Learning to breathe properly can help overcome Long Covid

Rebecca Hales was barely breathing when she contracted Covid. The former London marathoner gasped as he lay in his bed in July 2021.

Recovery was painfully slow: it took several weeks for the high fever and sore throat to go away, and the respiratory problems continued.

“At the slightest effort, I was out of breath,” says Rebecca, 55, a district nurse who lives in Wantage, Oxon, with her husband, Richard, 56.

But it wasn’t until January that the problem was identified: he was diagnosed with a breathing pattern disorder (BPD), mainly chronic shortness of breath caused by an abnormal breathing pattern.

While BPD often affects people with chronic lung conditions such as asthma or chronic obstructive pulmonary disease (such as emphysema) or anxiety disorders, it also emerges as a major post-infection problem for many Covid patients.

Rebecca’s diagnosis came after her family doctor referred her to a longstanding Covid NHS clinic in Oxford. At the time, she says she thought she “never thought I’d be able to breathe easily again—to be the fit and healthy person I was before Covid.”

BPD is when a person develops an abnormal breathing pattern (usually faster, shallower breathing), says Emma Tucker, respiratory physical therapist who treats Rebecca at the Oxfordshire Post-Covid-19 Evaluation Clinic at Churchill Hospital.

He adds: ‘But while shortness of breath can be part of an acute or short-term condition, in BPD it is chronic. Sick people complain of air hunger and shortness of breath. This breathing pattern can become a habit: in some people, the level of carbon dioxide in the blood drops because when you hyperventilate, you give off more carbon dioxide than usual, which causes fainting and dizziness.

Emma says the number of patients she sees with BPD as part of the long-term Covid is “really significant and continues to rise.”

Since opening in May 2020, the clinic has treated 4,000 adults, about a quarter of whom have BPD.

It is estimated that around 1.3 million people in the UK have symptoms of Covid lasting more than four weeks after initial infection; After one year in 554,000, symptoms such as shortness of breath, fatigue and brain fog occur.

Emma says many report the same symptoms: a feeling of not having enough air, frequent yawning and tingling in the hands, feet, and chest, which can be caused by a lack of carbon dioxide.

BPD is when a person develops an abnormal breathing pattern (usually faster, shallower breathing), says Emma Tucker, respiratory physical therapist who treats Rebecca at the Oxfordshire Post-Covid-19 Evaluation Clinic at Churchill Hospital. A stock photo of the lungs can be seen above

“She’s always out of breath when she’s resting, talking, or even eating, which is incredibly scary,” says Emma.

But although borderline and pulmonary Covid are clearly linked, it is not yet clear how.

Unlike people with COPD who have changes in their lungs that affect the way they breathe, people with long-term Covid-related BPD have no physical signs that something is wrong. ‘Respiratory function tests and chest X-ray can vacuum; normal,” added Emma, ​​co-author of the Long Covid Self-Help Guide. Despite serious respiratory problems, “oxygen saturation levels, the percentage of oxygen in their blood, are also normal.”

One theory is that the Covid virus is causing the body’s autonomic nervous system (which controls our fight-or-flight response, heart rate, and breathing) to get out of control, causing faster and shallower breathing.

Associate professor of respiratory physiology and exercise at Derby University, Dr. Mark Faghy explains that another possibility may be due to vagus nerve dysfunction in long-term Covid patients.

The vagus nerve, which runs from the brain to the colon, controls signals between the brain and organs and supports the parasympathetic nervous system (regulating the body’s ability to relax).

Dr. “Basically, the feedback from the body to the brain is disrupted and the signals don’t match what the body is experiencing,” says Faghy. Factors such as pain, stress, and anxiety can all trigger BPD, and poor posture can also contribute by changing the position of the diaphragm, making it difficult to breathe properly.

The underlying causes are not fully understood, but it is clear that BPD “can be a very painful condition and some of the patients we see are helpless,” says Dr. Faghy.

Regardless of the triggering factor, a person with BPD typically breathes faster than they should, using their chest and neck muscles instead of the abdomen and diaphragm, says Rebecca Livingstone, MD, a respiratory physical therapist in the post-Covid era. NHS Foundation Trust. “Normal breathing should be much slower with relatively little change in air volume in the lungs and only a small movement in the abdomen.”

Treatment involves managing symptoms by discovering ways to improve breathing, posture, and speech.

Emma Tucker says the most important technique to learn is to breathe effectively so that most of the work is done from the stomach, not the chest.

Rebecca Livingstone adds: “We show people what a normal breathing pattern should look like and have them put their hands on their stomachs to see where the diaphragm should be working. The most important thing is that we can help solve the problem.’

Rebecca Hales found that the virtual seminars she attended helped her retrain her breathing rate to get back to daycare work.

“I’ve been sick with Covid for a long time, but my breathing has returned to normal and I’m less tired,” she says.

He also started running again at a measured pace. “I signed up for Couch to 5K and hope to reach that milestone in the not-too-distant future,” he says.