People who are suffering with breathlessness, one of the commonly reported symptoms of long-Covid, are being given new hope in the form of diaphragm exercises they can do themselves.
Dublin respiratory physician Professor Seamus Linnane, of the Beacon Hospital in Dublin, set up Ireland’s first long-Covid clinic and has recently shared the positive findings seen in his own patients with other doctors who are treating people for the debilitating condition.
“We have found a lot of patients have diaphragm weakness and we have been promoting diaphragm training and seen a benefit,” said Prof Linnane.
“Patients are coming back and saying their breathing feels much better, their dizziness is improving as well as their sense of well-being and energy.”
He said patients can be instructed on how to do the diaphragm-strengthening training exercise using a cheap device at home. “Some patients with long-Covid can feel dreadful a lot of the time. They go through a hard time but it is important to tell them about progress,” he said.
Prof Linnane said positive trends are emerging in the progress of patients who had long-Covid, and people he first saw early on in the pandemic are being discharged from his care. “There are people who are taking six to 12 months to work through it. There is a smaller percentage of people who are taking up to two years,” he said.
He added that there are a host of symptoms associated with long-Covid and that people are affected in different ways.
Among the common symptoms are fatigue, breathlessness, brain fog, palpitations and chest pain.
More women than men are impacted and it is still unclear why, or whether it relates to their autoimmune profile. It is important that patients with long-Covid have access to a multi-disciplinary team of specialists including psychologists and physiotherapists.
Public hospitals with long-Covid clinics are still building up these teams. There are no specific treatments for long-Covid although clinical trials are under way and it should be clearer next year which of them will work best.
Prof Linnane said the experience so far is that a lot of cardiac and respiratory symptoms disappear over time but the neurology problems relating to the brain take longer.
“We are applying the concept of treatable traits. So we focus on treatments that we know will treat a particular case in, for example, airways obstruction or cognitive alertness,” said Prof Linnane.
“We feel more comfortable when we are applying treatments that have a validated use.”
Asked about the role of exercise in long-Covid patients, he said the strategy is one of exercise and pacing.
“We are anxious to build in the concept of pacing and avoid post-exertion malaise.
“It is a very challenging area and one that we review on a regular basis.
“Some will experience a worsening of symptoms with exercise and we are also seeing weaknesses in some muscle groups which indicate people are losing capacity.”
The balance is challenging, he said. “Some are walking 5km a day and others are struggling to move about the house.
“Applying the same paradigm to a range of patients is inappropriate and it must be targeted towards their individual needs and abilities.”
Some people have long-Covid after a very mild infection but the risk increases for those who have been hospitalised. The number of symptoms that people who develop long-Covid show after contracting the Omicron variant, currently circulating in Ireland, is less than that seen after the Delta strain which was dominant here last year.
“We found that in the types of symptoms shown we had a slight excess of palpitations or cardiological presentations with Omicron compared to Delta, Alpha or the Wuhan strain,” he added.
He also revealed the intense struggle many are experiencing going to work even though they are suffering from fatigue. “They are banking all their energy to go to work for however long they can but are coming home with nothing left.
“We have seen people who felt a responsibility to go back to work or had no option. They can then suffer relapses and are out again for weeks or months. It is important to give someone time to recover.”
However, over the passage of time people are making substantial recovery, he said. “We are supporting them through the process and helping them avoid any harm as they make their recovery.”
He said those who develop long-Covid after vaccination seem to be less impacted, strengthening the argument for the vaccine.