Breathlessness
Breathlessness is a normal response to being active, but it is also normal to experience when doing simpler tasks after having a lung infection. It is important that you don’t avoid activities that make you breathless, but you should use how breathless you feel to guide how much activity you do. If you are too breathless to speak, slow down until your breathing improves. Try not to not get so breathless that you have to stop immediately, remember to pace your activities.
The breathlessness scale below can be used to help measure this. It describes how much effort your breathing feels. When you are being active or exercising in the first 6-8 weeks after being unwell, you should aim to keep your breathlessness score at or below 3.
Shortness of breath modified BORG dyspnea scale
- 0 = nothing at all
- 0.5 = extremely slight
- 1 = very slight
- 2 = slight
- 3 = moderate
- 4 = somewhat severe
- 5 = severe
- 6
- 7 = very severe
- 8
- 9 = extremely severe
- 10 = maximal
Tips for managing breathlessness
When you feel short of breath there are several positions that might help you to get control of your breathing with minimum effort. These positions below help your upper chest relax and allow your lower chest expand. These positions are called positions of ease.
Psychological management
The main symptoms of COVID-19 include fever (37.8ºC or above), cough or chest tightness, and breathing difficulties. If we are feeling stressed or panic about our breathlessness a vicious cycle occurs which leads to further tension and worse breathlessness. The feeling of breathlessness can be distressing. It can impact on the way we think, the way we breathe and our ability to function. What we are thinking about and stress itself can make breathlessness worse.
Stress makes breathlessness worse as it activates the ‘fight or flight’ response where it recognises you are feeling anxious. The brain will speed up breathing and make the heart pump faster. This can make us feel breathless, hot, sweaty and shaky.
A vicious cycle can occur where worry and stress can lead to panic, and the body reacts to the panic with more breathlessness. It is possible to slowly manage breathlessness by managing stress, using good breathing techniques and postures.
Positioning
Any of the following positions will assist relaxation of the upper chest while encouraging use of the lower chest. Breathe at the rate at which you feel comfortable, as quickly as necessary but gently. As control is gained you will be able to slow down the rate of your breathing. Try adopting one of these positions between exercises, to recover. Try to make sure your hands are loose and relaxed.
- Sit leaning forward, with your elbows resting on your knees, or on a table.
- You could also lean forwards onto a windowsill or worktop if you are standing.
- Stand leaning backwards onto a wall, whilst letting your arms and hands relax.
Breathing Control
Below is a technique for reducing the effort of breathing. It is helpful when you are short of breath or feeling anxious.
How do I do it?
- Get into a comfortable position with your arms supported.
- Closing your eyes may help.
- Breathe in gently through your nose, then purse your lips as though you were going to blow out a candle or whistle.
- Breathe out with your lips in this pursed position.
- Breathe out a little longer than you breathe in but only for as long as is comfortable; do not force your lungs to empty.
- Try to use as little effort as possible and make your breaths slow, relaxed and smooth.
- With each breath out, try to let go of any tension in your body.
- Gradually try to make your breaths slower. Do not force your breath.
Watch this video for a demonstration of breathing techniques
Blow-as-you-go
This helps make tasks and activities easier, use it while you’re doing something that makes you breathless.
How do I do it?
Breathe in before you make the effort. Then breathe out while you’re making the effort. For example, when standing up, breathe in before you stand up, and then blow out as you stand up. Try using pursed-lips as you blow out.
Using a fan
The cold draught from a hand held fan can reduce the feeling of breathlessness.
How do I do it?
Do this alone as it can spread air particles. Other people should avoid the room for at least 20 minutes after you have stopped using the fan.
Hold the fan approximately 15cm from your face. Aim the draught of air towards your face, moving the fan slowly from side to side so that the air hits your nose, mouth and sides of your cheeks. A cool flannel to the face and opening windows may also help
There are also lots of resources and information available from the British Lung Foundation (opens in new tab) with various leaflets and booklets available on the British Lung Foundation information page (opens in new tab).
Managing your thoughts
Breathlessness can be frightening, and this anxiety can make us think negative thoughts and images. Getting caught up in negative thinking patterns can increase anxiety and make breathlessness worse. If you are having lots of anxious thoughts, it may be useful to say to yourself and write down the following statements that are true for you:
- Even though I am breathless I am still breathing in oxygen.
- Stress and worry will make me even shorter of breath, relaxing will help.
- I need to practice the breathing techniques now in a good breathing position.
- This difficult time will pass.
Useful relaxation and mindfulness links
Yoga with Adriene (opens in new tab)
Get some headspace (opens in new tab)