What is the prevalence of dyspnea (shortness of breath) or shallow breathing as a complication of COVID-19, particularly in individuals with pre-existing respiratory or cardiovascular conditions?

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Last updated: January 21, 2026 • View editorial policy

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Prevalence of Shortness of Breath in COVID-19

Shortness of breath is an extremely common complication of COVID-19, occurring as one of the most frequent symptoms during acute infection and persisting in a substantial proportion of patients with long COVID.

Acute COVID-19 Phase

Prevalence in Hospitalized Patients

  • Dyspnea is present in 69.8% of COVID-19 patients and represents one of the cardinal symptoms alongside fever and cough 1.
  • Among critically ill patients requiring ICU admission, 60-70% develop acute hypoxemic respiratory failure from acute respiratory distress syndrome (ARDS), making it the most common complication 2.
  • Shortness of breath is strongly associated with disease severity, with an odds ratio of 2.43 for severe COVID-19 1, 3.

Severity Classification

  • Severe COVID-19 (occurring in 13.8-14% of cases) is specifically defined by dyspnea, respiratory rate ≥30 breaths per minute, oxygen saturation ≤93%, PaO2/FiO2 ratio <300 mmHg, and lung infiltrates >50% within 24-48 hours 2, 1.
  • The median time from symptom onset to severe hypoxemia requiring ICU admission is approximately 7-12 days 2.

Pediatric Considerations

  • In hospitalized children, shortness of breath is among the most common presenting symptoms along with fever, nausea/vomiting, and cough 2.
  • Children generally have milder presentations than adults, with up to 45% being asymptomatic 2.

Long COVID (Post-Acute COVID-19 Syndrome)

Persistent Respiratory Symptoms

  • More than one-third of COVID-19 patients develop symptoms persisting beyond 3 months after SARS-CoV-2 infection, with breathlessness being a frequently cited symptom 4.
  • Shortness of breath persists for at least 7 months in 40% of patients with long COVID, making it one of the most common long-term respiratory sequelae 2.
  • Respiratory conditions occur twice as often in COVID-19 survivors as in the general population 2.

Mechanisms of Persistent Dyspnea

  • Some patients have residual pulmonary disorders with abnormal pulmonary function tests to explain their dyspnea 5.
  • Others have dyspnea out of proportion to measurable lung function changes, with abnormal respiratory patterns referred to as dysfunctional breathing 5.
  • 90% of patients with self-assessed respiratory dysfunction at 4 months post-hospitalization had one or several objectively measured respiratory function abnormalities 6.

High-Risk Populations

Pre-existing Conditions

  • Patients with pre-existing respiratory or cardiovascular conditions face significantly worse outcomes 2, 3.
  • Respiratory disease increases the odds of critical/mortal COVID-19 by 5.15-fold (OR = 5.15,95% CI 2.51-10.57) 3.
  • Cardiovascular disease increases the odds of critical/mortal COVID-19 by 5.19-fold (OR = 5.19,95% CI 3.25-8.29) 3.
  • Patients with hypertension, diabetes, and chronic lung disease are at substantially higher risk for severe complications 2.

Age and Comorbidity Impact

  • Critically ill patients with COVID-19 are older and have more comorbidities including hypertension and diabetes compared to non-critically ill patients 2.
  • Age over 65 years increases the odds of disease progression by 6.06-fold (OR = 6.06,95% CI 3.98-9.22) 3.

Clinical Implications

Warning Signs Requiring Immediate Attention

  • Oxygen saturation ≤93-94% on room air, respiratory rate ≥30 breaths per minute, or lung infiltrates >50% require immediate escalation of care 7.
  • Severe respiratory distress, including grunting or severe chest indrawing, is a critical warning sign 7.
  • Patients may develop hypoxemia without respiratory distress, particularly elderly patients 2.

Multidimensional Assessment Needed

  • Patients with remaining respiratory symptoms may benefit from multidimensional measuring of breathing movement, thoracic expansion, and respiratory muscle strength along with traditional measurements 6.
  • Decreased thoracic expansion was observed in 62% of patients, abnormal respiratory movements in 58%, and decreased vital capacity in 40% at 4 months post-discharge 6.

Long-Term Cardiovascular Sequelae

  • A significant proportion of patients experience long-term complications 4 weeks from index infection, including chest pain, palpitations, and dyspnea related to cardiac dysfunction 2.
  • New-onset right ventricular dysfunction can result from acute pulmonary embolism or strain from ARDS and elevated pulmonary artery pressures 2.

References

1
Guideline

COVID-19 Diagnosis and Differentiation

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Dyspnea and long COVID patients.

The American journal of the medical sciences, 2024

7
Guideline

Red Flags for Severe COVID-19

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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