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Covid-19 Primary Care Resources


Managing breathlessness



Information for patients on post Covid breathlessness, GP guidelines from NICE and links to prescribing guidance for EOLC

This information is sourced from Homerton University Hospital NHS Foundation Trust and the Chartered Society of Physiotherapy(CSP):

The ACERs team at Homerton Hospital have produced a Post Covid-19 patient information pack which includes a section on positions and exercises to manage breathlessness

The CSP have produced a video for patients on managing breathlessness

This information is sourced from NICE:

Be aware that severe breathlessness often causes anxiety, which can then increase breathlessness further

The following may help to manage breathlessness:

  • keeping the room cool
  • encouraging relaxation and breathing techniques and changing body positioning
  • encouraging patients who are self-isolating alone, to improve air circulation by opening a window or door (do not use a fan because this can spread infection)
  • when oxygen is available, consider a trial of oxygen therapy and assess whether breathlessness improves

Techniques to help manage breathlessness

  • Controlled breathing techniques include positioning, pursed-lip breathing, breathing exercises and coordinated breathing training
  • In pursed-lip breathing, people inhale through their nose for several seconds with their mouth closed, then exhale slowly through pursed lips for 4 to 6 seconds. This can help to relieve the perception of breathlessness during exercise or when it is triggered
  • Relaxing and dropping the shoulders reduces the ‘hunched’ posture that comes with anxiety
  • Sitting upright increases peak ventilation and reduces airway obstruction
  • Leaning forward with arms bracing a chair or knees and the upper body supported has been shown to improve ventilatory capacity
  • Breathing retraining aims to help the person regain a sense of control and improve respiratory muscle strength. Physiotherapists and clinical nurse specialists can help patients learn how to do this

Identify and treat reversible causes of breathlessness, for example pulmonary oedema

Consider an opioid and benzodiazepine combination for patients with Covid-19 who:

  • are at the end of life and
  • have moderate to severe breathlessness and
  • are distressed

Consider concomitant use of an antiemetic and a regular stimulant laxative

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