Dyspnea, the medical term for shortness of breath, describes the feeling of being unable to breathe deeply or catch one’s breath. A person experiencing this sensation may feel a tightness in the chest or an increased effort is required for breathing. Public concern surrounding this symptom is high because it is often a marker of the disease progressing to a more severe state requiring medical attention. Shortness of breath can occur even in mild cases, but its presence signals the potential for serious complications within the respiratory system.
Shortness of Breath as a Defining COVID Symptom
Shortness of breath is a defining symptom that often signals the progression of a COVID-19 infection. The symptom typically does not appear immediately with the onset of illness, unlike fever or a cough. Instead, it tends to develop several days into the illness, often around five days after the initial symptoms begin. This delayed timing is a key feature in the clinical presentation of COVID-19.
Studies have shown shortness of breath affects a significant portion of symptomatic adults, around 43% in early reports. Its severity is a major factor in determining a patient’s overall risk and the need for hospitalization. Health professionals use the presence and worsening of dyspnea as an indicator for risk assessment, suggesting more extensive lung involvement. Even when the acute infection clears, breathlessness can sometimes persist for weeks or months, becoming a common component of long COVID.
How COVID-19 Affects Respiratory Function
The underlying cause of COVID-related shortness of breath is the damage the SARS-CoV-2 virus inflicts upon the lung tissue. The virus primarily targets the epithelial cells that line the airways and the alveoli, the tiny air sacs where oxygen exchange occurs. Viral infection and the subsequent immune response trigger intense inflammation, leading to viral pneumonia. This inflammation causes fluid and immune cells to accumulate in the alveoli, leading to pulmonary edema.
This fluid build-up and damage impair the lungs’ ability to transfer oxygen into the bloodstream and remove carbon dioxide. The resulting lack of oxygen in the blood is called hypoxia, which causes the sensation of breathlessness. A unique presentation in COVID-19 patients is “happy hypoxia,” where individuals have dangerously low oxygen saturation levels despite not exhibiting the severe distress expected. When the damage is severe, it can progress to Acute Respiratory Distress Syndrome (ARDS), characterized by widespread inflammation and fluid in the lungs.
Distinguishing COVID-Related Breathing Issues from Other Illnesses
Differentiating COVID-related shortness of breath from other common causes requires attention to accompanying symptoms. Shortness of breath caused by anxiety or a panic attack often has a rapid onset and is typically short-lived, usually lasting only 10 to 30 minutes. This type of breathing difficulty is generally not accompanied by systemic symptoms like a fever or persistent cough, which are common in COVID-19. Breathing exercises or coping mechanisms can often alleviate anxiety-induced breathlessness.
In contrast, breathing issues from asthma or allergies are usually triggered by environmental factors and respond to prescribed inhalers or allergy medication. While these conditions can cause wheezing and a tight chest, they usually do not lead to the new and persistent systemic decline seen with COVID-19.
Shortness of breath from a common cold or influenza is often linked to nasal congestion and upper airway obstruction. COVID-19 dyspnea, however, feels like a deep lung distress and a profound inability to take a satisfying breath, distinguishing it from the localized breathing issues of a typical cold.
Recognizing Emergency Warning Signs
A sudden or worsening difficulty breathing requires immediate medical attention, and any severe or persistent trouble breathing should prompt an immediate call to emergency services. Other warning signs include persistent pain or pressure located in the chest area. This could signal serious lung or heart involvement related to the infection.
New confusion, an inability to wake up, or difficulty staying awake are also signs of severely compromised oxygen levels. A bluish tint to the lips or face, or the nail beds appearing pale, gray, or blue, indicates a dangerous lack of oxygen in the blood. These signs require emergency intervention.