Understanding Breathlessness Including Breathing Pattern Disorder in Adults Following a Hospital Admission With COVID-19

Abstract

Understanding breathlessness including breathing pattern disorder in adults following a hospital admission with COVID-19 Saja Abdulaziz Almulhim Introduction SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection caused a global pandemic in March 2020 to May 2023. This resulted in a syndrome termed Long COVID. Long COVID is a patient derived term for ongoing symptoms for greater than four weeks after SARS -Cov-2 infection. Breathlessness is one of the most prevalent persistent symptoms of Long COVID. It has been hypothesized that some breathlessness after COVID-19 could be related to Breathing Pattern Disorder (BPD). Aims This thesis aims to understand breathlessness including breathing pattern disorder in adults following a hospital admission with COVID- 19. Three main study designs were undertaken. 1. A systematic review and meta-analysis to explore interventions for breathlessness. 2. A prospective cross-sectional study to investigate the contribution for BPD in people with and without breathlessness post COVID -19. 3. An exploratory study to investigate the underlying physiology contributing to exertional breathlessness in adults with and without breathlessness post COVID -19 hospital admission using Cardiopulmonary Exercise Testing (CPET) with Optoelectronic polysomnography (OEP). Results The systematic review showed that breathing exercises has no significant benefit over usual care whereas uncontrolled studies that involved rehabilitation programs demonstrated a positive impact on breathlessness outcomes. The overall evidence from RCTs was inconclusive due to heterogeneity in study design and interventions. Breathlessness in participants with long COVID is associated with higher prevalence of BPD and higher levels of anxiety, and depression symptoms compared to the non-breathless group. However, pulmonary function test was similar in both groups. Breathlessness was also associated with reduced exercise capacity measured by CPET and considerable desynchronization between the ribcage and abdomen compartments detected by OEP during exercise. Conclusion Breathing pattern disorder is a major contributor to breathlessness in patients with long COVID, particularly among those with normal lung function. This emphasizes the importance of a comprehensive rehabilitation approach that addresses both the physical and psychological dimensions of breathlessness to enhance outcomes for patients with long COVID.