Breathlessness and coughing

When you have a virus your breathing pattern can change, and you can become breathless. Breathlessness is when you are short of breath or have difficulty breathing, and it can be frightening. This can be hard to manage. It can be a common symptom when you recover from coronavirus (COVID-19). 

You might still have a cough. Coughing is useful to help clear phlegm from your lungs. Too much coughing can be tiring, and lead to irritation and inflammation, which could make your cough worse.

There are exercises to help re-establish a good breathing pattern, and manage breathlessness and coughing. 

If you feel that your breathing is getting worse, or you have new breathlessness after COVID-19, it's important to get medical advice.

You can watch our film about breathing techniques and other tips to help you recover.

Managing breathlessness

Here are some tips that might help you manage your breathlessness.

• Avoid holding your breath during activities, such as climbing stairs or bending. 
• Try to ‘blow as you go’. This means breathing out when you do something that involves an effort.  Examples are bending, lifting, reaching or standing up from a chair.
• Try and pace yourself and avoid rushing.
• Match the rhythm of your breathing to your steps. For example, when climbing stairs, breathe in on one step and out on the next.
• Sometimes, it can help to point a fan towards your mouth and nose. This can reduce feelings of breathlessness.

Positions to help breathlessness

There are positions that can help to ease breathlessness at rest and after activity.

These positions place your arms so that the breathing accessory muscles are in a better position to help with breathing. Leaning forward might also improve the movement of your diaphragm. This is the main muscle that you use when you breathe.

• Position 1. Lie down on your side, on a bed. Make sure that you are fully on your side. Resting your upper arm on a pillow in front of you might help.
• Position 2. Sit on a chair with a table in front of you. Put pillows or cushions onto the table, stacked to a comfortable height for you. Relax your head down onto the pillows as much as possible. It might help to keep your legs apart.

You can try different positions and change them until you find what works best for you. Only do the positions that feel comfortable for you. 

Breathing when you are active

Try to breathe in through your nose and out through your mouth. If this gets too hard, try breathing in and out of your mouth, but keep shoulders relaxed and focus on the out breath.

When you stop and have recovered, return to nose breathing when it's comfortable.

Positions after you've been active

These are positions that might help with breathlessness after you have been active.

With all the positions, try to relax your hands, wrists, shoulders, neck and jaw as much as possible. Only do the positions that feel comfortable for you. 

• Position 1. Sit on a chair with your legs apart. Lean forward, resting the lower part of your arms on your thighs.
• Position 2. Keeping a straight back, lean your back against a wall. Keep your feet shoulder-width apart and a short distance from the wall, with your knees slightly bent.
• Position 3. Stand with your feet shoulder-width apart. Put your hands on your hips. 
• Position 4. Sit on a chair with a table in front of you. Keep your legs apart and rest the lower part of your arms down onto the table. 

You can experiment with your arm positions. Does your breathing feel easier with your hands behind your head or back?

Relaxed breathing

Relaxed breathing is moving air in and out of your lungs with the least effort, using the right muscles.

Doing this exercise often (several times every day) will help you to use your diaphragm when breathing, and re-establish a good breathing pattern.

You can visit the Physiotherapy for breathing pattern disorders website for more information, www.physiotherapyforbpd.org.uk

Pursed-lips breathing

Some people find that breathing in through the nose and out through narrowed lips helps with breathlessness. People who find this helpful often do it without realising.

Pursed-lips breathing helps to keep your airways open. This allows the air to leave your lungs more easily. It creates more room for your next breath in.

This technique is helpful for people who have breathlessness with conditions like chronic obstructive pulmonary disease (COPD) or emphysema (lung conditions that cause breathing problems).

You can also use it when you have the urge to cough.

Managing a dry cough

Try to breathe in deep into your stomach. If you put your hand on your stomach, you should see your hand rise and fall as you breathe. It is a good idea to practice this regularly.

If your breathing becomes shallow and rapid, use the relaxed breathing technique to bring your breath back to your stomach. This is important because rapid breathing can make a cough worse.

Try to work out if there is anything that causes your cough or makes it worse, and avoid this where possible. Examples are:

• spicy foods
• air conditioning
• smoky environments
• dust
• talking a lot on the phone

It is important to stay hydrated and regularly sip water or other drinks that do not contain caffeine.

The urge to cough

When you first notice the urge to cough, try these techniques.

• Sip water.
• Suck boiled sweets (but not menthol sweets).
• Close your mouth and swallow.
• Breathe in and out through your nose.
• Try pursed-lips breathing.

Remember

• Try to stay calm and continue your usual physical, work and social activities and routines.
• If you focus on something you enjoy, this can distract you from the need to cough. 
• Most people will be concerned about you rather than find your cough troublesome.

You can watch our film about managing your cough, for more tips.