Struggling with shortness of breath after a COVID-19 infection? You are not alone.
Here’s what you need to know about the signs of long COVID and what you can do to manage the symptoms.
When Kelly Soh*, 35, recovered from COVID-19, she thought everything would go back to normal. "A week later, I was still having chesty coughs and experienced my worst asthma attack in years. I had to go to the hospital for the nebuliser three times in a month," she recounts.
"Before I got COVID, I was running and cycling three to four times a week. After recovering, I was always feeling lethargic. I was only able to engage in light exercises after I stopped my asthma medication. It took me almost four months to recover. To me, the lingering effects are worse than when I had to isolate after testing positive," she muses.
It was the same for Jeannie Teh*, 47, who still experienced post-infection symptoms two months after recovering from COVID-19. "I had sinus block, persistent cough, and my allergies were flaring up. I'm not asthmatic but I had to use a doctor-prescribed inhalant to clear my congested airway," she shares.
What seemed like regular activities, such as walking out for lunch, would leave them breathless. Both felt that their airways have gotten extra sensitive and reactive post-COVID. "I never had a problem with dust or fur before but these days, slight exposure gives me a blocked nose," explains Jeannie.
A study led by the National Centre for Infectious Diseases (NCID) showed that one in 10 recovered COVID-19 patients had persistent symptoms, such as lingering shortness of breath and cough, six months after infection. These symptoms are part of a post-infection condition doctors are calling 'long COVID'.
"Fortunately, most symptoms usually resolve and improve with time," assures Dr Poh Kai Chin, Consultant, Department of Respiratory Medicine at SKH. But the recovery period varies between individuals. For example, some patients may experience shortness of breath for up to a year, while some may recover within six months. Most post-infection coughs usually resolve in two to three months.
Pulmonary rehabilitation, if applied early, can also help with faster functional recovery for some patients. This includes specific exercise training and breathing exercises.
Dr Poh advises that people who have persistent symptoms for more than two months or develop new or worsening symptoms after recovery should seek medical advice.
*Names have been changed.
1. Why do some people develop long-COVID?
Around the world, experts are still learning about COVID-19 as it is a relatively new disease. Researchers have reported that long-COVID is challenging to study as it is not clearly defined, having been linked to more than 200 symptoms of varying severity and duration. Also, the duration and intensity differ from person to person. More research needs to be done to understand why some patients face ongoing symptoms and what can be done about it.
2. How can I differentiate between COVID-related symptoms and those of other health conditions?
Post-COVID or long-COVID symptoms may not just involve the respiratory system. There have been reports of mood or psychiatric changes, discomfort, lethargy, numbness and weakness being linked to COVID-19. In most cases, post-COVID symptoms improve with time.
If symptoms worsen or persist months after the infection, it is best to seek further evaluation by a medical professional. An initial consultation can be with a general practitioner (GP) or a polyclinic doctor. The doctor can run a variety of tests, with the most basic used to evaluate the respiratory system being a chest X-ray if the GP provides radiology services.
3. What causes these symptoms?
There are many different possible causes for symptoms that we commonly associate with the respiratory system. For some, the symptoms could mean other ailments. An example will be the sensation of shortness of breath. Patients can feel short of breath due to many reasons – ranging from mood disorders (anxiety, fear, etc), low levels of oxygen in the blood, or due to an increased level of blood carbon dioxide.
For patients who had severe COVID-19, some can become very physically deconditioned or develop lung scarring, which leads to lower levels of oxygen and shortness of breath on exertion.
Coughing, on the other hand, is part of a reflex response to irritation in the respiratory tract. The irritation can be present in the nose, throat, airways and lungs. Patients who have just recovered from a respiratory illness, such as COVID-19, can have an exaggerated cough reflex. This is because their respiratory tract is recovering from inflammation and is more sensitive to external stimuli.
4. If I have an existing respiratory condition like asthma, how does COVID-19 aggravate it?
COVID-19 is predominantly a respiratory illness and people with pre-existing respiratory diseases are at increased risk of developing severe disease and complications. Common respiratory diseases in Singapore are asthma, pneumonia, chronic obstructive pulmonary disease (COPD) and lung fibrosis. During the period of acute COVID infection, some people may also develop a secondary bacteria pneumonia, although this is uncommon. In rare cases, those with severe COVID-19 may also develop lung fibrosis, whereby their lungs become chronically damaged and scarred.
Patients with COVID-19 should look out for low oxygen levels, prolonged fevers (lasting more than a week), or respiratory symptoms that persist for more than four weeks after recovery. To check your oxygen level, you may use a portable pulse oximeter. Most households in Singapore would have received an oximeter given out by the government as part of a COVID-19 package. It can also be purchased from pharmacies.
According to the World Health Organization, an oxygen level between 95 to 100% is normal. Levels under 94% should be evaluated by a doctor, while levels below 90% are considered an emergency and require immediate medical attention.
5. What are your top tips for managing post-infection symptoms?
We generally advise COVID-19 patients to start physical activities two weeks after contracting the disease.
Being breathless does not mean you should stay in bed, so avoid prolonged bed rest and start engaging in social and physical activities as soon as possible. Start slow by going on walks and performing static exercises, and if you can endure these, gradually build up to higher-intensity cardiovascular activities. But keep in mind that some people may take up to a year to regain their initial level of fitness post-infection.
Consider lying flat on your stomach, or prone, which can help breathlessness.
Lying on your side propped up by pillows to support your head and neck.
Sit at a table, lean forward from the waist with your head resting on a pillow placed on the table.
Adapted information from World Health Organisation's self-management of COVID-19-related illness (second edition) leaflet.
This technique will help you to relax and control your breathing.
This is useful to practise when carrying out activities that might take more effort or make you breathless, like climbing the stairs.
Post-infection coughs can last for a month or two. A chronic cough lasts for more than eight weeks. Common causes include allergic rhinitis, post-nasal drip, asthma, acid reflux and smoking-related conditions, such as COPD. If you have a cough lasting more than four weeks, please consult a GP or go the nearest polyclinic.
To manage a nagging cough, coughing out excessive phlegm and drinking more warm water can help to ease it. Those with existing conditions, like asthma, might be more sensitive to triggers, such as cold water or cold air which can worsen coughing episodes.
Smoking greatly increases the risk and severity of all respiratory conditions, especially COPD, so if you are a smoker, stop smoking. Smoking can irreversibly damage the lungs and cause long-term impairment of lung function. Because of the impaired healing process, smokers also take a longer time to recover from an injury or infection.
Lastly, keep up to date with vaccinations. According to NCID, those who are fully vaccinated are much less likely to develop post-COVID symptoms, and if they do, symptoms tend to be less severe.
At the same time, we clear the air to debunk several common misconceptions about respiratory diseases.
Respiratory diseases, especially COPD, only affects smokers.
Truth: While most cases of COPD are caused by smoking, some patients who develop it have never smoked. COPD can also be caused by long term exposure to second-hand smoke, air pollution, dust, fumes and chemicals. In rare cases, if can be caused by an enzyme deficiency.
Patients with respiratory diseases should avoid exercise.
Truth: Exercise is beneficial to everyone as it improves cardiovascular health and respiratory muscle strength — both of which are immensely important in helping patients with respiratory diseases manage their conditions and live healthy, active lives. Consult your physician if you need medication to control your symptoms while exercising.
Asthma is a childhood disease and I'll outgrow it.
Truth: Asthma can be diagnosed in all age groups. You can even develop it as an adult despite not having it when you were younger. While it is true that many children outgrow the condition, about half will continue to have symptoms as adults.
Pneumonia only affects older people.
Truth: Pneumonia can affect infants as well as seniors although elderly patients over 65 are at higher risk. Seniors are more likely to develop infections and complications as their immunity is lower and they often have other underlying conditions.
Face masks can impair breathing for patients with respiratory conditions.
Truth: Wearing a mask does not restrict breathing and does not mean you are taking in less oxygen. Masks also do not affect air intake for patients living with respiratory conditions. In fact, it can help minimise the likelihood of contracting infections like the flu or pneumonia, which can have adverse effects on them.
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