Dear Editor:
COVID-19 pneumonia patients who responded successfully to intensive care treatments and were able to be discharged from hospital appear to experience a prolonged recovery, demanding resolute inpatient and outpatient rehabilitation services. Those include predominantly physiotherapy, occupational therapy, and speech-language retraining, with respect to recovery of the respiratory system as well as mobility and function. The recent European Society for Clinical Nutrition and Metabolism (ESPEN) concise guidance on clinical nutrition in COVID-19 patients properly addressed nutritional intervention and therapy as an integral part of the approach to patients victim to SARS-CoV-2 infection in the ICU setting, in an internal medicine ward setting as well as in general healthcare but omitted to consider nutritional guidance for COVID-19 survivors.1 Besides other early and short-term rehabilitative interventions, the International Task Force of the European Respiratory Society recently itemized adequate nutrition among rehabilitation needs for COVID-19 survivors upon release from hospital.2 Among other candidates, dietary creatine might emerge as one of the key elements of nutritional support following COVID-19 respiratory distress due to its beneficial effects demonstrated during rehabilitation in various lung conditions. For instance, creatine supplementation augments functional recovery during pulmonary rehabilitation in patients with chronic obstructive pulmonary disease,3 but also ameliorates cystic fibrosis, stroke, and respiratory failure,4–6 acting as an anti-inflammatory and energy-boosting agent. Although no disease-specific guidelines exist at present, a conventional creatine dosage of 5 g per day administered over 4 weeks or more might be risk-free and sufficient to back up pulmonary rehabilitation in COVID-19. Creatine is inexpensive, widely available, and has a favorable safety profile, therefore being a suitable promising compound that could meet a growing need for nutritional help during pulmonary rehabilitation in post-COVID-19 world.
Footnotes
Author contributions: SMO solely contributed to this article.
Conflict of interest statement: The author declares that there is no conflict of interest.
Funding: The author received no financial support for the research, authorship, and/or publication of this article.
ORCID iD: Sergej M. Ostojic 
https://orcid.org/0000-0002-7270-2541
References
- 1. Barazzoni R, Bischoff SC, Breda J, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr 2020; 39: 1631–1638. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. European Respiratory Society. Report of an ad-hoc international task force to develop an expert-based opinion on early and short-term rehabilitative interventions (after the acute hospital setting) in COBID-19 survivors, https://ers.app.box.com/s/npzkvigtl4w3pb0vbsth4y0fxe7ae9z9 (accessed 1 June 2020).
- 3. Fuld JP, Kilduff LP, Neder JA, et al. Creatine supplementation during pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax 2005; 60: 531–537. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Braegger CP, Schlattner U, Wallimann T, et al. Effects of creatine supplementation in cystic fibrosis: results of a pilot study. J Cyst Fibros 2003; 2: 177–182. [DOI] [PubMed] [Google Scholar]
- 5. Meulengracht MC, Ingvoldstad TE, Versterre SM, et al. Randomized controlled trial examining the effect of creatine and maltodextrin on functional level in stroke rehabilitation. Clin Nutr 2018; 37: S5. [Google Scholar]
- 6. Marinari S, Manigrasso MR, De Benedetto F. Effects of nutraceutical diet integration, with coenzyme Q10 (Q-Ter multicomposite) and creatine, on dyspnea, exercise tolerance, and quality of life in COPD patients with chronic respiratory failure. Multidiscip Respir Med 2013; 8: 40. [DOI] [PMC free article] [PubMed] [Google Scholar]