Shortness of breath is described by those affected as a debilitating symptom that has a negative impact on their quality of life and psychological well-being, or something that physically impairs them due to tense neck and shoulder muscles, for example.
The difficulties are usually caused by a problem with the interplay between pathophysiological, psychological, and biomechanical factors (see graphic). This means that pathological restrictions of organs (pathophysiological), influences such as stress, panic, and anxiety (psychological), or the interactions within and control of the musculoskeletal system (biomechanical) can therefore have an impact on breathing difficulties.
Triggers of breathing pattern disorders.
This means: a breathing pattern disorder is complex and can have a variety of possible triggers. This article explains the basic function of the breathing process, as well as diagnostic tools that can be used to find the causes of disorders. After all, knowing the causes makes it possible to initiate the correct treatment.
Shortness of breath is one of the most common symptoms of Long COVID. Nevertheless, the exact correlation and the underlying mechanism are, so far, mostly unclear. This is why symptom-oriented therapies are often used to treat people with Long COVID.
How does comfortable breathing actually work?
The respiratory system’s primary function is the exchange of two gases: oxygen and carbon dioxide.
The gases are exchanged between the millions of air sacs (alveoli) in the lungs and the extremely small blood vessels (capillaries) that surround them. In order for the inhaled oxygen (O2) to get to all of the cells, the blood stream, and the airways – i.e. the nose, bronchial tubes, and alveoli – need to be as clear and open as possible.
Gas is exchanged both in the lungs and at cell level.
Furthermore, there must be sufficient – and sufficiently permeable – points of contact for the exchange of gases between the alveoli and the capillaries, which will ultimately allow the oxygen to reach its destination, the energy-generating systems within the cells (mitochondria), where it goes on to stimulate energy production.
This is why we talk about internal respiration or cellular respiration. The carbon dioxide that is generated during energy production (CO2) needs to be removed from the blood into the capillaries via the alveoli and then exhaled.
With external respiration, the muscular system is of central importance: when the heart muscles are pumping regularly, the respiratory muscles (in particular, the diaphragm) are tensing and relaxing efficiently and the skeletal muscles are well trained, the cogs in the skeletal musculature system and in the heart and lungs are able to mesh and move together easily (see graphic below or download the PDF).
Abnormal breathing patterns, such as shortness of breath, can develop for a variety of reasons: from breathing with the “wrong” muscles, i.e. with the auxiliary respiratory muscles rather than with the diaphragm, or breathing through the mouth instead of the nose, right through to chronic hyperventilation syndrome.
Tests can help provide clarity
If tests performed on individual organs do not reveal anything of note, the Cardiopulmonary Exercice Test (CPET) also known as Spiroergometry may be a useful tool in clarifying the cause of the shortness of breath. CPET looks at the overall interplay between breathing, the cardiovascular system, and the skeletal musculature when under load.
In this regard, also read the Blog: “Cardiopulmonary exercise testing (CPET) and Long COVID: Benefits and background”
In order for someone to recover physically, mentally, and emotionally, and to stay healthy, it is important to identify the causes of shortness of breath and respiratory distress.
The Cardiopulmonary Exercise Test (CPET)
This maximum-load, symptom-limited, cardio-pulmonary stress test is the gold standard when it comes to measuring physical performance. The test measures the gas-exchange parameters using a mouthpiece or a mask, while the test subject uses a treadmill or stationary bike with a controlled increase in resistance or output. CPET (or spiroergometry) is frequently used to measure the fitness level of athletes or patients with cardio-pulmonary disorders. In these target groups, CPET measurements are very reliable and reproducible.
Based on the respiratory gases CO2 and O2 in the exhaled air, the spiroergometry test distinguishes between the following possible causes of shortness of breath:
- Cardiac factors (e.g., heart failure)
- Pulmonary factors (e.g., gas-exchange disturbance)
- Muscular factors (e.g., reduced energy generation in the mitochondria)
- Psychological factors (e.g., hyperventilation, panic, anxiety syndrome)
- Deconditioning (e.g., due to an extended period of being bedridden, period of inactivity)
Individual causes can also occur together.
Benefits and optimal time for a spiroergometry test
There is a legitimate reason for not conducting the CPET (or spiroergometry test) on people with lasting shortness of breath following a COVID-19 infection: the affected person could experience a crash (PEM) as a result of the stress test, and, in some cases, could take from several days to several weeks to recover from the test. It is therefore essential that an extremely careful evaluation be carried out regarding the benefits of a spiroergometry test and the optimal time for this test or a less strenuous maximum stress test to be performed. In this regard, also read the Blog: “Stress tests: The do’s and don’ts”
Essential in the case of Long COVID: a careful evaluation of the benefits, timing, and side effects of a maximum stress test.
Breathing exercises provide relief
Non-pharmacological measures, i.e., breathing exercises, can be a huge help in alleviating respiratory disorders and increasing well-being, provided that they are followed regularly and in a targeted manner. With this knowledge and the willingness to undergo breathing therapy, patients can start to relearn how to breathe correctly. Breathing therapy typically focuses on three elements: nasal breathing, deep breathing, slow breathing.
Lung physiotherapists and breath therapists play a key role in the analysis and treatment of breathing pattern disorders.
The Vademecum about shortness of breath features practical therapeutic approaches and exercises from various therapy areas that can be used as part of self-management.
Talking about Long COVID in the Altea Forum
Altea opened a Forum for direct exchange about Long COVID. Addressed are those affected by Long COVID, their relatives, doctors, researchers, therapists and other interested parties.
The discussions are located in a protected member area that is accessible after creating a profile. Discuss, for example, about changes in the sense of taste and smell, about Long COVID in children or about tips against shortness of breath. Suggestions for further discussion topics are welcome. Log in now or create a profile »
