- Breathing problems are not uncommon following a corona infection.
- But you shouldn’t resort to tips and exercises from the Internet, says Professor Judith Löffler-Ragg from the Medical University of Innsbruck.
- Improvement can only be achieved with the help of experts. The first point of contact is always the family doctor.
After a corona infection, many patients have persistent breathing problems. The decisive factors here are which virus variant you have been infected with, what the body’s immune response is like and the course of the disease, says Judith Löffler-Ragg, a professor at the Medical University of Innsbruck. In a moderate to severe course, the virus can be associated with pneumonia. If the course of the disease is mild, patients with persistent breathing problems may have a disorder, for example on a functional level.
In principle, shortness of breath is a threatening symptom. “Acute shortness of breath must always be clarified by a doctor, especially if it is accompanied by chest complaints or a feeling of pressure and tightness,” says the lung specialist and Secretary General of the Austrian Society for Pneumology (ÖGP). “Home remedies or standard tips from the Internet won’t help either,” warns Löffler-Ragg. “After an initial examination, the family doctor knows whether there are warning signs of acute illnesses and which experts to consult,” says Löffler-Ragg.
Sick and later short of breath: Avoid exertion
However, there is no shortness of breath if you still feel short of breath for several weeks following a “normal” cold, according to the pulmonologist. Many of these patients also find it difficult to exert themselves. “But that’s not shortness of breath,” explains the expert. These are unspecific breathing difficulties, triggered, for example, by bronchial hypersensitivity and an infection-related reduction in muscular performance, which generally occurs with infections and usually gets better and better. The patient himself should take a step back in the weeks following an infection and avoid physical exertion in order to be able to regenerate.
The regeneration following COVID-19 often lasts for weeks in many patients. However, if the symptoms are still present three months following the infection has subsided, experts speak of post-Covid syndrome. “However, the symptoms should gradually improve from week to week,” says the lung specialist. If stagnation or even deterioration occurs, experts must clarify whether an organic cause is the reason.
“It is not yet understood why many people with post-Covid syndrome have functional abnormalities such as changed breathing patterns and hyperventilate, especially when they are under stress,” says Löffler-Ragg. This is probably due to many factors. It might be disturbances in the muscle metabolism, which particularly affect the provision of energy, but disturbances in the regulation of the autonomic nervous system are also possible. Stress can also have an impact on the symptoms and should be taken into account during rehabilitation. The problem, however, is that there are no timely rehab places and the like for many long-Covid patients.
Charitè video for breathing exercises: Not suitable for every long-Covid patient
Dr. Anett Reißhauer and her team from the Charité in Berlin found out at the beginning of the Covid situation, which is why they asked Videos with special breathing exercises on the Internet.
“We had many patients for whom we issued prescriptions for respiratory therapy on an outpatient basis, but there weren’t that many free appointments in the practices,” says Reißhauer. Demand far exceeded capacity. Other patients would not even have had a therapist in their area. “So many of our prescriptions came up empty,” says Reißhauer, head of the Physical Medicine and Rehabilitation department.
That’s why she and her team produced the videos. “We wanted to compensate for this situation quickly and offer the patients something that was as uncomplicated, low-threshold and free of charge as possible.” That has worked well. “The patients are examined by us during the consultation hours and then instructed in the videos. At home they can then do the exercises independently.” As part of the post-Covid network, the videos were made known nationwide so that other doctors and patient associations can also access them.
However, these exercises are not suitable for all patients and situations. “If panic attacks have been confirmed by a doctor, the best thing to do is seek professional help that is tailored to this problem,” says Reißhauer. In addition, in the case of persistent breathing problems in the context of post-Covid, it is always important not to do such exercises without a medical examination. “You have to be listened to, X-rays taken if necessary, a lung function test carried out. All of that has to be clarified.” Because sometimes other causes would be behind the breathing problems. “But if everything is clear, you can do these breathing exercises.”
In general, the expert recommends that when doing breathing exercises from the Internet, only follow videos from expert staff such as doctors, respiratory therapists and physiotherapists. Also, you should strictly follow the instructions. “If you have the feeling that the breathing exercises won’t help you, you stop,” says Reißhauer. If breathing exercises are carried out regularly, the patient should notice improvements in himself. “If nothing changes in the problem or in the symptoms, the limit has been reached and you should consult your doctor.”
Patients can work their way up in intensity
According to the Innsbruck pulmonologist Löffler-Ragg, if patients suffer from exhaustion and fatigue syndrome in addition to breathing problems, classic training therapy is often not possible. “You have to take things slowly and you can only gradually work your way up in intensity.” A so-called “pacing” has to be learned. Occupational therapy is also very helpful. Additional psychological support is helpful if the patients also feel fear or panic. “Both increase the breathing difficulties,” says Löffler-Ragg. “A spiral develops from which the patient can no longer get out.” A form of psychological support is also important from the outset for coping with the illness and for gaining new perspectives.
If patients had severe corona courses with virus-related pneumonia and mechanical ventilation behind them, they would usually be taken from the hospital to inpatient rehabilitation. From the first week, the psychological, neurological and psychological symptoms and abnormalities would then be addressed. “This is important if, for example, the patient has suffered nerve damage from lying in the intensive care unit for a long time,” says Löffler-Ragg.
After severe corona courses, scar-like changes remain visible
In Innsbruck, Löffler-Ragg and her team followed difficult courses for up to a year. The realization: Slowly the symptoms subside. “After six months, every second patient has scar-like changes that are visible on CT,” reports the expert. “These do not change until the twelfth month.” Fortunately, most patients only have a few of these scars, which hardly cause any symptoms.
Irrespective of the residual pneumonia visible on the CT scan, more than half of those affected complain of persistent exhaustion, difficulty concentrating, insomnia and shortness of breath following a stay in the intensive care unit. According to the expert, these are similar consequences to post-Covid patients with mild courses: complex and the cause is not yet understood. “Unfortunately, there are no specific medications available for this yet,” says Löffler-Ragg. “Only experienced therapists and long-term rehabilitation lead to an improvement.”
About the experts: Prof. Dr. Judith Löffler-Ragg is Senior Physician in the Pneumology Outpatient Clinic at the University Clinic for Internal Medicine in Innsbruck.
dr Anett Reißhauer heads the Physical Medicine department at the Charité in Berlin.
A recent study has now found which symptoms occur more frequently following a corona disease than following other infections. (Image credit: picture alliance/abaca/Joly Victor)
Teaser image: © IMAGE / imagebroker
