When Rebecca caught Hale’s Covid she could hardly breathe. The former London Marathon runner gasped as she lay in bed in July 2021.
Recovery was painfully slow – it took many weeks to shake off her high temperature and sore throat, and her breathing problems continued.
“I gasped at the slightest exertion,” says Rebecca, 55, a community nurse who lives with her husband Richard, 56, in Wantage, Oxon.
But it wasn’t until January that the problem was realised: She was diagnosed with breathing pattern disorder (BPD), essentially chronic breathlessness caused by an abnormal breathing pattern.
While BPD often affects people with chronic lung diseases such as asthma or chronic obstructive pulmonary diseases (such as emphysema) or those with anxiety disorders, it is also proving to be a major problem post-infection for many Covid sufferers.
An estimated 1.3 million people in the UK have Covid symptoms lasting more than four weeks after initial infection; 554,000 have symptoms such as shortness of breath, fatigue and brain fog after a year. An archive image is used above
Rebecca’s diagnosis came after her GP referred her to a long-running NHS Covid clinic in Oxford. She says at that point she thought it was unlikely she would “ever be able to breathe easy again – I never thought I would go back to being the fit, healthy person I was pre-Covid”.
BPD is when someone develops an abnormal breathing pattern (usually faster, shallower breathing), says Emma Tucker, a respiratory physiotherapist at the Oxfordshire Post-Covid Assessment Clinic at Churchill Hospital, who treated Rebecca.
She adds: “While shortness of breath can be part of an acute or short-term condition, in BPD it is chronic. Those affected complain of hunger for air and shortness of breath. This breathing pattern can become a habit — in some people, because when you hyperventilate you exhale more carbon dioxide than usual, carbon dioxide levels in the bloodstream drop, leading to fainting and dizzy spells.”
Emma says the number of patients she sees with BPD as part of Long Covid is “really significant and continues to rise”.
Since opening in May 2020, the clinic has treated 4,000 adults, almost a quarter of whom have had BPD.
An estimated 1.3 million people in the UK have Covid symptoms lasting more than four weeks after initial infection; 554,000 have symptoms such as shortness of breath, fatigue and brain fog after a year.
According to Emma, most report the same symptoms — feeling like you can’t get enough air, frequent yawning, and tingling in your hands, feet, and chest, which can be caused by a lack of carbon dioxide.
BPD is when someone develops an abnormal breathing pattern (usually faster, shallower breathing), says Emma Tucker, a respiratory physiotherapist at the Oxfordshire Post-Covid Assessment Clinic at Churchill Hospital, who treated Rebecca. An archive image of the lungs is shown above
“Being out of breath all the time, even when you’re resting, talking, or even eating, is incredibly scary,” says Emma.
But while BPD and Long Covid are clearly linked, it’s not yet clear how.
Unlike COPD patients, who have changes in their lungs that affect their breathing, people with long-Covid-related BPD have no physical signs that something is wrong. “Lung function tests and chest x-rays may reveal a void; they are normal,” adds Emma, co-author of the Long Covid Self-Help Guide. Despite severe breathing difficulties, “her oxygen saturation, the oxygen content in the blood, is normal”.
One theory is that the Covid virus causes the body’s autonomic nervous system (which controls our fight or flight response, as well as our heart rate and breathing) to go haywire, resulting in a faster and shallower breathing rate.
Another possibility is that it could be caused by vagus nerve dysfunction in long Covid patients, explains Dr. Mark Faghy, Associate Professor of Respiratory and Exercise Physiology at Derby University.
The vagus nerve, which runs from the brain to the colon, controls signals between the brain and organs and supports the parasympathetic nervous system (controls the body’s ability to relax).
“Essentially, the feedback from the body to the brain is jumbled up and the signals don’t match what the body is experiencing,” says Dr. Fagy. Factors like pain, stress, and anxiety can all trigger BPD, and poor posture — which changes the position of the diaphragm and makes it difficult to breathe properly — can also contribute.
watch clock
How to harness the power of your body clock. This week: Wear socks to bed
Bed socks can help us fall asleep faster by encouraging the body to cool down.
When the feet are cold, the body produces heat to warm them up; this also warms up the whole body. Wearing socks eliminates this need and allows body temperature to drop, which is necessary for falling asleep.
Cotton and linen, on the other hand, wick sweat better than artificial fabrics like polyester, which is also important for temperature regulation, says sleep expert Neil Stanley.
The underlying causes are not fully understood, but it is clear that BPD “can be a deeply distressing condition and some patients that we see are distressed,” says Dr. Fagy.
Whatever the trigger, a person with BPD is typically breathing faster than they should, using the chest and neck muscles rather than the abdomen and diaphragm, explains Rebecca Livingstone, a specialty respiratory physiotherapist in University College’s Post-Covid Service London Hospitals NHS Foundation Trust. “Normal breathing should be much slower, with relatively little air volume change in the lungs and little movement in the abdomen.”
Treatment includes managing symptoms by exploring ways to improve breathing, posture, and speech.
The most important technique to learn is breathing efficiently to ensure most of the work is done by the stomach and not the chest, says Emma Tucker.
Adds Rebecca Livingstone, “We show people what a normal breathing pattern should look like and get them to place their hands on their stomach to see where the diaphragm should be working. The most important thing is that we can help solve the problem.”
Rebecca Hales found that the virtual workshops she attended helped her retrain her breathing pattern enough to return to her day job as a kindergarten teacher.
“I still have long Covid, but my breathing is back to normal and I’m less tired,” she says.
She even started walking again – at a measured pace. “I’ve signed up for a Couch up to 5K and I’m hoping to reach that milestone in the not too distant future,” she says.