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Breathlessness is the second most common symptom reported in Long COVID. Breathlessness post COVID can be caused by several possible mechanisms including changes in autonomic regulation, stress and anxiety, fatigue, weight gain, reduced physical activity due to length of time being unwell and breathing pattern disorders. Please note this is not an exhaustive list.

When you are unwell with COVID-19 this can result in a change in your breathing pattern in the acute phase. For most people this will return to normal post infection however for some this does not happen. This new heightened awareness of breathing becomes the new normal and does not return to your previous level. This is known as a breathing pattern disorder.

Heightened sensations of breathlessness can be worrying, difficult to understand and different for everyone. You may feel as if you are short of breath more easily, chest tightness or feeling as though you are unable to get enough air into your lungs.

Common signs and symptoms of a Breathing Pattern Disorder (BPD) include:

Frequent sighing and yawning

Feeling breathless, at rest or after minor exercise

Feeling exhausted and unable to concentrate Difficulty co-ordinating breathing and talking/eating
Disturbed sleep Erratic heartbeats/Palpitations
Breathless when feeling anxious or upset
Pins and needles in hands/arms around mouth
Feeling lightheaded Chest pain
Feeling unable to get enough air in Chest tightness

What is a normal breathing pattern?

When resting and sitting comfortably your breathing should be:

  • Silent and air should pass in and out through your nose.
  • Originate from your tummy and not from the top of your chest.
  • Comfortable and slow with a breathing rate of between 8-12 breaths a minute.

Improving your breathing pattern

You may be encouraged to undertake breathing pattern retraining this starts with breathing control. This may be completed in a lying position or seated position to begin with as directed by your physiotherapist.

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Completing breathing control at rest:

  1. Place one hand on your chest and one hand on your tummy just below your rib cage or bra line.
  2. Make sure you are breathing in and out through your nose.
  3. With each breath in feel your tummy lift and with each breath out feel it relax back down. Make sure your upper chest is still when you are breathing.
  4. If you can feel both your tummy and upper chest rising and falling with each breath, try making your breaths smaller.
  5. After each breath out ensure there is a slight and natural pause before the next breath in.
  6. Your breathing should be silent- if you can hear your breathing, slow down your breaths in and out to obtain a silent breath.

Whilst completing breathing control initially you may feel an urge to take a deep breath, sigh or yawn. This is known as air hunger. Ideally you will resist this urge which will become easier over time and with practise.

The aim is to complete breathing control for five minutes four times per day. This is known as habit formation and will likely result in changes to your breathing at rest.

We have created some videos explaining how to complete this exercise in both lying and sitting positions. Please see the link below to the UCLH website.

Once you can complete breathing control in sitting for five minutes with no air hunger, you can consider practising breathing control on walking. When walking at a gentle pace on the flat, you should be able to maintain a nose in, nose out breathing pattern.

Page last updated: 07 May 2024

Review due: 01 November 2025