What to know about COVID-19 and shortness of breath

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People experience shortness of breath differently. As experts observe, the sensation is subjective and can range in intensity.

Some people describe feeling always out of breath. Others feel as if they cannot breathe deeply enough or take satisfying breaths.

When it is severe, the issue can cause a person to continually gasp or struggle to catch their breath.

A person may also feel tightness in their chest, especially when trying to inhale or exhale fully.

These symptoms may occur during physical activity, though they can be present during periods of rest, as well.

COVID-19 can cause a wide range of symptoms. The World Health Organization (WHO) report that the most common are a fever, a dry cough, and fatigue.

The Centers for Disease Control and Prevention (CDC) observe that many people with COVID-19 experience:

• a fever
• chills
• a cough
• muscle aches
• headaches
• a sore throat
• congestion or a runny nose
• shortness of breath or other difficulties breathing
• a loss of taste or smell
• nausea, sometimes with vomiting
• diarrhea

The CDC say that the most common symptoms of cases that do not require hospital care are: fatigue, headaches, and muscle aches.

If a person has digestive symptoms, these may occur before other symptoms, such as respiratory ones.

The CDC also note that a loss of taste or smell is present in up to 33% of people with COVID-19 and that it is especially common in females and younger or middle-aged people.

Among people who require hospital care for COVID-19, the European Centre for Disease Prevention and Control say that the five most common symptoms include:

• a history of fever
• shortness of breath
• a cough
• general fatigue
• confusion

In severe cases requiring emergency attention, shortness of breath may occur with:

• persistent pain or tightness in the chest
• confusion
• a high fever
• loss of speech or movement
• difficulty waking or staying awake
• pale or bluish lips, face, or nails

Overall, it is important to keep in mind that COVID-19 can present atypically and that the symptoms can vary greatly from person to person.

COVID-19 symptoms may appear 2–14 days after exposure to SARS-CoV-2.

The incubation period, the amount of time between exposure to the virus and developing symptoms, is up to 14 days. But many people begin to experience symptoms within 4–5 days.

Some research indicates that difficulty breathing occurs, on average, 5 days after the first COVID-19 symptom appears, in people who require hospital care for the disease.

Shortness of breath, like some other COVID-19 symptoms, occurs because of how the disease affects the lungs.

Normally, the lungs take in oxygen with each breath and tiny air sacs called alveoli capture this oxygen and transfer it to nearby blood vessels. In this way, oxygen enters the bloodstream and reaches the rest of the body. The alveoli also absorb carbon dioxide from the blood, and this is exhaled.

When SARS-CoV-2 infects lung tissue, it spreads rapidly and may affect the epithelial cells lining the airways. The immune system responds by releasing cells that cause inflammation in the affected tissues.

When this inflammatory immune response continues to happen, it inhibits the regular transfer of gases, including oxygen, in the lungs, and fluid can build up.

These factors combined can make it difficult to breathe.

Each person with COVID-19 experiences it differently — and not all breathing issues mean that the disease is serious.

Shortness of breath may be mild, similar to that resulting from a cold or the flu. In this case, it is important to stay home and rest.

If any breathing issue seems serious, especially if it rapidly worsens, seek medical attention. Some signs that this is necessary include:

• needing to pant or catch the breath constantly
• being unable to fill the lungs with air
• having pain in the chest while breathing
• having pain while holding the breath or being unable to do so
• coughing while inhaling

These may indicate a more severe infection that requires treatment in a hospital.

A person may need emergency treatment if they:

• have trouble breathing
• feel persistent pressure or pain in the chest
• have a pale or bluish tint to their lips, face, or nails
• demonstrate confusion
• find it difficult to wake up or stay awake

Therapies for severe cases

A person with severe COVID-19 may need supplemental oxygen or mechanical ventilation. The latter involves inserting a tube into a person’s windpipe. The tube is connected to a machine called a ventilator that helps the person breathe.

Other treatments aim to help control the infection and address problems involving the blood and the functioning of other organs.

The American Lung Association say that doing breathing exercises can help make the lungs work more efficiently. This may help a person with a mild case of COVID-19 that causes shortness of breath.

Here are a few strategies to try:

Pursed-lip breathing

This involves breathing deliberately and slowly. Inhale through the nose and exhale slowly through pursed lips. Aim for each exhale to take at least twice as long as each inhale.

Belly breathing

This involves actively engaging the belly and diaphragm while breathing, and it may help strengthen the diaphragm.

Breathe in through the nose. Try placing the hands on the belly to feel how it extends. Exhale slowly through the mouth, so that the exhalation lasts two to three times as long as the inhalation.

It is best to start practicing belly or pursed-lip breathing when the person can breathe most comfortably, such as while resting.

Lying on the front

Lying in a prone position, on the stomach with the head turned to one side, while resting may help relieve shortness of breath. This position can reduce the weight of the other organs on the lungs and the pressure from gravity, helping the lungs expand.

A prone position may particularly help people who have acute respiratory distress syndrome (ARDS), which can be a COVID-19 complication. ARDS involves serious issues such as the lungs filling with fluid and difficulty taking in enough oxygen, and it can be life threatening.

It is important to monitor shortness of breath, as it may be mild initially but become severe and require emergency medical attention.

Severe shortness of breath may be a sign of continuing damage in the lungs. This can lead to ARDS and the need for more intensive intervention, such as mechanical ventilation.

ARDS may develop in about 3–17% of people with COVID-19. The CDC note that the average time between the onset of the illness and the complication, ARDS, is 8–12 days.

After recovering from the initial infection, some people continue to experience COVID-19 symptoms for weeks or months. This is called long COVID, and it may involve shortness of breath.

An analysis from February 2021 indicates that about 20% of people who tested positive for the infection had symptoms after 5 weeks, and about 10% had symptoms after 12 weeks. In others, the symptoms may last 6 months or longer.

The extended effects of long COVID are still unclear, and ongoing monitoring, with checkups and blood tests, is key.

Doctors may recommend treatments and therapies to reduce the symptoms. This may include pulmonary rehabilitation and breathing exercises.

COVID-19 is not the only cause of shortness of breath. Other issues that may cause this and similar symptoms include:

• high-intensity workouts
• high levels of stress or anxiety
• asthma, chronic obstructive pulmonary disease, or another type of lung disease
• other infections, such as a cold or the flu

The virus responsible for COVID-19 can infect the lungs, causing shortness of breath and other symptoms.

Shortness of breath can be mild, requiring home care, or severe, requiring treatment in a hospital.

If this symptom is serious or suddenly gets worse, seek medical attention right away.