From the Guidelines
Dyspnea post Coronavirus Disease (COVID) is primarily caused by pulmonary complications, including pulmonary embolism, pneumonia, impaired diffusion capacity for carbon monoxide, pulmonary fibrosis, neuromuscular weakness, new or worsening asthma, and bronchial hyperreactivity due to pulmonary vascular inflammation 1.
Causes of Dyspnea
- Pulmonary embolism: especially if dyspnea is accompanied by exercise-induced oxygen desaturation, tachycardia, and/or presyncope/syncope
- Pneumonia: a common complication of COVID-19
- Impaired diffusion capacity for carbon monoxide: a measure of lung function
- Pulmonary fibrosis: scarring of lung tissue
- Neuromuscular weakness: weakness of respiratory muscles
- New or worsening asthma: inflammation of airways
- Bronchial hyperreactivity: constriction of airways
Pathophysiology
The cytokine storm caused by COVID-19 can lead to acute lung injury, ARDS, and multiorgan failure 1. The degree of increase in pro-inflammatory cytokines determines the degree of COVID-19-induced lung injury.
Clinical Recommendations
If you are experiencing shortness of breath post COVID, it is recommended that you seek medical attention immediately. As a precautionary measure, your healthcare provider may prescribe a course of prednisone, a corticosteroid, at a dose of 20-30 mg per day for 5-7 days to help reduce inflammation in the lungs. Additionally, your provider may recommend supplemental oxygen therapy if your oxygen saturation levels are below 92%. It is also essential to stay hydrated by drinking plenty of fluids, such as water or electrolyte-rich beverages, and to rest as much as possible. In some cases, your provider may prescribe a bronchodilator, such as albuterol, at a dose of 2.5-5 mg via inhalation every 4-6 hours as needed, to help open up airways. It is crucial to follow up with your healthcare provider for further evaluation and guidance, as the severity and duration of shortness of breath can vary from person to person 1.
From the Research
Causes of Dyspnea Post COVID-19
- Lung damage is a possible cause of dyspnea in post-COVID-19 patients 2
- Cardiovascular pathology, hyperventilation syndrome, dysfunction of the autonomic nervous system, detraining, and anemia are also potential causes of dyspnea in post-COVID-19 patients 2
- Immune activation, dysregulation, and suppression may contribute to the development of post-COVID sequelae, which can resemble an acute asthma exacerbation and cause dyspnea 3
- Organizing pneumonia (OP) and fibrosis progression can also lead to dyspnea in post-COVID-19 patients 4
Mechanisms of Dyspnea
- Hyperventilation has been identified as a cause of exercise-induced dyspnea in post-COVID syndrome (PCS) 5
- A combined disturbance of poor skeletal muscle energetic situation and autonomic dysfunction can lead to hyperventilation and dyspnea in PCS 5
- Mitochondrial calcium overload by high intracellular sodium can be a key driver for fatigue and chronification in post-COVID-19 patients 5
Clinical Presentations
- Dyspnea can persist from one to several months and even years after COVID-19 infection, resulting in low quality of life for patients 2
- Patients with a history of COVID-19 may complain of persistent cough, shortness of breath, weakness, and memory/concentration disorders six months after recovery 6
- Pulmonary function tests (PFT) may not always be impaired in patients with persistent shortness of breath six months after COVID-19 infection 6