A treatable nerve injury may cause persistent shortness of breath for COVID-19 long-haulers. This indicates that shortness of breath does not necessarily mean you are experiencing pulmonary problems.
Sandy, a 42-year-old previously healthy woman, presented with a history of four months of inability to have conversations or Zoom meetings without feeling out of breath.
Normal chest X-rays (CXR), and computerized chest tomography (CT), scans were taken. She had an unusual anomaly on her spirometry lung-breathing test, with flattening in the inspiratory curve.
In March 2020, she had mild COVID-19 symptoms. She was unable to be tested because she did not have access.
In July 2020, an ENT (ear, nose and throat) examination of her voice box (voice box) revealed that her vocal cords were closing abnormally during quiet breathing. They should have been open at this time. This was diagnosed as a paradoxical vocal fold movement syndrome.
The treatment included a low-acid diet and speech therapy via telemedicine. Six weeks later, Sandy could continue full conversations and lead Zoom meetings without difficulty. Her examination was also normal.
COVID-19 Long haulers and shortness of breath
Persistent shortness of breath (SOB), even after recovery from COVID-19 infection, is a frustrating and troubling symptom that affects many people.
SOB is a common symptom in people suffering from what is now known as the COVID-19 “long hauler syndrome”.[2] In Britain, it is called COVID “long”. The “long” refers not only to the fact that people may “recover” from COVID-19 but also to the possibility of persistent symptoms that defy further treatment.
Two types of COVID-19 long-haulers
- Permanent damage to the lungs, heart, kidneys or brain can impair one’s ability to function.
- People who experience persistent debilitating symptoms, despite no detectable damage.
Fauci discusses the causes of long-haul COVID-19 symptoms.
There are many theories about why persistent symptoms occur. One of the most common theories is from
Since COVID-19, a new disease, has been confirmed, there is little hope. These patients have hope because we believe that there is a treatment option.
Respiratory symptoms that persist after other viral illnesses are common among long-haul COVID-19 long-haulers.
Post-viral syndromes can present with upper respiratory symptoms similar to those experienced by people with other viral-mediated diseases.
- Mononucleosis
- A severe acute respiratory syndrome.
We treat viral infections from unknown sources in otolaryngology, ENT, where we also treat chronic cough and shortness of breath.
ENT and Allergy Associates in New York City, the largest single-specialty group for ear, nose and throat allergy doctors in the United States, started seeing patients with a persistent SOB and cough this past June.
They said that they had been very ill during the peak of the COVID-19 pandemic, which occurred in New York City between March 2019 and April 2020. We published a study with Byron Thomashow MD (one of the most prominent lung specialists or pulmonologists at Columbia University Medical Center), describing it as a TREATABLE reason for shortness of breath in these patients.
Common characteristics for our COVID-19 long-haulers
Accurate diagnosis is the key to finding the cause of the symptoms. These were the common traits of our patients:
- Fever, cough, and SOB between March 2020 and May 2020. Not severe enough to warrant hospitalization.
- We first noticed the SOB for four to twelve weeks.
- These patients were generally not awakened by the SOB. They also reported that it did not affect their exercise tolerance. They often felt breathing problems after their activity. The SOB is often brought on by talking, shouting and singing.
- Because of limited access, only a few of the patients we saw were able to get COVID-19 testing. Only a handful of those who were tested developed antibodies against COVID-19. Only one person was positive for the polymerase chain reactions test.
- All imaging, including CXR or CT scans of the chest, were unremarkable.
- Only a few patients could obtain a lung function test called spirometry. They all showed a particular pattern in the flow-volume loop, where there was flattening of the inspiratory curve. The patient was unable to take a deep breath and showed evidence of poor airflow INTO their lungs. They had a normal expiratory curve which indicated normal airflow OUT.
