From the Guidelines
Involuntary gasping (dyspnea) after COVID-19 infection is primarily caused by respiratory muscle weakness and damage, and management should focus on respiratory muscle testing and training (RMT) to improve symptoms and quality of life. The causes of involuntary gasping post COVID-19 are multifactorial, including lung damage, inflammation, blood clots in the lungs, deconditioning, and anxiety. However, recent evidence suggests that respiratory muscle performance plays a significant role in the development of persistent dyspnea in patients with COVID-19 1.
Key Factors Contributing to Involuntary Gasping
- Respiratory muscle weakness and damage
- Lung damage and inflammation
- Blood clots in the lungs
- Deconditioning
- Anxiety
Management Strategies
- Respiratory muscle testing and training (RMT) to improve respiratory muscle performance and reduce symptoms of dyspnea 1
- Pulmonary rehabilitation exercises to rebuild lung strength and endurance
- Medications such as bronchodilators, corticosteroids, and anticoagulants as needed
- Breathing techniques such as pursed-lip breathing and diaphragmatic breathing to control symptoms
- Lifestyle modifications including gradual physical activity, adequate hydration, and avoiding respiratory irritants
The underlying mechanism involves damage to lung tissue and respiratory muscles from the viral infection and the body's inflammatory response, which can affect gas exchange and breathing mechanics even after the acute infection resolves 1. Recovery time varies significantly between individuals, from weeks to months, and some patients may develop long COVID requiring ongoing management. RMT has been shown to be effective in improving dyspnea and other functional outcomes in patients with COVID-19, and should be considered as a key component of rehabilitation 1.
From the Research
Causes of Involuntary Gasping Post-COVID
- Dyspnea, or difficulty breathing, is a common complaint among patients with post-acute COVID-19 syndrome, also known as "COVID-19 long-haulers" 2
- Post-COVID interstitial lung disease (ILD) is a potential cause of persistent symptoms, including dyspnea, in patients after COVID-19 infection 3
- Other possible causes of involuntary gasping post-COVID include fatigue, brain fog, and chest pain, which are all common symptoms of post-acute COVID-19 syndrome 2
Management of Involuntary Gasping Post-COVID
- A cautious multidisciplinary preoperative evaluation is recommended for patients with post-acute COVID-19 syndrome, including assessment of critical care myopathies and neuropathies, preoperative workup of insidious cardiac or pulmonary pathologies, and thorough medication review 2
- Bronchodilator reversibility testing may be useful in post-COVID-19 patients undergoing pulmonary rehabilitation, as it can induce a functional improvement in breathing 4
- Nebulized in-line endotracheal dornase alfa and albuterol may be beneficial in mechanically ventilated COVID-19 patients, as it can help reduce the viscosity of mucopurulent secretions and improve respiratory function 5
- Lung-protective ventilation and avoidance of benzodiazepines in patients with cognitive impairment are also recommended as part of the management of post-acute COVID-19 syndrome 2
Treatment Options
- Bronchodilators, such as salbutamol, may be used to improve breathing in post-COVID-19 patients 4
- Dornase alfa, a mucolytic agent, may be used to reduce the viscosity of mucopurulent secretions in mechanically ventilated COVID-19 patients 5
- Albuterol, a bronchodilator, may be co-administered with dornase alfa to increase delivery to the alveoli 5