Difficulty Breathing/Dyspnea
What it is:
Breathing difficulty, despite normal oxygen levels, is a distinctive and perplexing symptom observed in Long COVID. Individuals experiencing this symptom may feel short of breath (SOB or breathlessness) or struggle with respiratory discomfort even when standard oxygen measurements appear within the normal range.
Breathing problems in Long COVID can exist on their own or be part of multi-organ problems caused by the coronavirus directly or pre-existing or separate problems. for example, involving the heart – (heart failure as a result of a heart attack or other cardiac issue), damage to the lungs (interstitial lung disease), or pulmonary embolism (a large blood clot or clots forming in the pulmonary blood vessels). Difficulty in breathing can also be part of a breathing pattern disorder1. Breathing pattern disorders are patterns of over-breathing, where the depth and rate of breath are in excess of the body’s needs2.
It is important that your Physician thoroughly assesses you as different causes of breathing difficulty have specific treatments to remedy them.
Typical Symptoms:
People with Long COVID and breathing difficulty often report a sensation of air hunger, chest tightness, chest pain, burning, pressure, soreness or difficulty taking deep breaths3. These symptoms can occur both at rest and during physical exertion.
Who Gets It:
Shortness of breath and Breathing difficulty in long COVID can affect individuals across a wide range of ages and COVID-19 severity. It is not exclusively tied to the severity of the initial respiratory symptoms but appears as a lingering issue in some individuals, pointing to the multifaceted nature of the post-acute sequelae of SARS-CoV-2 infection.
Key Points:
- Breathing problems in Long COVID can exist on their own or be part of multi-organ problems caused by the coronavirus directly or pre-existing or separate problems.
- Symptoms can include air hunger, chest tightness, chest pain, burning, pressure, soreness or difficulty taking deep breaths.
- This issue can occur regardless of the severity of the initial COVID-19 respiratory symptoms.
- Breathing pattern disorder has many causes and is often an interplay between the physiological, pathological, psychological and biomechanical issues in an individual.
The enigma of breathing difficulty with normal oxygen levels in long COVID highlights the need for continued research and personalized interventions, emphasizing the complexity of the post-COVID landscape and the importance of tailored healthcare strategies.
Long Covid The Answers
Relief:
1. First, please see your/a Family Physician so that you can be assessed thoroughly to rule out severe and/or common causes of breathing difficulty. Your physician may refer you onto a specialist such as a Respiratory Physician or Cardiologist if s/he feel that you have a disease process that needs specialist treatment or investigation. You may also be referred to a Long COVID rehabilitation clinic if one is available in your area. The wait times to get an appointment are often extremely long.
2. Finding a good Respiratory Physiotherapist with experience of working with Long Haulers is ideal. Unfortunately these qualified and experienced health care professionals are in short supply, so accessing self-help guides in the interim can be useful.
3. ENO Breathe – a great online programme available to Long Haulers in the UK. Breathing difficulty is alleviated through singing! It is only available to patients who have been medically assessed by a post-COVID clinic or referral centre in England. We’ve included it here for UK citizens and in the hope that other organisations will start up something similar!
4. Air Physiotherapy help with breathing difficulties for Long Haulers and are based in London, UK.
Credible sources of information:
1. Long COVID Physio – Breathing Pattern Disorders – Excellent resource with links
2. Breathing Pattern Disorders – NHS University Hospital Southampton leaflet – Excellent overview, very easy read. Please see our summary of the guide here.
3. Evans R, Pick A, Lardner R, Masey V, Smith N, Greenhalgh T. Breathing difficulties after covid-19: a guide for primary care. bmj. 2023 Jun 14;381. – Great concise guide aimed at General Practitioners/Family Physicians. Please see our summary of the guide here.
4. Physiotherapy for Breathing Pattern Disorders – Excellent website with lots of information and self-help videos