Q. I am recovering from COVID-19 but still feeling breathless and fatigue. Why?

Answered by
Dr. Zubayeralam
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Nov 12, 2020

Hi doctor,

I am recovering from COVID-19, and I am on day 26 since the symptoms started. After day 11, I spent two nights in the hospital where I had some oxygen, and a chest x-ray showed viral pneumonia or typical COVID-19 changes. I was discharged after oxygen levels stabilized. After a funny turn two days ago, I had more hospital tests due to some chest pain. ECG was fine. D dimers and infection markers had come down, which is good. My question is, why am I still breathless and fatigued after nearly a month? Also, when taking in a deep breath, I hear a squeaky noise in my chest. I am not sure if this is air or the release of parts stuck together or friction. Is this noise anything to worry about? I am currently taking Fluoxetine 40 mg, Propranolol 10 mg, two tablets per day, and Heparin injections to finish tomorrow. I have recently stopped taking antibiotics. Thanks.

#

Hi,

Welcome to icliniq.com.

Thanks for the query. I can understand your concern. According to your statement, you have been suffering from breathlessness and squeaky noise on inspiration after recovering from COVID-19. This noisy sound may be wheezing, which is high pitched whistling sound during exhalation. It can happen during inspiration too. Wheezing is a sign which indicates either narrowing or obstruction of your airway or respiratory passage. It can result from asthma, COPD (chronic obstructive pulmonary disease), an infection like pneumonia or respiratory tract infection, an allergic reaction, or physical obstruction of the airway by a tumor or foreign body.

You may be suffering from post-viral asthenia, also known as weakness, is the feeling of body fatigue or tiredness. It can be associated with anorexia, body ache, muscle pain, chest pain, drowsiness, dizziness, breathlessness, headache, etc. Post viral asthenia or fatigue, occurring after a severe viral infection like COVID-19, can cause fatigue, which may last up to six months.

You can use nebulization with salbutamol, salbutamol inhaler to open airways, steroid inhaler to reduce airway inflammation with or without oxygen therapy according to the severity.

You should keep your body hydrated for your post-viral fatigue, follow a balanced diet chart, take proper rest, do less exercise, keep energy, take adequate sleep, ease your breathing by medications, etc.

In case of any other query, knock me, and I will try to reply to you.

Hi doctor,

Thank you for your reply.

Yes, with the sweaky noise it feels something is unsticking in the chest when breathing in. Would standard inhalers do rather than a nebuliser for breathlessness or wheeze? Also do you think Propranolol is fine for treating my blood pressure and high pulse and that it will not hinder my breathing, at 10 mg day it is only a small dose. Thanks again.

#

Hi,

Welcome back to icliniq.com.

Thanks for the query again.

Yes, you can use inhalers only like Salbutamol inhaler and Corticosteroid inhaler. Propanolol is used for controlling high pulse rate and blood pressure. Propanolol can block beta 2 receptors in the bronchioles that cause the bronchioles' narrowing and can ultimately cause breathing difficulties in a person with pre-existing lung disease like you. And many medications can control your pulse rate and blood pressure without affecting your respiratory system. So I think it will be wise to change your propanolol. In case of any other query, ask me, and you will try to reply to you.

Hi doctor,

Thanks for your reply.

So you think Propranolol should be changed even at this low dose. Can you recommend any alternative medications for treating high pulse or blood pressure that I can bring to the attention of my doctor that will not affect respiratory function? Would a more selective beta blocker be fine? I did have a second chest x-ray but they did not really discuss any difference with the first. I will try to get more details. They did discharge me so I am hoping there was improvement with the second x-ray. As I mentioned infection markers and D Dimers did reduce. Thanks.

#

Hi,

Welcome back to icliniq.com.

Thanks for the query again. Yes, I think your propanolol be changed even at a very low dose. Let me explain according to British guidelines. British guidelines advise avoiding beta-blockers in asthma, COPD generally. They concluded, "Cardioselective beta-blockers do not produce clinically significant adverse respiratory effects in patients with mild to moderate reactive airway disease. So you can use a Cardioselective beta-blocker like Bisoprolol (Cardicor, Congescor trade name) or Metoprolol (Lopressor, Metolar trade name). Again those antihypertensive medications that I have already mentioned, you can use any of them for controlling your blood pressure and rapid pulse rate without any respiratory complications. So the choice is yours and your physician. If you want to know any other information, feel free and ask me and I will try to help you further.

Hi doctor,

Thank you so much for your reply.

I guess this fatigue could happen with something like Bisoprolol as well as Propranolol. I will speak to my doctor about changing the Propranolol to one of your suggestions. Thanks again for all your help and advice.

#

Hello,

Welcome back to icliniq.com.

Thanks for the query again. I am extremely sorry for the late reply. Yes, you are right. Both Bisoprolol and Propanolol are Beta-blockers in a therapeutic class. So both of them can cause more or less fatigue or weakness. You have respiratory distress too, and you have many options for controlling your blood pressure and rapid pulse rate. Again changing Propanolol is a wise decision. Thank you very much. You are a highly educated and co-operative person. Discussion with you is honorable and pleasurable to me. Long live, and have a nice day.


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