Management of Post-COVID Breathlessness

Initial Non-Pharmacological Interventions

• The British Medical Journal recommends initiating controlled breathing techniques, including pursed-lip breathing, upright positioning with forward lean, and breathing retraining exercises as first-line management for post-COVID patients experiencing inability to take full deep breaths 1
• Implementing pursed-lip breathing, which involves inhaling through the nose and exhaling slowly through pursed lips, relieves the perception of breathlessness in post-COVID patients 1
• Positioning the patient sitting upright increases peak ventilation and reduces airway obstruction, according to the British Medical Journal 1
• Encouraging forward-leaning posture improves ventilatory capacity in post-COVID patients 1
• Teaching shoulder relaxation reduces the hunched posture that accompanies anxiety and worsens breathlessness 1
• Referring patients for breathing retraining helps them regain a sense of control and improves respiratory muscle strength, as recommended by the British Medical Journal 1

When to Consider Pharmacological Management

• The European Respiratory Society suggests that low-dose opioids may be considered for patients with serious COVID-19 and distressing breathlessness despite optimal treatment of underlying causes, with morphine sulfate immediate-release 2.5-5 mg every 2-4 hours as needed 2
• The use of low-dose opioids for palliative treatment of distressing breathlessness in post-COVID patients is based on palliative care experience rather than specific COVID-19 trials, and should be used cautiously with careful consideration of individual circumstances and risk of adverse effects, as noted by the European Respiratory Journal 2

Common Pitfalls to Avoid

• Severe breathlessness often causes anxiety, which then increases breathlessness further, creating a vicious cycle that breathing techniques specifically address, according to the British Medical Journal 1