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.
What is PBMT?
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.
Liang T: Handbook of COVID-19 prevention and treatment. Zhejiang University School of Medicine, March 2020
Huang C, Wang Y, Li X et al: Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30;]. Lancet, 2020; 395(10223): 497–506
Anders JJ, Lanzafame RJ, Arany PR: Low-level light/laser therapy versus photobiomodulation therapy. Photomed Laser Surg, 2015; 33(4): 183–84
Cotler HB, Chow RT, Hamblin MR, Carroll J: The use of low-level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol, 2015; 2(5): 00068
Hamblin MR: Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys, 2017; 4(3): 337–6
Amirov NB [Parameters of membrane permeability, microcirculation, external respiration, and trace element levels in the drug-laser treatment of pneumonia]. Ter Arkh, 2002; 74(3): 40–43 [in Russsian]
Derbenev VA, Mikhailov VA, Denisov IN: Use of low-level laser therapy (LLLT) in the treatment of some pulmonary diseases: Ten-year experience. Proceedings of the SPIE, Volume 4166; 1999 Oct 28–31; Florence, Italy. SPIE digital library 2000; 323–25
Ostronosova NS: [Outpatient use of laser therapy in bronchial asthma.] Ter Arkh, 2006; 78(3): 41–44 [in Russsian]
Mehani SHM: Immunomodulatory effects of two different physical therapy modalities in patients with chronic obstructive pulmonary disease. J Phys Ther Sci, 2017; 29(9): 1527–33
Miranda EF, de Oliveira LV, Antonialli FC et al: Phototherapy with a combination of super-pulsed laser and light-emitting diodes is beneficial in the improvement of muscular performance (strength and muscular endurance), dyspnea, and fatigue sensation in patients with chronic obstructive pulmonary disease. Lasers Med Sci, 2015; 30(1): 437–43
Enwemeka CS, Bumah VV, Masson-Meyers DS: Light as a potential treatment for pandemic coronavirus infections: A perspective. J Photochem Photobiol B, 2020; 207: 111891
Fekrazad R: Photobiomodulation and antiviral photodynamic therapy as a possible novel approach in COVID-19 management. Photobiomodul Photomed Laser Surg, 2020; 38(5): 255–57
Mokmeli S, Vetrici M: Low-level laser therapy as a modality to attenuate cytokine storm at multiple levels, enhance recovery, and reduce the use of ventilators in COVID-19. Can J Respir Ther, 2020; 56: 1–7
Aimbire F, Lopes-Martins RA, Albertini R et al: Effect of low-level laser therapy on hemorrhagic lesions induced by immune complex in rat lungs. Photomed Laser Surg, 2007; 25(2): 112–17
de Brito AA, da Silveira EC, Rigonato-Oliveira NC et al: Low-level laser therapy attenuates lung inflammation and airway remodeling in a murine model of idiopathic pulmonary fibrosis: Relevance to cytokines secretion from lung structural cells. J Photochem Photobiol B, 2020; 203: 111731
Cury V, de Lima TM, Prado CM et al: Low-level laser therapy reduces acute lung inflammation without impairing lung function. J Biophotonics, 2016; 9(11–12): 1199–207
da Cunha Moraes G, Vitoretti LB, de Brito AA et al: Low-level laser therapy reduces lung inflammation in an experimental model of chronic obstructive pulmonary disease involving P2X7 receptor. Oxid Med Cell Longev, 2018; 2018: 6798238
Miranda da Silva C, Peres Leal M, Brochetti RA et al: Low-level laser therapy reduces the development of lung inflammation induced by formaldehyde exposure. PLoS One, 2015; 10(11): e0142816
WALT: Dosage recommendations. Recommended treatment doses for low- level laser therapy. Available at URL: https://waltza.co.za/documentation- links/recommendations/dosage-recommendations/; https://waltza.co.za/ wp-content/uploads/2012/08/Dose_table_904nm_for_Low_Level_Laser_ Therapy_WALT-2010.pdf
Receive the latest news, articles, updates and events from us
Written by the best, for the best.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form. Please try again.