Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is a condition where symptoms persist or emerge weeks or months after the initial infection. Shortness of breath, medically termed dyspnea, is a common and distressing symptom for affected individuals. This persistent breathlessness significantly impacts daily life, often limiting activities and reducing overall well-being. Understanding its nature and underlying causes is important for managing its effects.
What Long COVID Shortness of Breath Feels Like
Individuals experiencing Long COVID often describe their shortness of breath in distinct ways, differing from the acute phase of illness. Many report a sensation of “air hunger,” feeling unable to take a full or satisfying breath even when oxygen levels appear normal. This can manifest as chest tightness or a feeling of suffocation, as if they cannot get enough air into their lungs. Some also experience shallow breathing or a persistent, irritating cough accompanying their breathlessness.
This breathlessness often fluctuates in intensity throughout the day or week, rather than being a constant, severe state. It frequently feels disproportionate to the activity, meaning even light tasks can trigger a significant increase. It tends to worsen with exertion, a phenomenon known as post-exertional malaise, where minor physical or mental effort can lead to a crash and increased respiratory distress. This impacts daily activities, making simple tasks like walking, talking, or even dressing feel exhausting.
Why Breathlessness Persists
The persistence of breathlessness in Long COVID is attributed to a combination of factors, reflecting the widespread effects of the initial viral infection.
Microvascular Damage
The SARS-CoV-2 virus can injure endothelial cells lining tiny blood vessels in the lungs. This can lead to small clots that impair oxygen and carbon dioxide exchange. This subtle damage reduces gas exchange efficiency, even if major lung structures appear intact on standard imaging.
Persistent Inflammation
The body’s immune response can remain active long after the initial infection, causing chronic low-grade inflammation in tissues, including the lungs. This sustained inflammatory state can affect lung function and contribute to discomfort and breathlessness. Such inflammation might not always be evident on routine tests but can still impact how the lungs operate.
Autonomic Nervous System (ANS) Dysfunction
Dysfunction of the autonomic nervous system (ANS) is another factor. The ANS regulates involuntary bodily functions like heart rate and breathing patterns. In Long COVID, ANS dysregulation can lead to symptoms resembling Postural Orthostatic Tachycardia Syndrome (POTS), where the heart rate increases significantly upon standing, often accompanied by breathlessness. This imbalance can disrupt normal breathing rhythms and contribute to air hunger.
Subtle Lung Abnormalities
While severe lung damage is less common, subtle lung abnormalities can play a role. Some individuals have residual inflammation in small airways or microscopic changes in lung tissue, visible on advanced imaging techniques, such as hyperpolarized Xenon MRI. These changes can affect lung mechanics and gas exchange, leading to persistent breathlessness. The extent of these changes varies widely among individuals.
Deconditioning and Muscle Weakness
Prolonged illness and reduced activity can lead to deconditioning and muscle weakness, impacting respiratory function. Breathing muscles, like the diaphragm, can weaken due to inactivity, making breathing more effortful. This physical deconditioning exacerbates breathlessness, creating a cycle where less activity leads to more weakness and increased difficulty breathing.
Diaphragm Dysfunction and Altered Breathing Patterns
Diaphragm dysfunction, affecting the primary breathing muscle, has been observed. Impaired movement or weakness of the diaphragm can reduce lung capacity and breathing efficiency. Altered breathing patterns, such as hyperventilation or shallow chest breathing, can also develop as a compensatory mechanism or due to ANS dysfunction. These dysfunctional patterns can lead to a feeling of not getting enough air, even if the lungs are physically capable of more.
Strategies for Managing Breathlessness
Managing Long COVID breathlessness begins with a medical evaluation to understand underlying causes. Diagnostic tests like lung function tests, chest imaging, and blood tests help tailor a management plan.
Pulmonary rehabilitation programs offer structured support. Therapists teach breathing exercises to improve lung efficiency, incorporating energy conservation and pacing strategies to manage activity levels and prevent symptom exacerbation.
Specific breathing techniques provide immediate relief. Diaphragmatic breathing uses the diaphragm effectively. Pursed-lip breathing slows exhalation, improving oxygen exchange. Positional changes, like leaning forward, can make breathing easier.
Pacing and energy conservation are central to managing symptoms, especially breathlessness and post-exertional malaise. This involves planning activities, taking breaks, and avoiding overexertion. Resting before exhaustion helps maintain stable energy and reduce breathlessness.
Lifestyle adjustments support respiratory health. Staying hydrated and maintaining a balanced diet are important. Gentle, graded activity, like short walks or stretching, can help rebuild stamina and muscle strength.
The psychological impact of persistent breathlessness can lead to anxiety. Mindfulness and relaxation techniques can help manage this. Seeking support from mental health professionals can provide coping strategies. In some cases, a doctor might prescribe medications.