If you have experienced symptoms of COVID-19, you likely felt the effects it has on your ability to breathe easily. You may have been short of breath, coughing a lot, and in more severe cases, required oxygen supplementation or mechanical ventilation. After recovering from the virus, you may notice that you are still short of breath. Many people report experiencing this breathlessness long after fighting off the virus.
How does COVID-19 affect your breathing?
Medically / Physiologically
The virus spreads through the respiratory tract (nose, throat, lungs) and infects cells. In response, the body’s immune system fights back, which involves airways becoming inflamed, resulting in sore throat, cough and breathlessness. If the infection progresses into the lower airways of the lungs, it may cause pneumonia and/or Acute Respiratory Distress Syndrome, meaning that the little air sacs (alveoli) deep in the lungs become inflamed and filled with fluid. The air sacs are where oxygen that we breathe is supposed to move into our bloodstream to be sent all over the body. However, when the air sacs are inflamed and filled with fluid, oxygen cannot properly move between the lungs and the bloodstream, causing further breathlessness.
After the acute infection has passed, breathlessness may persist due to lung damage, heart damage, and/or dysautonomia. Dysautonomia is an umbrella term for conditions involving dysfunction of the autonomic nervous system, which regulates heart rate, blood pressure, breathing, and other bodily functions.
Typically, we breathe by using a large dome-shaped muscle below our lungs and rib cage, which is called the diaphragm. To inhale, the diaphragm descends, creating a vacuum effect above it, which pulls air into our lungs. “Diaphragmatic breathing” is a relaxed form of breathing and allows the belly to rise and fall as we breathe. In contrast, when we are short of breath and/or feel distressed, our body responds by activating all muscles that can help us take a breath. These muscles are called the accessory muscles of breathing. They are smaller muscles typically involved in the movement of our head, neck, and shoulders but are now recruited as breathing muscles to pull the chest open to allow air to enter. This breathing pattern, known as “apical breathing,” is a distressed form of breathing that involves the chest and shoulders rising as we take a deep breath. Apical breathing is how many people breathe during and after recovering from COVID-19. Despite the body no longer being infected with the virus, the body gets used to functioning this way, and we continue to breathe in an apical, distressed manner. Further, if one has changes in their heart or lung function or has dysautonomia after having COVID-19, these can all contribute to continued shortness of breath. The body may compensate with apical breathing in response to this shortness of breath.
Why is apical breathing not healthy in the long term?
Breathing in an apical manner can lead to neck and shoulder problems and does not allow the deep parts of our lungs (air sacs/alveoli) to fill properly with air. It also makes the body feel as though it is still in a dangerous situation, keeping the sympathetic / fight or flight mode activated, during which our heart rate and blood pressure are raised.
How can we help you with your breathing pattern?
During the ReCOVery program, we will help you breathe in a healthy manner again. Through specialized exercises and cues from your physiotherapist, you will relearn to breathe using the diaphragm instead of the accessory muscles of breathing.
While challenging at first, it will help you feel less short of breath in time. Diaphragmatic breathing will allow you to fill the deep parts of your lungs with air, improve oxygenation of the entire body, put less strain on the heart, and may also reduce stress and anxiety.
If you want to discuss your breathing further, please reach out to Bella at Pro Motion Physiotherapy.
We look forward to helping you in your recovery!
Written by Bella Levi, Registered Physiotherapist