Breathlessness in Long Covid

As you know I have post Covid-19 Postural Orthostatic Tachycardia Syndrome (POTS). This is associated with Dysfunctional Breathing (DB). I have seen several experts recently who insist my shortness of breath is due to my POTS however when they come to examine me I display no signs of DB - I breath through my nose, I use my diaphragm, I can hold my breath* - and yet despite what they are seeing in front of them, and because they don't know enough to seek an alternative diagnosis, I think I will always remain with a diagnosis of DB and no further investigations or therapies offered.

* a very different story after my first infection when my breathing was very very dysfunctional - mouth breathing, sighing, unable to hold my breath for more than 7 seconds, using my upper chest muscles, unable to speak a full sentence.

My current issue is the shortness of breath I have on exertion. Going up the stairs, speaking more than a few sentences, walking on the flat and when I swim. I am not unfit ( I get my daily steps in, I swim 3 times a week, I am probably doing more exercise than was able when I was working) and yet a few seconds in I am panting and out of breath. This has not changed since my first infection in March 2020. This is exercise intolerance. I have a feeling that it is more than just DB and over the next few weeks I am going to bring you some current theories into Long Covid breathlessness. Monique at @coronadiary has kindly allowed me to use her fabulous artwork to highlight these blogs.

First up an article in Medscape March 2022 by Dr Rob Hicks "Dampening Immune Response May Resolve Post-COVID Breathlessness".

Persistent breathlessness is reported by more than 50% of patients recovering from COVID-19. Now researchers have suggested that this may be due to long-lasting immune activity in the airways, raising the possibility of finding ways to overcome the problem.

In their study, published in Immunity, researchers from Imperial College London’s National Heart and Lung Institute (NHL) looked directly at which immune cells are active in the lungs following COVID-19 infection. They found that COVID-19 causes a prolonged change to the airway immune landscape in those with persistent lung disease.

For their research they studied 38 post-COVID-19 infection patients undergoing bronchoscopy 3-6 months after they left hospital for the investigation of persistent respiratory abnormalities. They compared this group with 29 healthy volunteers who had no underlying diseases and who had not had COVID-19, assessing lung CT scans and lung function, and analysing lung fluid samples and blood samples.

Persistent Immune Response in Lungs

The authors said that at 3-6 months after infection, there was no difference in the immune cells seen in the blood of the post-COVID-19 and the healthy participants. However, there were more immune cells in the lungs of the post-COVID-19 participants than in the healthy controls.

Joint lead author, Dr James Harker, from the NHL, said:

"Our study found that many months after SARS-CoV-2 infection, there were still abnormal immune cells in the airways of patients with persistent breathlessness. We also identified a protein 'signature' in the lungs indicating ongoing injury to the airways."

All post-COVID-19 patients tended to have higher levels of immune cells linked to cell death, epithelial damage and tissue repair, the authors said, adding that there also appeared to be distinct roles for the different immune cells in the lungs. For example, higher numbers of cytotoxic T cells led to damage to the lung tissue and greater airway dysfunction, while having more B cells was associated with greater signs of lung abnormalities on CT scans, such as scarring and physical changes in the lung tissue.

Joint senior author, Professor Pallav Shah, also from the NHL, said:

"These findings suggest that persistent breathlessness in our group of COVID-19 patients is being caused by failure to turn off the immune response, which leads to airway inflammation and injury."

Possible Improvement Over Time

Co-author, Dr Bavithra Vijayakumar, from the NHL, explained that other research has found that the immediate response to COVID-19 involves an uptick in various types of immune cells in the blood and in the lungs to fight the virus.

"For severe infections, like those seen in our study participants, there also tends to be heightened signs of inflammation. However, after 3-6 months, it appears that these signs in the blood return to normal, while those in the lungs take longer to resolve."

The researchers also investigated whether symptoms and lung immune system findings improved over time by re-assessing 17 of the post-COVID-19 participants a year after they had left hospital. They found that by then, 14 participants had improvements in their symptoms and fewer lung abnormalities on CT scans. The other three participants still showed lung abnormalities on CT scans, however, there was a reduction in the numbers of immune cells present in their airways compared with earlier assessments. This suggests that these immune responses may improve over time, said the researchers.

Dr Vijayakumar said:

"Our finding that the immune response in the blood doesn’t appear to match that of the lungs emphasises the importance of assessing airway immunity in order to better understand persistent respiratory symptoms post COVID-19."

Dampening Down Immune System May Help

The authors note some limitations of their study, pointing out that participants had severe COVID-19 disease requiring hospitalisation and ongoing monitoring, meaning it was unclear if their results would apply to people with less severe disease. They also explained how they were only able to study the participants’ lungs after COVID-19, so couldn’t rule out if signs they discovered were present before infection.

While their findings needed to be confirmed by a larger study, the researchers said that recovery from COVID-19 might be accelerated by treatments to dampen the immune system and reduce inflammation.

Professor Shah said:

"The next steps of our research will be to see if there are treatments that can reduce the immune activity and whether they help to reduce the persistent breathlessness some patients experience."


I wonder what happens when you have 5 acute Covid-19 infections over 2 years? Do your lungs ever recover? Of course it is very unlikely that any of us will be tested like this, we will have to rely on bigger studies. However we can help ourselves by reducing inflammation generally and I refer you to Dr Jockers Top 12 Immune Support Strategies to Thrive in Life.

Bromelain, a pineapple extract, is also good at reducing lung inflammation something I always use during and after an acute infection - Naturally Natural Bromelain 90 Vegan Capsules High Dose 2400gdu per Serving, Pure Formulation for Inflammation, Swelling and Digestion


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