Why am I short of breath?
It is very common for people to feel breathless when they have COVID and for a few people this can continue for many weeks and longer after their COVID illness.
You can get breathless for lots of reasons. It can be scary and make you feel anxious.
Breathlessness might stop you from doing your daily activities or you might find them more difficult.
What does breathlessness feel like in everyday life?
- Getting out of breath when you walk up and down the stairs
- Getting out of breath when you go for a walk and having to stop a lot to catch your breath
- You notice your shoulders going up and down as you breathe
- You may find yourself gripping or holding onto things tightly to help yourself feel less breathless
- Tightness in your chest
How can I manage my breathlessness?
Being breathless may make it more difficult to manage all of the daily activities that you need, and want to do. It is important to plan ahead to help you manage your daily activities whilst you continue to live with the effects of COVID.
Plan your tasks and activities and think about the best time of day to do things.
- When planning your day think about how much you can manage
- Think about your week ahead, do not plan too many things in one day
- Break down the tasks you find most difficult into smaller more manageable tasks
- Decide which tasks must be done and which you find the most difficult – spread these tasks out across the day or week and plan breaks between these tasks
Rest and pacing
- Start off doing tasks for a short time then slowly try doing them for a longer period of time – you can increase or reduce what you do depending on how you feel after each task and you should also consider how you feel the next day
- Give yourself time to relax and rest – this can help you feel in control of your breathlessness
- Try not to rush – this can make your breathlessness worse
- Take your time when you are doing a task
- Rest before you get too tired – this will help to save your energy
- Take a lot of short breaks rather than a few long breaks
- When tasks are tiring you need to think about how to do them differently
- Carry on doing things that make you feel breathless because this will make your muscles stronger – if you feel worse or your breathlessness increases, you may need to reduce the activities and your healthcare professional can advise you on this
- If you use support to walk, such as a stick or a frame, you can lean on it when you feel breathless, this can help you catch your breath
It’s important to remember: We all get breathless and short of breath when we do exercise.
Learn more about:
Remember that your breathing will be better on some days and worse on other days. If you do these breathing exercises regularly they should help your breathing to get better over time.
You can learn to have better control of your breathing when:
- You are sat resting
- You are moving around
- After you have carried out a task
How can I control my breathing?
The following exercise can help you to breathe gently with the smallest amount of effort:
- Practice when you are sitting first
- Put one hand on your chest and the other hand your stomach
- Keep your mouth closed and slowly breathe in and out through your nose
- If this is too hard, breathe in through your nose and out through your mouth
- If you’re relaxed, you will be able to take a deep breath and you will feel your stomach push out
- If you are controlling your breathing then the hand on your chest should hardly move
- When you breathe out your stomach will gently move back
- Every time you breathe out try to feel more relaxed
- Try to breathe more slowly every time you do this exercise
When you can easily do this task sitting down, try it out when you are doing your daily tasks.
Relaxation can also give you a sense of control over feelings or problems such as breathlessness. Try to give yourself time to relax and rest.
There is another breathing exercise that can help you control your breathing and relax. This is called the breathing rectangle method:
- This should be done sitting down in comfortable chair
- Look for a rectangle shape such as a door, window, picture or book
- Follow the sides of the rectangle with your eyes as you breathe in and out using the diagram below as a guide
- Gently slow the speed that your eyes move round the rectangle
- Stop at each corner to slow your breathing
When you breathe out this should be twice as long as when you breathe in.
- Try wiping a cool wet flannel over your nose and cheeks – this sometimes helps reduce the feeling of breathlessness
- It is a good idea to open windows to get fresh air
- If you have a fan at home, you can sit by an open window and have the fan near to you but do not point it directly at your face
- Focus on your daily progress and remember everyone’s recovery journey is different
- Be kind to yourself – some days will be better than others so take each day as it comes and do what you can based on how you feel each day
If I get very breathless with daily activities, what can I do?
- Choose a position to help reduce your work of breathing and effort (see images below)
- Try and support your arms rather than gripping them
- Try to stay calm, stop, relax your shoulders and use the breathing control methods above
- When walking, putting your hands in your pockets or tucking your thumbs into your belt loop or resting your hands on your handbag can help keep your shoulders from becoming tense and rising up
- If you are getting worse, increased breathlessness, or no better, then contact your healthcare professional, hospital team or GP
- If you get suddenly short of breath, especially if with chest pain seek urgent medical advice via 999/111
When my breathing isn’t normal
The way you breathe is very important for your body to work. After an illness such as COVID, your breathing pattern may have changed and this can affect your recovery.
Do you suffer with any of these symptoms?
- Breathlessness (at rest, moving around or even when you are talking)
- Fatigue and low energy levels
- Tired muscles
- Tense or twitchy muscles
- Unable to exercise
You may have other symptoms throughout your body that you may not think are anything to do with your breathing such as:
- Tingling sensations
- Heart palpitations
These symptoms can continue to make you feel worried and unwell.
Why does breathing go wrong after COVID?
Developing a chest infection like COVID may change your breathing in:
- The way you breathe
- The amount of air you breathe in and out
- How fast you breathe
As the infection improves and your lungs recover, your breathing does not always return to the ‘best way’ of breathing and the poor pattern becomes a habit. This can leave you feeling exhausted, breathless, and slows down the body’s ability to recover.
After the acute infection you may be left with a different breathing pattern to which you are completely unaware of. Other factors such as:
- Poor diet
- Poor posture
- Inactivity can prevent your breathing from returning to normal
Ongoing symptoms can be frightening and frustrating and this gets you stuck in a vicious cycle of breathlessness and poor breathing.
What is a normal breathing pattern?
- Nose breathing: do you breathe through your nose when you are resting? The nose protects the lungs by cleaning, warming and dampening the air that goes into them – breathing through your mouth can make you breathless and lead to a feeling of ‘air hunger’
- Gentle, diaphragmatic (tummy) breathing with very little upper chest movement: when there is tension in the body (such as in your shoulders, neck and hips), it is hard for the main breathing muscle (diaphragm) to work – this tension makes you breathe into your upper chest
- Breathing quietly and with little effort: can you hear yourself breathing? If you can, it might mean you are taking in too much air – sighing, yawning or clearing your throat too much are also signs of over-breathing or breathing with too much effort
- Breathing rate: a natural, healthy breathing rate at rest is usually 12 to 20 breaths per minute – breathing too fast can make you tense and stop your muscles from relaxing
What can I do?
- Try and breathe in through your nose
- If you find breathing through your nose difficult, do not worry – you may only manage 2-3 breaths at a time, that’s okay, keep practicing and it will get easier
- Aim to practice little and often, setting yourself targets to increase the number of breaths, or length of time, you can manage
- Practise breathing gently into your tummy, feeling the tummy rising and falling with each breathe coming in and out
- Make sure you breathe quietly when you are resting
- You can actively slow your breathing down which can be calming and help you to relax – the best way to slow your breathing is to add a 1-2 second pause at the end of each breath
- When you are resting, practise relaxed breathing in and out slowly and quietly through your nose and into your tummy – this can really help you to feel less breathless and less tired, and have some energy to be able to be more active again
- Remember just as breathing is essential for life, breathing well is essential for health
For more advice, please visit: www.physiotherapyforbpd.org.uk
If you continue to have issues with your breathing, then ask your healthcare professional to refer you to a respiratory physiotherapist that can help you.