion of the fourth treatment, the patient was able to ambulate in the room with physical therapy. On the day following his final treatment, the patient was discharged to an acute rehabilitation facility on 1 L/min oxygen. On the day after arrival to the acute rehabilitation facility, the patient was able to complete 2 trials of stair climbing with physical therapy and was in the process of weaning to room air.
The patient’s response to PBMT was evaluated by comparing different scoring tools before and after laser therapy. The patient showed improvement in all evaluation criteria.
This report has presented a patient with severe COVID-19 pneumonia associated with ARDS who was given a supportive treatment with PBMT. Based on this case report, as well as clinical experience of PBMT in respiratory tract diseases in humans, professionals consider PBMT to be a feasible adjunct modality for the treatment of COVID-19. There are published experimental work demonstrating the anti-inflammatory effect of PBMT on lung tissue. Professionals suggest that the use of adjunct PBMT in the early stages of severe ARDS seen in COVID-19 patients can enhance healing and reduce the need for prolonged ventilator support and ICU stay.
