What causes covid breathlessness and why won't an inhaler relieve it?

[Bluewavescrashing]

Any medical people about who know the answer?

Asthma causes airways to narrow and an inhaler helps them relax and reopen. Covid can cause breathlessness and ultimately hypoxia (not enough oxygen). Narrow airways is not the issue with Covid.

What they worry about with Covid isn't normal breathlessness caused by narrowing of airways - but something called silent hypoxia - where your blood oxygen levels drop, but without any obvious breathing difficulties. I don't think they have identified the cause yet, but various hypotheses are that it could be neurological or some kind of mismatch between air and blood flow in the lungs.

The lack of breathleness was one contributer to higher deaths at home at the start of the crisis - because the 111 monitoring questions were looking for people with more classic breathing difficulties.

Would be interested to know more about it myself, I found the description (quote below and it's scary) in the article in this link:
www.google.com/amp/s/www.nytimes.com/2020/04/20/opinion/sunday/coronavirus-testing-pneumonia.amp.html

The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.

Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until oxygen levels plummet. In effect, patients are injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.

I was still hypoxic for 4 months post covid. Now my sats are 94-95% on a good day.
I gave up smoking in June when I had covid.
During sats low as 88%
I didn't feel breathless as such.
We had patients with sats of 78% who were not showing symptoms of breathlessness but their blood gases and observations were horrific

I think that the other type of inhaler, the steroid one, might help with covid symptoms as it reduces inflammation in the lungs. I think they are doing a study at the moment.

www.independent.co.uk/news/health/inhaled-steroids-to-be-trialled-as-covid-treatment-b1762382.html

Would a pulse oximeter detect the low oxygen before symptoms?

Thanks for the info! Really interesting

@MrsMiaWallis

Would a pulse oximeter detect the low oxygen before symptoms?

Yes. That's why lots of people have bought them to have at home since March.

@MrsMiaWallis a sats prob may be helpful but may also give false reassurance/false alarm (low sats don’t necessarily mean low oxygen levels and high sats don’t necessarily mean all is well either). They definitely should not be used as a fail safe guide to spotting a sick person. (DOI: anaesthetics/icu doctor)

When I had Covid my chest felt clear, my breathing felt fine but I felt like I was at altitude. Like I wasn't getting enough oxygen with deep breaths. It was a horrible feeling.

Breathing is a really complex process. It is partly mechanical (chest expands, diaphragm drops, etc.,), partly neurological (the brain detects rising carbon dioxide levels and triggers a breath, and can alter the frequency and depth of breathing to balance the pH of the blood) and partly chemical (the lungs exchange carbon dioxide with oxygen in the blood).

If anything disrupts that process, the body will compensate for a time. It's really clever. But after a while, the body tires and those compensations fail. So someone can still seem quite 'well' for some time after their body has started to fail.

Salbutamol inhalers (the blue 'reliever' inhaler) open up the airways, but if the problem is inflammation and congestion of the alveoli (the little air sacs in the lungs), then the air just isn't going to get there in order for the carbon dioxide to be swapped for oxygen in the blood.

When I had Covid my chest felt clear, my breathing felt fine but I felt like I was at altitude. Like I wasn't getting enough oxygen with deep breaths. It was a horrible feeling

That's exactly how I feel. Test done today

Maybe that's why vitamin D is mentioned as it apparently acts in a similar way to steroids..