Breathing exercises for long COVID breathlessness

Why breathlessness lingers after COVID

Breathlessness is one of the most common symptoms of long COVID. Sometimes there is an underlying problem in the lungs, heart or blood vessels that needs treatment, so it is important to be checked. But often tests come back normal, and the problem is partly in how you breathe. After a frightening illness, many people slip into a faster, shallower pattern from the top of the chest, which is tiring and leaves you feeling short of air. In a Swiss study of 51 people with long COVID and persistent breathlessness, exercise testing found this kind of breathing pattern problem in about three in ten, mostly younger people who had had a milder infection.

Breathing exercises target that pattern. They are one part of NHS long COVID care, alongside managing fatigue and other symptoms.

Exercises to start with

1. Breathing control: gentle, relaxed breathing low into your tummy. Practise for a few minutes, several times a day, sitting or lying.
2. Pursed-lip breathing: when you feel breathless, and during activity.
3. Positions that ease breathlessness: to recover.
4. Humming breath: a long, steady out-breath. The ENO Breathe programme used singing and humming techniques.

Keep the breaths soft and slow. Avoid fast breathing methods and long breath-holds while you are recovering.

What the research shows

The main trial is ENO Breathe, run by the English National Opera with Imperial College London. It recruited 150 adults with ongoing breathlessness referred by 51 UK long COVID clinics. Half took part in a six-week online programme of breathing retraining using singing techniques; half had usual care. The programme improved the mental health part of a quality-of-life measure and reduced breathlessness while running, but didn’t change the physical health score or other breathlessness measures.

That is one trial of one programme, so we grade the evidence as weak. It suggests breathing retraining can help, especially with how breathlessness feels and how people cope.

Pace yourself

Many people with long COVID find that doing too much on a good day leaves them much worse a day or two later. Keep breathing practice short at first, build up slowly, and rest before you are exhausted. If physical activity makes your symptoms worse, tell your GP or long COVID team.

When to get help

See your GP if you are still breathless several weeks after COVID-19, or it is getting worse, so they can look for treatable causes. The NHS calls it long COVID when symptoms last longer than 12 weeks. Call 999 if you have sudden or severe breathlessness, chest pain, coughing up blood or blue or grey lips. A blood clot in the lung can cause sudden breathlessness and needs urgent treatment. See breathlessness: when to get help.