Around one in four adults who were hospitalised with covid-19 and one in six who were not hospitalised experience persistent breathing difficulties beyond four weeks after SARS-CoV-2 infection,12 and a cohort study in China demonstrated that breathlessness can persist beyond two years.3 In long covid (defined as symptoms beyond four weeks4) breathing difficulties can be the predominant feature or be part of a multisystem presentation.5 Cardiorespiratory complications after covid-19 include thromboembolic disease, interstitial lung disease, and heart failure and need to be excluded. This article predominantly focuses on other, more common causes of post-covid breathing difficulties that can be treated but are often less well understood.6
Definitive, evidence based protocols and treatment for persistent breathlessness after covid-19 are currently lacking. Until they exist, the pragmatic approach outlined here, including a careful history and examination and appropriate use of investigations, should help identify treatable conditions and improve symptoms. In particular, a positive diagnosis of breathing pattern disorder (box 2) can often be made in general practice. Self management resources (box 3) should be offered early. Timely referral to specialist services is needed for patients whose symptoms are severe or progressive.
Breathing difficulties can present in several ways, including breathlessness or pressure, tightness, soreness, and pain or burning in the chest. These symptoms can be associated with considerable distress. The general multisystem approach and investigation of …