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Elaine Chin is the founder of Executive Health Centre. This piece is excerpted from her book We Are Not Okay: The Pandemic and its Consequences from Sutherland Quarterly. Now available in bookstores or subscribe at

Somewhere around the three-year mark of the pandemic, I began to hear a lot of people say they were done with COVID – meaning they were tired of the lockdowns, tired of the precautions, tired of living in fear and eager to resume their prepandemic lives. Unfortunately, COVID-19 is not done with us.

Fifty-seven people died of the infection last week and the peak number of people hospitalized with COVID this spring was higher than during the first prevaccine wave in spring 2020. More alarmingly, studies are showing that long COVID, or post-COVID-19 syndrome, is far more prevalent, multifarious and disabling than most in the medical community expected. Millions of Canadians who caught the virus are walking wounded today. They’re sick, they’re down, they don’t know why. Nothing shows up in the usual tests. It’s probably some form of long COVID.

Post-COVID-19 syndrome, according to the Mayo Clinic, involves a variety of new, returning or continuing symptoms that people experience more than four weeks after getting COVID-19. For some individuals, the syndrome can last months or years, and it can also cause disability, the organization warns.

Among the symptoms: fatigue, neurological issues, including difficulty thinking or concentrating, headache, sleep problems and dizziness; respiratory problems, including difficulty breathing or shortness of breath and coughing; joint or muscle pain; heart issues; digestive problems; skin rashes; and mental-health issues, including depressed mood and anxiety. Symptoms can occur as soon as one month or longer after having COVID-19.

The incidence of long COVID is higher than you might think. Global data from the end of 2022 suggest almost half of COVID-19 survivors report persistent symptoms four months after their diagnosis. The prevalence of long COVID is around 43 per cent and the range can vary from 9 per cent to 81 per cent due to differences in sex, region and study population. As one would expect, those who were hospitalized with the virus were far more likely to experience long COVID (54 per cent compared with only 34 per cent of outpatients). Also, the unvaccinated appear to have it the worst. A 2021 survey showed that more than 90 per cent of the 3,700 participants who had COVID-19 without the benefit of vaccines reported a recovery time exceeding 35 weeks. By month six, most still reported fatigue, malaise and cognitive dysfunction.

A Statistics Canada survey, released in October, 2022, found that 15 per cent of people who had contracted COVID – 1.4 million Canadian adults – were still suffering from symptoms consistent with long COVID after the acute phase of infection. Since then, millions of Canadians likely contracted COVID, but it’s not clear how many of them, or how many previous long-COVID sufferers, still have lingering symptoms.

It can be difficult to tell whether long COVID symptoms are specifically due to COVID-19 or are an exacerbation of pre-existing medical conditions. The virus does tend to exacerbate things. It became apparent early in the pandemic that people with pre-existing physical conditions such as heart disease, diabetes, cancer and asthma were at higher risk of serious complications and death if they contracted COVID-19. It also appears that the virus can trigger entirely new problems.

Any infection such as COVID-19 can cause the body to mount a response to fight it off. The body releases a chain of reactions that can range from creating heat – what we call a fever – to producing mucus in our nose and lungs to flush out the virus, which is why we get runny noses and cough phlegm when we’re sick. Various types of white blood cells attack tissues infected with the virus. This causes local areas to become red and swollen – we call that inflammation.

Unfortunately, sometimes the body can mount an overactive response that causes inflammation throughout the body, leading to aches and pains. Sometimes, in more serious cases, other organs are involved. All of this happens while the body begins to manufacture antibodies over several days to lock down and remove the virus.

Most of the time, the organ tissue recovers by renewing itself, but if the inflammatory response is especially intense, there can be unintended consequences. Lungs can drown in fluid from the mucus being produced. The heart can beat irregularly due to damaged electrical circuits in the heart tissues. Hence, the heart cannot produce enough blood pressure to oxygenate tissues. Meanwhile, the liver and kidneys cannot filter the massive amount of toxins. In extreme cases, acute multiorgan failure can result.

People who suffered severe cases of COVID-19 and recovered from the acute phase may nevertheless experience new multiorgan effects or autoimmune conditions with symptoms lasting weeks, months or even years after their original illness. These are the result of that superinflammatory response. It can result in permanent tissue damage and scarring of the body’s organs.

A study of Manitoba patients who landed in intensive care units with COVID-19 and technically beat the infection found that many developed these other problems. After 13 days in hospital, less than 8 per cent of patients were still testing positive, and by Day 25, all patients’ viral loads had become undetectable. Yet some patients remained in ICU due to organ failure caused by acute inflammation in the early days of their infection.

It should be obvious, given that COVID-19 is a respiratory infection, that some amount of lung damage would be evident in patients postinfection. A United Kingdom study from October, 2022, concluded that approximately 11 per cent of COVID-19 patients develop interstitial lung disease after hospitalization. For some, this lung damage resolves, but for others, it appears to lead to a progression of lung fibrosis.

Simply put, fibrosis is scarring. After a significant amount of damage due to COVID-19 pneumonia, the tissues of the lung stiffen, making breathing more difficult because the lungs are no longer able to expand and collapse easily to exchange gases. Such an outcome worsens the patient’s quality of life and decreases life expectancy. With weaker lungs, it is far easier to develop pneumonia with any respiratory infection. Scientists have also noted that our immune system weakens after infection and even more so after reinfection, leading to other non-COVID causes of death such as bacterial or other viral infections.

Cardiologists have now recognized that the risk of cardiovascular problems such as a heart attack or stroke can remain heightened for many months even after a full recovery from a COVID-19 infection. As one might expect, patients who were admitted to intensive care with acute infections had a 20-fold higher risk of cardiovascular problems such as congestive heart failure and deep vein thrombosis (or blood clots) when compared with the uninfected. Even those who had not been hospitalized had increased risks of a variety of heart conditions, ranging from an 8-per-cent increase in the rate of heart attacks to a 247-per-cent increase in the rate of heart inflammation.

Blood vessels can also become inflamed, which increases the risk of atherosclerosis – the narrowing and hardening of the arteries. When they get to a critical narrow width, blood cannot easily flow through the arteries, and heart attacks and strokes can occur. Clotting can also happen. When this occurs in the veins, we call it a deep vein thrombosis. The most dangerous complications of DVTs are when a part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage known as a pulmonary embolism. Even a small pulmonary embolism can damage the lungs, and a large one can be fatal.

The kidneys are not spared in the acute and postacute phases of COVID-19 infection. Patients displayed a lower glomerular filtration rate, meaning kidney function had become suboptimal. Technically, how sick you were with COVID-19 determined the severity of acute kidney injury. Unfortunately, the kidney does not regenerate its tissues, unlike the liver and some other organs. It houses many delicate filters that act as a recycling system. Once these fine filters get damaged from inflammation and scarring, the kidney no longer functions efficiently. Treatment may then include dialysis and, hopefully, a successful kidney transplant. Unfortunately, some long COVID-19 patients do succumb to kidney failure.

In a massive study of more than 200,000 patients, researchers at the Veterans Affairs St. Louis Healthcare System in Missouri found that those who had been infected with even a mild COVID-19 infection had a greater risk of developing diabetes. People who caught the virus were 40 per cent more likely than veterans in the control group to develop diabetes up to a year after infection. Those with a high body mass index (BMI) doubled their chances of developing diabetes in the year after.

Two of the most common forms of diabetes are Type 1, largely a genetic condition that manifests early in a person’s life, and Type 2, which is related to a person’s lifestyle. You are more likely to develop Type 2 diabetes if you are overweight and physically inactive, hence the increased risk to people with a high BMI. We know that Type 2 diabetes is largely due to an insufficiency in the pancreas: In simple terms, this organ does not make enough insulin to reduce blood sugar levels. It is not difficult to see how a pancreas weakened by COVID-19 infection and damaged by inflammation can set a person up for the onset of diabetes months or years later. While diabetes does not directly kill the patient, we know diabetes causes inflammation of the arteries and later, atherosclerosis. Diabetes kills indirectly by increasing one’s risk of heart attack, stroke and kidney failure.

Many who have been infected by COVID-19 complain of brain fog, memory loss, trouble with smell and taste, and a change in sleeping patterns. Researchers are just beginning to learn about COVID’s impact on parts of the brain. Forty per cent of recovered patients in one study showed material changes in their brains, specifically in the white matter and brainstem. Changes in our white matter can lead to brain fog, fatigue, insomnia, anxiety, depression, headaches and cognitive problems. Brainstem changes can affect our circadian-rhythm control, which may account for the sleep problems.

Using MRI imaging, the UK Biobank study has discovered brain changes in patients who have contracted COVID compared with non-vaccinated/non-infected controls. They include brain atrophy (tissue shrinking), loss of grey matter (which controls movement, memory and emotions), and overall cognitive decline. This new study confirms the effect of inflammation on the brains of COVID patients, even when their infections were mild.

In one study, researchers in Munich examined the brains of patients who passed away from non-COVID causes but were documented to have had COVID when they were alive. They discovered that 12 of 20 of these individuals had marked accumulation of the SARS-CoV-2 spike protein in the skull-meninges and brain tissue, which was not found in control subjects. It’s notable that only the spike protein and not other parts of the virus were found in their brain tissues.

Animal models show these spike proteins cause brain cell injury and persistent inflammation. This finding gives us a better understanding of why so many people, even after a mild bout of COVID, continue to experience neurological symptoms even after the apparent recovery of their COVID infection.

This implication of brain damage on a subset of the population is significant for the workplace and future ability to function with activities of daily living. This is yet another knock-on effect of COVID and one that many health care practitioners may be dismissing because the symptoms have no apparent cause.

It is understandable that after an intense three-year ordeal, people want to put COVID-19 behind them, but it is nevertheless a mistake. I’ve only touched on the lingering medical consequences of the pandemic; there is strong evidence that the mental-health consequences are just as dire. Combine these with the damage done to our health care system, our education system, our economy, our workplaces, and our public sphere, and it becomes abundantly clear that we need a full-scale government inquiry into how we’ve handled COVID-19 and what we might do better in the future. As the World Health Organization said last month, the next pandemic is only a matter of time. There’s very little evidence that we’ll be any better equipped for it.

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wildfire smoke

As a huge plume of smoke from over 400 Canadian wildfires swept south and turned New York City into a landscape that resembled Mars more than Earth, heart experts warned that air pollution can damage your heart as much as it damages your lungs.

It’s obvious that wildfires can affect breathing and respiratory health, but exposure to this smoke can also cause or worsen heart problems, the American Heart Association said in an alert issued Wednesday.

“Most people think of breathing problems and respiratory health dangers from wildfire smoke, but it’s important to recognize the impact on cardiovascular health, as well,” says Dr. Comilla Sasson, vice president for science and innovation at the American Heart Association and a practicing emergency medicine physician. “Wildfire smoke contains a lot of pollutants, including fine, microscopic particles linked to cardiovascular risk.”

In fact, experts have said that it would be healthier to smoke a 1/2 pack of cigarettes than it would be to simply breathe in wildfire smoke all day.

The dangers of wildfire smoke

Breathing in smoke can have immediate health effects, including:

  • Coughing
  • Trouble breathing normally
  • Stinging eyes
  • A scratchy throat
  • Runny nose
  • Irritated sinuses
  • Wheezing and shortness of breath
  • Chest pain
  • Headaches
  • An asthma attack
  • Tiredness
  • Fast heartbeat

Older adults, pregnant women, children, and people with preexisting respiratory and heart conditions are more likely to get sick if they breathe in wildfire smoke, according to the Centers for Disease Control and Prevention (CDC).

Previous research has demonstrated that the cost can be heavy.

In one 2020 study, researchers found that exposure to heavy smoke during wildfires raised the risk of out-of-hospital cardiac arrests by up to 70 percent. That risk was elevated in both men and women, among adults aged 35 to 64 and in communities with lower socioeconomic status.

Earlier findings showed that wildfire smoke exposure was associated with increased rates of emergency room visits for heart disease, irregular heart rhythm, heart failure, pulmonary embolism and stroke.

Those ER visits increased 42 percent for heart attacks and 22 percent for ischemic heart disease within a day of exposure to dense wildfire smoke. This was especially concerning for adults 65 and up, according to that study, which was published in the Journal of the American Heart Association.

Tips for Protecting Yourself

Here are the measures you can take to protect yourself from wildfire smoke.

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Thrombosis is a severe condition in which blood clots form in one or more of your blood vessels or your heart. The blood clot either blocks the blood flow where it is located or can break loose and travel to other areas of the body. 

A moving blood vessel is more concerning. This is because it can get stuck in critical locations and cause life-threatening conditions like heart attacks or strokes. A better understanding of this condition can help you be more aware of the risks and find solutions before it becomes critical. 

What is Thrombosis?

When a blood clot or thrombus is formed inside a blood vessel or chamber of the heart, it is known as thrombosis. A moving blood clot can embed itself in critical areas like your lungs or brain and disrupt blood flow to those areas. People with certain health conditions or external factors may be at a higher risk of developing thrombosis. Understanding these risks and learning about the symptoms can help you recognise a problem. 

Types of Thrombosis 

There are two primary types of thrombosis 

Arterial Thrombosis

In this type, a blood clot is formed in an artery. Your arteries are responsible for carrying blood from the heart to all the other parts of your body. A blockage in your arteries can result in strokes or heart attacks. 

Venous Thrombosis

As you probably guessed, venous thrombosis refers to a blood clot formed in a vein. Veins carry blood from the rest of your body to your heart. Veno thrombosis is one of the primary causes of pulmonary embolism/blood clots in the lungs.

Both these types are equally as dangerous as they can 

  • Stay in place and grow big enough to block blood flow to vital organs. The bigger the blockage, the more severe it can be. 
  • Travel to other areas and cause blockages in smaller blood vessels resulting in strokes or pulmonary embolisms. 

Thrombosis Symptoms 

Every individual is different, so thrombosis symptoms also differ from person to person. These symptoms also depend on the location of the blood clot. 

Blood clots in the lungs:

  • Sharp pain in chest and surrounding area
  • Pain when breathing 
  • Sudden trouble breathing while at rest or active 

Blood clots in the neck or brain

  • Weakness/trouble controlling the muscles on one side of the brain
  • Garbled or slurred speech
  • A noticeable droop or lack of muscle control on one side of the face
  • Agitation, confusion, or any unusual behavioral changes 

Blood clots in the heart

  • Discomfort or pain in the chest 
  • Dizziness or passing out 
  • Trouble breathing

Blood clots in the belly

  • Bloating, nausea, and vomiting 
  • Severe stomach pain that occurs after eating 
  • Diarrhoea that could also contain blood 
  • Fever

Blood clots in an artery in the arm or leg

  • Pale skin in certain areas
  • Skin feels cool to the touch 
  • Numbness or tingling sensation 
  • Weakness and inability to move the affected body part 
  • Blisters, wounds, or sores
  • Sloughing of skin (when skin falls away from the tissue underneath)
  • Tissue death or necrosis

Blood clots in a vein in the arm or leg

  • Skin appears redder or darker than the surrounding area
  • Pain around the affected area
  • Skin feels warm to the touch 
  • Swelling caused in the area

Complications of Thrombosis

Thrombosis can cause many different conditions, so one needs to be aware of these complications to prevent major issues causing thrombosis: 

Location of the Blood Clot  Complication
Lungs  Pulmonary embolism
Brain  Stroke or Transient ischemic attack
Heart  Heart attack
Neck TIA/stroke
Belly  Mesenteric ischemia thrombosis is the underlying cause of dangerous conditions we discussed earlier, it is thought to be the underlying cause of 1 in 4 deaths worldwide. 

Causes of Thrombosis

Thrombosis is caused due to 

On the other hand, art thrombosis is caused due to the hardening of the arteries, known as arteriosclerosis. This is when the walls of the arteries thicken due to calcium or fatty deposits. This leads to a build-up of fatty materials along the artery walls. 

Individuals with certain health conditions, as listed below, are more at risk of thrombosis

Other factors, such as:

  • A family history of blood clots in veins deep in the body, 
  • Being on hormone therapy or birth control pills 
  • Pregnancy
  • Old age 
  • Lack of movement

The above can put individuals at risk of thrombosis.

Diagnosis of Thrombosis

Thrombosis is diagnosed in three ways: a physical exam, blood test, or imaging tests. Once your physician has checked your symptoms and looked into your family history, they may make a diagnosis or suggest further tests, including a blood test, ultrasound, CT scan, or MRI. 

A blood test can indicate how easily your blood can clot, and the reason behind it. 

Blood components: These tests measure multiple types of blood cells, like platelets and other chemical components that can affect clotting. One of the most common blood tests for the diagnosis of thrombosis is the DVT test. It is the Deep Vein Thrombosis test. It helps identify the presence of blood clots in the individual. 

Clot formation markers: These chemicals will only appear in the blood when a clot occurs. This helps healthcare providers rule out the possibility of an active clot in the blood. 

Heart damage markers: Cells in the heart muscles contain specific types of tropins that can’t be found in other areas of the body. Any damage to your heart can lead to tropins leaking into the blood. A tropin test helps rule out heart attacks that can often occur due to thrombosis. 

Thrombosis Treatment Includes

  • Medication like blood thinners 
  • Thrombolytic therapy helps dissolve blood clots 
  • Thrombectomy is a minimally invasive treatment that helps remove a blood clot


Thrombosis is a condition that can quickly become life-threatening. Maintaining healthy habits, knowing the symptoms, and getting regular tests can ensure you catch it at the right time and take the required steps to treat it. We at Metropolis Labs are a chain of diagnostic labs that provides accurate blood testing and health checkup services. You can even opt for at-home testing services. 



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Experiencing breathlessness and difficulty breathing while climbing stairs may indicate an underlying health condition. While temporary symptoms can be attributed to aging, stress, or lack of exercise, persistent or worsening breathlessness may suggest specific disorders. Let’s explore some conditions associated with breathing difficulties.

Cardiovascular Disorders: If you feel breathless and experience chest pain while climbing stairs, it may indicate angina, a condition caused by impaired blood flow to the heart due to factors like arterial sclerosis, blood clots, or coronary spasms. Physical exertion, such as climbing stairs or brisk walking, puts additional strain on the heart, leading to breathlessness and chest pain. Angina can be managed through medication (antiplatelet agents, lipid-lowering drugs), stent placement, or coronary artery bypass surgery. Other cardiovascular conditions, such as constrictive pericarditis or pulmonary embolism, can also cause chest pain and breathlessness.

Respiratory Conditions: Respiratory disorders like chronic obstructive pulmonary disease (COPD) and asthma can also contribute to breathlessness, accompanied by coughing and phlegm production, especially during stair climbing. COPD typically manifests as breathlessness during physical exertion due to factors like smoking. Treatment options include inhalers to relieve symptoms, oxygen therapy, or lung transplantation. Asthma, characterized by airway constriction due to allergic inflammation, can be managed with medication and immunotherapy. Other respiratory conditions, such as respiratory muscle weakness, Guillain-Barré syndrome, interstitial lung inflammation, or idiopathic pulmonary fibrosis, may also lead to breathlessness.

Anemia and Obesity: Anemia, a condition characterized by a deficiency of red blood cells, can cause breathlessness even during mild physical activity. When fatigue and breathlessness persist, considering anemia is crucial. Obesity can also contribute to breathing difficulties. Individuals with a body mass index (BMI) of 30kg/m² or higher may experience obesity-hypoventilation syndrome, a condition where inadequate breathing persists. Symptoms include fatigue, breathlessness, and excessive sweating. As the condition worsens, it can lead to impaired cardiac function and liver cirrhosis, highlighting the importance of early medical intervention.

Recognizing the signs of breathlessness during stair climbing is essential for identifying potential underlying conditions. If you experience persistent or worsening symptoms, it is recommended to consult a healthcare professional for accurate diagnosis and appropriate treatment.

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Patients with persistent dyspnea after pulmonary embolism (PE) who underwent rehabilitation had greater exercise capacity compared with those who received usual care, according to study findings published in Chest.

Investigators conducted a randomized controlled trial to evaluate an 8-week exercise-based rehabilitation program for patients with persistent dyspnea following pulmonary embolism. Outcomes of interest included exercise capacity, dyspnea, and quality of life.

Participants were identified from the thrombosis registry (TROLL) at a hospital in Norway. To be eligible, the patients (aged 18 to 75 years) had to have: (1) PE greater than isolated subsegmental emboli on computed tomography pulmonary angiography 6 to 72 months before inclusion; and (2) persistent, self-reported dyspnea of at least grade 1 as measured by the modified Medical Research Council dyspnea scale, with onset or exacerbation at PE diagnosis. The participants were enrolled from January 1, 2018, to June 1, 2022.

A total of 211 patients were randomly assigned to an intervention group (n=108) or control arm (n=103). Their overall median age was 57 (49-67) years, 56% were male, and their median time from diagnosis to inclusion was 10.3 (7.2-21.0) months. The intervention group engaged in a supervised outpatient exercise program for 1 hour twice a week for 8 weeks. They also had a home-based exercise program once or twice weekly. Patients in the control arm received usual care based on guidelines. The primary endpoint was the difference in Incremental Shuttle Walk Test (ISWT) in the 2 groups at follow-up. The median walking distance at baseline for the ISWT was 695 (530-940) meters.

Rehabilitation should be considered in patients with persistent dyspnea following PE, though further research is needed to assess the optimal patient selection, timing, mode, and duration of rehabilitation.

Follow-up and primary outcome data were available for 89 participants from the rehabilitation group and 87 participants from the control group. The researchers found that participants in the rehabilitation group performed better on the ISWT compared with those in the control group, with a mean difference between groups of 53.0 meters (95% CI, 17.7-88.3; P = .0035). No adverse events occurred.

In comparing participants based on time since diagnosis, researchers found that the difference in ISWT between the rehabilitation and control group consistently favored the rehabilitation group; the difference for those who were 6 to 12 months post-diagnosis was 63.8 meters (95% CI, 12.4-115.2; P =.015) and 47.4 meters for those who were 12.1 to 27 months post diagnosis (95% CI, 2.0-92.9; P =.041).

No difference was found regarding the EuroQol-5 Dimension index score or Shortness of Breath Questionnaire sum score between the 2 groups. The rehabilitation group had a better Pulmonary Embolism Quality of Life questionnaire total score vs the control group (difference -0.04 [-4%]; 95% CI, -0.09 to 0.00; P =.041).

The researchers noted that the primary endpoint was subject to a considerable ceiling effect, which may have affected the findings. In addition, a number of different physiotherapists participated in the completion of the intervention owing to the COVID pandemic, which may have resulted in some heterogeneity in the rehabilitation. Furthermore, a majority of participants had mild symptoms, which may have limited the potential benefits of the program.

“Rehabilitation should be considered in patients with persistent dyspnea following PE, though further research is needed to assess the optimal patient selection, timing, mode, and duration of rehabilitation,” the investigators commented.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

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Chronic thromboembolic pulmonary hypertension (CTEPH) is increased blood pressure in the arteries in the lungs due to long-term blood clots. It is possible to treat the condition with surgery.

The condition occurs due to a chronic or long-term blood clot in the lungs called a pulmonary embolism. The blood clot or embolism obstructs the blood flow in the lungs, which increases the pressure in the arteries in the lungs.

Read on to learn more about CTEPH. This article discusses symptoms, causes, treatment options, and more.

Researchers do not know exactly why some people with a blood clot develop CTEPH.

The condition most often follows pulmonary embolism. About 75% of people with CTEPH have had one or more blood clots in the lungs. This means that conditions that increase the risk of a pulmonary embolism also increase the risk of CTEPH.

CTEPH can also occur in people that do not have a known history of blood clots. A 2016 article reports that a small number of people with CTEPH do not have a history of pulmonary embolism.

Risk factors for developing CTEPH include:

  • long-term inflammatory conditions
  • having a spleen removed
  • family history of blood clots
  • thyroid replacement therapy
  • blood clotting conditions
  • cancer

Certain factors can also increase the chances of developing a pulmonary embolism, including:

In most cases, if there is an early diagnosis, it is possible to treat CTEPH with surgery.

Currently, the recommended treatment for CTEPH is pulmonary thromboendarterectomy (PTE). PTE is a surgical procedure that involves removing blood clots from the vessels in the lungs.

Not everyone with CTEPH is a candidate for surgery. More than 30% of people do not qualify for surgery.

If surgery is not an option, treatment can involve medical therapy to dilate the pulmonary arteries and balloon pulmonary angioplasty (BPA). BPA involves inflating a small balloon in the artery and temporarily inflating it.

Learn about recovering from a blood clot in the lungs.

Usually, the path to diagnosis of CTEPH involves a two-step process. The first part of the diagnostic process involves evaluating for pulmonary hypertension. The second step involves determining if blood clots cause elevated pulmonary pressure.

Possible diagnostic tests orders to confirm a diagnosis include:

  • Echocardiogram: An echocardiogram involves using sound waves to determine if the pressure on the right side of the heart is high.
  • Cardiac catheterization: This procedure allows doctors to measure the pressure in the pulmonary artery.
  • Ventilation-perfusion scan: This scan helps the doctor determine how efficiently air and blood move through the lungs.
  • Computed tomography pulmonary angiography: A CT pulmonary angiography creates images of the pulmonary arteries. These pictures help determine the extent and location of blood clots in the lungs.

CTEPH is a rare condition with an overall incidence of about 3–30 in every 30 million people in the general population.

It affects about 0.4–4.8% of all people with a pulmonary embolism.

Chronic thromboembolic pulmonary hypertension (CTEPH) refers to increased blood pressure in the arteries in the lungs. It often develops due to long-term blood clots in the lungs.

Symptoms may include trouble breathing, fatigue, and light-headedness. The preferred treatment involves surgery to remove the blood clots. Other treatments may be suitable if a person is unable to undergo surgery.

As early diagnosis can help improve the efficacy of surgery, it is best for a person with concerns about CTEPH to contact their doctor as early as possible.

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The Plymouth-born Olympic bronze medallist contracted Covid-19 in April 2022 and one night, sitting at the desk in his room doing life admin, felt some discomfort in his rib.

“It felt quite strange but I thought I’d take some paracetamol and try to sleep it off,” he said.

“Five minutes later I was lying on the floor, couldn’t breathe, couldn’t speak.”

The 29-year-old puts his body through hell on a daily basis in one of the most gruelling sports around but he’s unequivocal: “it’s the worst pain I’ve felt in my life.”

His girlfriend drove him to A&E where he was misdiagnosed with stressed ribs and sent home.

A week later, when Dawson had tested negative for Covid and returned to his training base at Caversham, British Rowing physio Steve Leonard found that his condition had deteriorated.

“Steve kept telling me to breathe and I was like, ‘I’m breathing as much as I can, I don’t know what to tell you.'

“It turns out the bottom part of my lung had collapsed.”

Dawson was rushed to a private clinic in London and there it was confirmed that he had suffered a pulmonary embolism, a life-threatening blood clot.

“In moments, everything was shattered, but my mind was just in survival mode.

“The hardest thing of it all was having to tell my mum while it was going on. I just emulated what the doctor told me, I didn’t know how to have that conversation.

“Of course there were tears - but I’m grateful that I’m here to tell the story.”

After blood thinners, three weeks of bed rest and two months away, Dawson returned to his old life at Caversham with a fresh mentality.

“It’s given me a new lease of life,” he said. “I’m at Caversham because I want to be there and that is so empowering.

“I feel very fortunate to be blessed with the opportunity to see things from that side.

“When the days are as bad as they can be, in winter training when you’re racking up the miles and going through hell, it can always be worse.

“It’s given me a much more healthy relationship to why I’m here and the goals I have in life.”

Dawson is now back on the road to Paris 2024 and pursuing a second Olympic appearance with Team GB.

“The same things that fuelled me before the event still fuel me to this day,” said Dawson.

“It’s because I’m in the hunt to win Olympic gold and to represent my country on the world’s biggest stage. But it’s not the like the world is ending when it doesn’t go to plan.”

British Rowing is the governing body for the sport and is responsible for the development of rowing in England and the training and selection of rowers to represent Great Britain. The GB Rowing Team is supported by the National Lottery Sports Fund. To find out more, and to follow the team, head to

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 EROS real-world outcomes data show prompt initiation of BREZTRI is associated with a reduced risk of future exacerbations in people living with COPD1

EXACOS-CV US data highlights increased risk of severe cardiovascular events following an acute COPD exacerbation2

Results from the EROS real-world retrospective study showed that initiating fixed-dose triple-combination therapy BREZTRI AEROSPHERE® (budesonide/glycopyrronium/formoterol fumarate) within 30 days of a qualifying moderate or severe exacerbation in patients with COPD (chronic obstructive pulmonary disease) is associated with a decreased risk of future exacerbations by 24% vs. delaying treatment by one to six months, and by 34% vs. delaying treatment six months to one year.1

The EROS study is the first real-world evidence analysis of BREZTRI in more than 2,400 patients with COPD from a claims database registry, and was presented today as a late-breaking abstract at the ATS 2023 International Conference in Washington, DC, hosted by the American Thoracic Society. AstraZeneca's presence at ATS 2023 also includes new data from TEZSPIRE and FASENRA.

Professor Charlie Strange, MD, Medical University of South Carolina, US and investigator in the EROS study, said: "A key treatment goal in COPD is to avoid exacerbations that may lead to increased risk of future exacerbations, possible hospitalization or even death. The EROS real-world data build on the body of clinical evidence that BREZTRI is effective in reducing COPD exacerbation rates and can significantly reduce the risk of future exacerbations if used as soon as a patient’s COPD symptoms worsen.”

Another late-breaking presentation at ATS 2023, the EXACOS-CV US retrospective cohort study using the HealthCore Integrated Research Database of people with COPD showed the risk of an acute severe cardiovascular (CV) event (including stroke, heart failure, pulmonary embolism, arrhythmia, or heart attack) increased by 32% in the first 30 days following a single acute moderate or severe COPD exacerbation, compared to those without a prior COPD exacerbation. According to the results, the risk of CV events was highest in the first 90 days following the COPD exacerbation, the risk remained elevated for one year, and each subsequent COPD exacerbation was associated with an even higher risk of acute CV events (>2 times increased CV risk following two or three COPD exacerbations).2 These results suggest that patients with COPD should be considered at risk of cardiopulmonary events following an acute exacerbation, even those who are newly-diagnosed.

Robert Fogel, Vice President, Global Medical Affairs, Respiratory & Immunology, AstraZeneca, said: “As the third leading cause of death worldwide3, improving outcomes for patients must be an urgent priority for physicians and healthcare systems. The EROS and EXACOS-CV studies increase our understanding of the significant cardiopulmonary risk COPD patients face as well as the opportunity to reduce COPD exacerbations through more proactive treatment with BREZTRI.”

AstraZeneca Respiratory & Immunology pipeline and portfolio highlighted in more than 50 abstracts at ATS 2023

Key additional data from AstraZeneca at ATS include:

  • Two post hoc analyses from the NAVIGATOR Phase III trial demonstrating efficacy of TEZSPIRE in patients with severe, uncontrolled asthma irrespective of prior omalizumab use; and in improving rhinosinusitis symptoms measured with SNOT-22 in patients who also have a history of comorbid nasal polyps.4,5
  • Real-world evidence from the retrospective RANS trial supporting the strong clinical efficacy of FASENRA specifically in patients with severe eosinophilic asthma and nasal polyps; and a post-hoc analysis of five FASENRA Phase III/IIIb trials showing an increased rate of achieving clinical remission in patients with severe eosinophilic asthma and concomitant nasal polyps.6,7

BREZTRI AEROSPHERE® (budesonide/glycopyrronium/formoterol fumarate) Important Safety Information

  • BREZTRI is contraindicated in patients who have a hypersensitivity to budesonide, glycopyrrolate, formoterol fumarate, or product excipients
  • BREZTRI is not indicated for treatment of asthma. Long-acting beta2-adrenergic agonist (LABA) monotherapy for asthma is associated with an increased risk of asthma-related death. These findings are considered a class effect of LABA monotherapy. When a LABA is used in fixed-dose combination with ICS, data from large clinical trials do not show a significant increase in the risk of serious asthma-related events (hospitalizations, intubations, death) compared with ICS alone. Available data do not suggest an increased risk of death with use of LABA in patients with COPD
  • BREZTRI should not be initiated in patients with acutely deteriorating COPD, which may be a life-threatening condition
  • BREZTRI is NOT a rescue inhaler. Do NOT use to relieve acute symptoms; treat with an inhaled short-acting beta2-agonist
  • BREZTRI should not be used more often than recommended; at higher doses than recommended; or in combination with LABA-containing medicines, due to risk of overdose. Clinically significant cardiovascular effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs
  • Oropharyngeal candidiasis has occurred in patients treated with orally inhaled drug products containing budesonide. Advise patients to rinse their mouths with water without swallowing after inhalation
  • Lower respiratory tract infections, including pneumonia, have been reported following ICS. Physicians should remain vigilant for the possible development of pneumonia in patients with COPD as the clinical features of pneumonia and exacerbations frequently overlap
  • Due to possible immunosuppression, potential worsening of infections could occur. Use with caution. A more serious or fatal course of chickenpox or measles can occur in susceptible patients
  • Particular care is needed for patients transferred from systemic corticosteroids to ICS because deaths due to adrenal insufficiency have occurred in patients during and after transfer. Taper patients slowly from systemic corticosteroids if transferring to BREZTRI
  • Hypercorticism and adrenal suppression may occur with regular or very high dosage in susceptible individuals. If such changes occur, consider appropriate therapy
  • Caution should be exercised when considering the coadministration of BREZTRI with long-term ketoconazole and other known strong CYP3A4 Inhibitors. Adverse effects related to increased systemic exposure to budesonide may occur
  • If paradoxical bronchospasm occurs, discontinue BREZTRI immediately and institute alternative therapy
  • Anaphylaxis and other hypersensitivity reactions (eg, angioedema, urticaria or rash) have been reported. Discontinue and consider alternative therapy
  • Use caution in patients with cardiovascular disorders, especially coronary insufficiency, as formoterol fumarate can produce a clinically significant cardiovascular effect in some patients as measured by increases in pulse rate, systolic or diastolic blood pressure, and also cardiac arrhythmias, such as supraventricular tachycardia and extrasystoles
  • Decreases in bone mineral density have been observed with long-term administration of ICS. Assess initially and periodically thereafter in patients at high risk for decreased bone mineral content
  • Glaucoma and cataracts may occur with long-term use of ICS. Worsening of narrow-angle glaucoma may occur, so use with caution. Consider referral to an ophthalmologist in patients who develop ocular symptoms or use BREZTRI long term. Instruct patients to contact a healthcare provider immediately if symptoms occur
  • Worsening of urinary retention may occur. Use with caution in patients with prostatic hyperplasia or bladder-neck obstruction. Instruct patients to contact a healthcare provider immediately if symptoms occur
  • Use caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, and ketoacidosis or unusually responsive to sympathomimetic amines
  • Be alert to hypokalemia or hyperglycemia
  • Most common adverse reactions in a 52-week trial (incidence ≥ 2%) were upper respiratory tract infection (5.7%), pneumonia (4.6%), back pain (3.1%), oral candidiasis (3.0%), influenza (2.9%), muscle spasms (2.8%), urinary tract infection (2.7%), cough (2.7%), sinusitis (2.6%), and diarrhea (2.1%). In a 24-week trial, adverse reactions (incidence ≥ 2%) were dysphonia (3.3%) and muscle spasms (3.3%)
  • BREZTRI should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors and tricyclic antidepressants, as these may potentiate the effect of formoterol fumarate on the cardiovascular system
  • BREZTRI should be administered with caution to patients being treated with:
    • Strong cytochrome P450 3A4 inhibitors (may cause systemic corticosteroid effects)
    • Adrenergic drugs (may potentiate effects of formoterol fumarate)
    • Xanthine derivatives, steroids, or non-potassium sparing diuretics (may potentiate hypokalemia and/or ECG changes)
    • Beta-blockers (may block bronchodilatory effects of beta-agonists and produce severe bronchospasm)
    • Anticholinergic-containing drugs (may interact additively). Avoid use with BREZTRI
  • Use BREZTRI with caution in patients with hepatic impairment, as budesonide and formoterol fumarate systemic exposure may increase. Patients with severe hepatic disease should be closely monitored 


BREZTRI AEROSPHERE is indicated for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD).


Not indicated for the relief of acute bronchospasm or for the treatment of asthma.

Please see full BREZTRI Prescribing Information, including Patient Information.

You may report side effects related to AstraZeneca products.

TEZSPIRE® (tezepelumab-ekko) Important Safety Information


Known hypersensitivity to tezepelumab-ekko or excipients.


Hypersensitivity Reactions

Hypersensitivity reactions were observed in the clinical trials (eg, rash and allergic conjunctivitis) following the administration of TEZSPIRE. Postmarketing cases of anaphylaxis have been reported. These reactions can occur within hours of administration, but in some instances have a delayed onset (ie, days). In the event of a hypersensitivity reaction, consider the benefits and risks for the individual patient to determine whether to continue or discontinue treatment with TEZSPIRE.

Acute Asthma Symptoms or Deteriorating Disease

TEZSPIRE should not be used to treat acute asthma symptoms, acute exacerbations, acute bronchospasm, or status asthmaticus.

Abrupt Reduction of Corticosteroid Dosage

Do not discontinue systemic or inhaled corticosteroids abruptly upon initiation of therapy with TEZSPIRE. Reductions in corticosteroid dose, if appropriate, should be gradual and performed under the direct supervision of a physician. Reduction in corticosteroid dose may be associated with systemic withdrawal symptoms and/or unmask conditions previously suppressed by systemic corticosteroid therapy.

Parasitic (Helminth) Infection

It is unknown if TEZSPIRE will influence a patient’s response against helminth infections. Treat patients with pre-existing helminth infections before initiating therapy with TEZSPIRE. If patients become infected while receiving TEZSPIRE and do not respond to anti-helminth treatment, discontinue TEZSPIRE until infection resolves.

Live Attenuated Vaccines

The concomitant use of TEZSPIRE and live attenuated vaccines has not been evaluated. The use of live attenuated vaccines should be avoided in patients receiving TEZSPIRE.


The most common adverse reactions (incidence ≥3%) are pharyngitis, arthralgia, and back pain.


There are no available data on TEZSPIRE use in pregnant women to evaluate for any drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Placental transfer of monoclonal antibodies such as tezepelumab-ekko is greater during the third trimester of pregnancy; therefore, potential effects on a fetus are likely to be greater during the third trimester of pregnancy.


TEZSPIRE is indicated for the add-on maintenance treatment of adult and pediatric patients aged 12 years and older with severe asthma.

TEZSPIRE is not indicated for the relief of acute bronchospasm or status asthmaticus.

Please see full Prescribing Information, including Patient Information and Instructions for Use.

You may report side effects related to AstraZeneca products by clickinghere.

FASENRA® (benralizumab) Important Safety Information


Known hypersensitivity to benralizumab or excipients.


Hypersensitivity Reactions

Hypersensitivity reactions (eg, anaphylaxis, angioedema, urticaria, rash) have occurred after administration of FASENRA. These reactions generally occur within hours of administration, but in some instances have a delayed onset (ie, days). Discontinue in the event of a hypersensitivity reaction.

Acute Asthma Symptoms or Deteriorating Disease

FASENRA should not be used to treat acute asthma symptoms, acute exacerbations, or acute bronchospasm.

Reduction of Corticosteroid Dosage

Do not discontinue systemic or inhaled corticosteroids abruptly upon initiation of therapy with FASENRA. Reductions in corticosteroid dose, if appropriate, should be gradual and performed under the direct supervision of a physician. Reduction in corticosteroid dose may be associated with systemic withdrawal symptoms and/or unmask conditions previously suppressed by systemic corticosteroid therapy.

Parasitic (Helminth) Infection

It is unknown if FASENRA will influence a patient’s response against helminth infections. Treat patients with pre-existing helminth infections before initiating therapy with FASENRA. If patients become infected while receiving FASENRA and do not respond to anti-helminth treatment, discontinue FASENRA until infection resolves.


The most common adverse reactions (incidence ≥ 5%) include headache and pharyngitis.

Injection site reactions (eg, pain, erythema, pruritus, papule) occurred at a rate of 2.2% in patients treated with FASENRA compared with 1.9% in patients treated with placebo.


A pregnancy exposure registry monitors pregnancy outcomes in women exposed to FASENRA during pregnancy. To enroll call 1-877-311-8972 or visit

The data on pregnancy exposure from the clinical trials are insufficient to inform on drug-associated risk. Monoclonal antibodies such as benralizumab are transported across the placenta during the third trimester of pregnancy; therefore, potential effects on a fetus are likely to be greater during the third trimester of pregnancy.


FASENRA is indicated for the add-on maintenance treatment of patients with severe asthma aged 12 years and older, and with an eosinophilic phenotype.

  • FASENRA is not indicated for treatment of other eosinophilic conditions
  • FASENRA is not indicated for the relief of acute bronchospasm or status asthmaticus

Please see full Prescribing Information, including Patient Information and Instructions for Use.

You mayreport side effects related to AstraZeneca products.



COPD refers to a group of lung diseases, including chronic bronchitis and emphysema, that cause airflow blockage and breathing-related problems.8 It affects an estimated 391 million people around the world and is the third leading cause of death globally.3,9


The EROS (Exacerbations and Real-World Outcomes) study is a retrospective analysis of real-world outcomes in 2,409 COPD patients appearing in the MORE2 Registry® claims database in the US to examine whether prompt initiation of BREZTRI following an exacerbation lowers risk of future exacerbations compared to delayed and very delayed initiation.1 In the study, qualifying exacerbations included: one moderate exacerbation while on maintenance treatment, the second of two moderate events without any maintenance treatment, and severe events defined as COPD hospitalizations.


EXACOS-CV US (EXACerbations and their OutcomeS – CardioVascular) is a retrospective cohort study of 355,978 patients 40 years and older who were diagnosed with COPD between 1 January 2012 and 31 December 2019. The study used US administrative claims data from the Healthcare Integrated Research Database, managed by Carelon Research (formerly HealthCore), to investigate a correlation between cardiovascular events and moderate-to-severe COPD exacerbations.2


BREZTRI AEROSPHERE (budesonide/glycopyrronium/formoterol fumarate) is a single-inhaler, fixed-dose triple-combination of formoterol fumarate, a LABA, glycopyrronium bromide, a LAMA, with budesonide, an ICS, and delivered in a pressurized metered-dose inhaler. BREZTRI AEROSPHERE is approved to treat COPD in more than 50 countries worldwide including the US, EU, China and Japan, and is currently being studied in Phase III trials for asthma.


TEZSPIRE (tezepelumab) is being developed by AstraZeneca in collaboration with Amgen as a first-in-class human monoclonal antibody that inhibits the action of TSLP, a key epithelial cytokine that sits at the top of multiple inflammatory cascades and is critical in the initiation and persistence of allergic, eosinophilic and other types of airway inflammation associated with severe asthma, including airway hyperresponsiveness.10,11 TEZSPIRE  is approved in the US, EU, Japan and other countries for the treatment of severe asthma.12-14


NAVIGATOR is a Phase III, randomized, double-blinded, placebo-controlled trial to evaluate the efficacy and safety of TEZSPIRE (210mg every four weeks) compared to placebo added to SoC in adults and adolescents with severe, uncontrolled asthma.15 Two post hoc analyses from the NAVIGATOR trial evaluated the effect of TEZSPIRE on the annualized asthma exacerbation rate (AAER) over 52 weeks with and without prior omalizumab, and changes in total and domain SNOT-22 scores from baseline to week 52 in patients with a history of nasal polyps.4,5

Amgen collaboration
In 2020, Amgen and AstraZeneca updated a 
2012 collaboration agreement for TEZSPIRE. Both companies will continue to share costs and profits equally after payment by AstraZeneca of a mid single-digit inventor royalty to Amgen. AstraZeneca continues to lead development and Amgen continues to lead manufacturing. All aspects of the collaboration are under the oversight of joint governing bodies. Under the amended agreement, Amgen and AstraZeneca will jointly commercialize TEZSPIRE in North America. Amgen will record product sales in the US, with AZ recording its share of US profits as Collaboration Revenue. Outside of the US, AstraZeneca will record product sales, with Amgen recording profit share as Other/Collaboration revenue.


FASENRA (benralizumab) is a monoclonal antibody that binds directly to IL-5 receptor alpha on eosinophils and attracts natural killer cells to induce rapid and near-complete depletion of eosinophils via apoptosis (programmed cell death).16 FASENRA is currently approved as an add-on maintenance treatment for severe eosinophilic asthma in the US, EU, Japan and other countries, and is approved for self-administration in the US, EU and other countries.

FASENRA was developed by AstraZeneca and is in-licensed from BioWa, Inc., a wholly-owned subsidiary of Kyowa Kirin Co., Ltd., Japan.  

AstraZeneca in Respiratory & Immunology

Respiratory & Immunology, part of AstraZeneca BioPharmaceuticals is a key disease area and growth driver to the Company.

AstraZeneca is an established leader in respiratory care with a 50-year heritage and a growing portfolio of medicines in immune-mediated diseases. The Company is committed to addressing the vast unmet needs of these chronic, often debilitating, diseases with a pipeline and portfolio of inhaled medicines, biologics and new modalities aimed at previously unreachable biologic targets. Our ambition is to deliver life-changing medicines that help eliminate COPD as a leading cause of death, eliminate asthma attacks and achieve clinical remission in immune-mediated diseases.


AstraZeneca is a global, science-led biopharmaceutical company that focuses on the discovery, development, and commercialization of prescription medicines in Oncology, Rare Diseases, and BioPharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. Please visit and follow the Company on Twitter @AstraZenecaUS.


Media Inquiries

Brendan McEvoy
Jillian Gonzales


+1 302 885 2677
+1 302 885 2677



US Media Mailbox: [email protected] 


  1. Pollack, M, Tkacz, J, Schinkel, J. et al. Exacerbations and real-world outcomes (EROS) among patients with COPD receiving single inhaler triple therapy of budesonide/glycopyrrolate/formoterol fumarate [Poster Discussion]. Presented at the American Thoracic Society International Conference 2023 (19-24 May)
  2. Daniels, K, Tave, A., Neikirk, A., et al. Incidence of acute cardiovascular events following acute exacerbation of chronic obstructive pulmonary disease in a large US claims database [Thematic Poster Session]. Presented at the American Thoracic Society International Conference 2023 (19-24 May).
  3. World Health Organization. The Top 10 Causes of Death. Accessible at: [last accessed May 2023]
  4. Menzies-Gow, A, Colice, G, Ambrose, C, et al. Efficacy of tezepelumab in patients with severe, uncontrolled asthma by prior omalizumab use: a post hoc analysis of the phase 3 NAVIGATOR study. [Mini Symposium] Presented at the American Thoracic Society International Conference 2023 (19-24 May)
  5. Spahn, J, Jacobs, J, Hoyte, F, et al. Tezepelumab efficacy by SNOT-22 domain scores in patients with severe, uncontrolled asthma and comorbid nasal polyps in the phase 3 NAVIGATOR study. [Poster Discussion] Presented at the American Thoracic Society International Conference 2023 (19-24 May)
  6. Le TT, et al. Real-World Evidence of Benralizumab in Patients with Severe Eosinophilic Asthma and Nasal Polyps: Initial Results of the RANS Study. [Poster discussion]. Presented at the American Thoracic Society International Conference 2023, 23 May 2023, 14:15-16:15 EST
  7. Louis R, et al. Approaching clinical remission in severe asthma: An analysis of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) treated with benralizumab across five clinical trials. [Poster discussion]. Presented at the American Thoracic Society International Conference 2023, 23 May 2023, 9:00-16:15 EST
  8. GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023. [Online]. Available at: [last accessed May 2023]
  9. Adeloye D, Song P, Zhu Y, et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. (2022) Vol 10(5); 447-458
  10. Corren J, et al. Tezepelumab in adults with uncontrolled asthma [supplementary appendix; updated April 18, 2019]. N Engl J Med. 2017;377:936-946.
  11. Varricchi G, et al. Thymic Stromal Lymphopoietin Isoforms, Inflammatory Disorders, and Cancer. Front Immunol. 2018;9:1595.
  12. AstraZeneca plc. Tezspire (tezepelumab) approved in the US for severe asthma. Available at: [Last accessed: May 2023].  
  13. AstraZeneca plc. Tezspire approved in the EU for the treatment of severe asthma. 2022. Available at: [Last accessed: May 2023].  
  14. AstraZeneca plc. Tezspire approved in Japan for the treatment of severe asthma. Available at: [Last accessed: May 2023]. 
  15. Menzies-Gow A, et al.  Tezepelumab in Adults and Adolescents with Severe, Uncontrolled Asthma. N Engl J Med. 2021;384: 1800-1809. DOI: 10.1056/NEJMoa2034975. 
  16. AstraZeneca. Fasenra Summary of Product Characteristics. Available at: [Last accessed: May 2023].


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For patients with COVID-19-associated venous thromboembolism (VTE), the risk is low and similar to the risk observed among patients with VTE secondary to hospitalization, according to a paper published in Research and Practice in Thrombosis and Hemostasis.

Investigators from the Arianna Anticoagulation Foundation compared characteristics, management strategies, and long-term clinical outcomes between COVID-19 patients linked to VTE and patients with VTE hospitalized by other acute illnesses. They enrolled 278 COVID-19 patients with VTE in their observational cohort study—which took place at 16 centers in Italy between 2020 and 2021—as well as 300 non-COVID-19 patients.

The investigators noted that other studies had reported a high incidence of VTE in patients hospitalized for COVID-19, with estimates between 15% in patients admitted to medical wards and 23% of patients admitted to intensive care units (ICUs).

The study participants underwent 12 months follow-up after treatment discontinuation, including at least 1 in-person visit at 6 and 12 months. The patients were included in the study if they had objectively diagnosed proximal or distal deep vein thrombosis (DVT) of the lower or upper limbs, and/or pulmonary embolism (PE) diagnosed during hospitalization from COVID-19.

At first, male gender and diabetes were more prevalent in patients with VTE related to COVID-19, but the prevalence of chronic inflammatory disease, history of cerebrovascular events, history of VTE, and history of major bleeding events was significantly lower in COVID-19 patients than in controls. Regarding other variables, the study authors found no difference between the groups. Additionally, PE without concomitant DVT occurred more frequently among patients with VTE secondary to COVID-19 than in the control group.

Significantly more patients with COVID-19-associated VTE received parenteral anticoagulant treatment than controls, with low molecular weight heparin (LMWH) being the most frequent. Fewer COVID-19 patients received fondaparinux or direct oral anticoagulants (DOACs) than controls, the study authors added. DOACs were prescribed more frequently to COVID-19 patients than to controls, but the median duration of anticoagulant treatment was similar between the 2 groups.

There were 27 deaths recorded during treatment: 11 in the COVID-19 group (7 during hospitalization) and 16 in the control group (none during hospitalization). Mortality rates were similar between the groups. COVID-19 group patients’ causes of death included myocardial infarction, acute respiratory failure, and sepsis. In the control group, causes of death included PE and heart failure. The remaining 12 deaths were reported with unknown causes.

“The low number of events seen in our study after discontinuation of therapy suggests that anticoagulant treatment for a limited period of 3-6 months is generally adequate for the majority of patients with COVID-19-associated VTE, similar to what it is currently recommended for patients with VTE secondary to a transient risk factor, including hospitalization for an acute medical disease,” study coordinator Walter Ageno said in a press release.

This research is also being presented as an oral communication at the ISTH Congress (International Society on Thrombosis and Hemostasis) to be held in Montreal, Canada in late June.

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The cause is a destruction or thickening of the vessel walls, their narrowing or obstruction, either total or partial.

This condition causes a fatigue of the right ventricle, which – if neglected – can culminate in heart failure of varying severity, up to and including death.

What is pulmonary hypertension?

Before gaining a better understanding of what pulmonary hypertension is, it is appropriate to do a little review of the exchanges that the heart and lungs have.

In a normal condition, the blood starts from the right side of the heart and, through the pulmonary arteries, irrigates all the blood vessels of the lungs, until it reaches the capillaries.

It is in these small vessels that the exchange between carbon dioxide and oxygen occurs.

The pulmonary pressure is generally low, so the right side of the heart has less muscularity than the left side (which instead sends blood to all the other parts of the body), which needs more pressure.

Sometimes, however, it happens that due to structural changes in the blood vessels (narrowing, obstruction, parietal thickening) the pressure increases from an average of 14mmHg to 25mmHg.

Under these conditions, the right ventricle is subjected to an excessive load of pressure and volume and could reach contractile failure and thus decompensation.

Or, it could happen that the right ventricle thickens and swells excessively, developing the so-called pulmonary heart, resulting in right heart failure.

If neglected or not properly treated, pulmonary hypertension can even culminate in fatal heart failure.

What are the causes?

To identify the causes of pulmonary hypertension, a distinction must be made in the disease.

It is possible for it to occur in the absence of any particular trigger or previous illness: we speak in this case of primary or idiopathic pulmonary hypertension.

Women – twice as many as men – between 30 and 50 years of age are particularly affected. In this case, the cause is unknown, but as research progresses, some associations with genetic mutations are being identified.

Unfortunately, the mechanism by which these mutations cause pulmonary hypertension is still unknown.

In addition, it has become apparent that the intake of drugs and substances such as fenfluramine (a substance used in weight loss), amphetamines, cocaine and Selective Serotonin Reuptake Inhibitors (SSRIs) can be serious risk factors for developing the disease.

Pulmonary hypertension can also develop in association with other diseases, in this case we speak of acquired or secondary hypertension, which is much more common than the former.

But what are these driving diseases? Emphysema, pulmonary fibrosis, chronic obstructive pulmonary disease and other pulmonary diseases, as well as sleep apnoea, respiratory pathologies linked to sleep disorders.

Still remaining in the lung area, hypertension can be caused by embolisms in the area.

Heart defects or diseases of the left heart can also be a cause, as can autoimmune diseases of the connective tissue, such as scleroderma or lupus erythematosus.

Finally, there are other diseases that can become a trigger for pulmonary hypertension, such as sickle cell anaemia, chronic liver disease and HIV.

Symptoms of pulmonary hypertension

Generally, pulmonary hypertension is manifested by rather abnormal shortness of breath (or dyspnoea), which occurs even during very light physical activity.

Accompanying dyspnoea is an easy loss of energy, chronic fatigue, feeling light-headed, light-headedness under even mild exertion and fainting.

In the more advanced stages of the disease, symptoms worsen: one may have difficulty breathing even at rest, pain very similar to angina pectoris, caused by the suffering of the right heart, and fluid stagnation, resulting in oedema of the lower limbs.

The diagnosis

Obviously, it is not possible to make a self-diagnosis of pulmonary hypertension; if you realise that something is wrong with your health to such an extent that you suspect this pathology, it is always a good idea to consult your general practitioner first, who will direct you to the appropriate specialist.

The case of secondary pulmonary hypertension is different: generally with that type of pathology listed above, one is already being followed by a specialist who will know how to prescribe the right diagnostic tests to best formulate the diagnosis.

Let’s take a step-by-step look at what tests are usually prescribed for a correct diagnosis.

Chest X-ray, which highlights any dilation of the pulmonary arteries.

Transthoracic echocardiography. This provides an accurate view of the heart and any morphological changes in the right atrium and ventricle, which we have seen are a consequence of increased pulmonary pressure. In addition, if an echodoppler is performed, an indirect estimate of the maximum pressure in the pulmonary artery can also be obtained.

Spirometry to detect lung abnormalities. This involves blowing into a tube connected to a device that measures various breathing parameters.

Angio computed tomography of the chest, an X-ray test to observe the pulmonary arteries and detect the presence of occlusions

Pulmonary perfusory scintigraphy, an investigation that allows the blood circulation of the lungs to be photographed in order to observe obstructions or defects in blood supply.

All these tests are non-invasive and are preliminary to the introduction of a catheter into the heart, the only method for a definitive diagnosis.

The catheter will have to start in an arm or leg to reach the right heart and be able to directly measure certain parameters, such as atrium pressure, mean pulmonary pressure and cardiac output.

In addition, only with cardiac catheterisation is it possible to perform the pulmonary vaso-reactivity test: the pulmonary blood vessels are dilated using certain drugs in order to identify any problems in the vessels.

Other tests can also be administered to confirm the diagnosis of pulmonary hypertension, measure its severity and establish its cause:

Blood tests to rule out the presence of autoimmune diseases.

CT angiography to examine for blood clots in the lungs.

EGA, Haemogasanalysis to measure the amount of oxygen and carbon dioxide in the blood through an arterial sampling.

Cardiopulmonary stress test.

Is it possible to prevent pulmonary hypertension?

As far as primary pulmonary hypertension is concerned, it is difficult to think of prevention, other than to advise against taking the substances listed above that could promote the onset of the disease.

Nor is there any real prevention for secondary pulmonary hypertension, other than treating one’s medical condition as best one can to reduce the risk factors that could cause hypertension.

How is pulmonary hypertension treated?

Fortunately, research and medical innovations are progressing from year to year: until recently, the only possible solution to pulmonary hypertension was a lung transplant or, in the case of severe heart impairment, a heart and lung transplant.

Obviously, this was a solution that was only practised in the most severe cases because the risks and contraindications are so many.

Today, however, there are several treatments that do not definitively solve the problem but slow down the progression of the disease and definitely improve the quality of life.

It must be said, however, that in the most extreme cases of patients in whom the progression of hypertension is not stopped, the only solution still remains transplantation.

Obviously, treatment will be easier when there is an exactly identified cause.

Let us now look specifically at what treatments are used in most cases:

  • Administration of drugs that manage to vasodilate the pulmonary circulation: calcium antagonists, prostacyclins, anti-endothelin drugs and phosphodiesterase type 5 inhibitors (sildenafil and the like).
  • These substances are able to reduce blood pressure in the pulmonary arteries. This can decisively improve the quality of the patient’s everyday life, extend life expectancy and reduce the likelihood of an impending transplant. Generally, vasodilators are tested on the patient during carotid catheterisation, because they may be dangerous in some individuals.
  • Administration of oral anticoagulants, which can be combined with diuretics and other heart failure therapies in the event of circulatory decompensation. These drugs may also be prescribed to prevent symptomatic complications. In particular, diuretics are used to ensure that the right ventricle maintains a normal volume and to reduce swelling in the limbs; while anticoagulants, by preventing blood clotting, reduce the risk of pulmonary embolism.
  • If reduced blood oxygenation is noted in the patient, oxygen can be administered via nasal cannulae or oxygen masks. The consequence will be to reduce the blood pressure in the pulmonary arteries and relieve shortness of breath.

Obviously, the case of a secondary form of the disease will be different: therapy will mainly be based on treatments to cure the condition.

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A recent study published in the Journal of Infection evaluated clinical differences between critically ill coronavirus disease 2019 (COVID-19) and influenza patients.

Study: Differences in clinical characteristics and outcomes between COVID-19 and influenza in critically ill adult patients: a national database study. Image Credit: Thaiview/
Study: Differences in clinical characteristics and outcomes between COVID-19 and influenza in critically ill adult patients: a national database study. Image Credit: Thaiview/


The most common cause of acute respiratory failure was influenza before COVID-19. The influenza pandemic has been used for modeling and planning for epidemics. The common features of COVID-19 and influenza are human-to-human transmission through droplets and acute respiratory distress syndrome. Nonetheless, only a few studies have compared the characteristics and outcomes of COVID-19 and influenza patients. 

About the study

In the present study, researchers compared the clinical features and outcomes between COVID-19 patients and a historical influenza cohort in France using data from an administrative healthcare database. COVID-19 patients admitted to intensive care units (ICUs) between March 2020 and June 2021 were included. Besides, patients in the historical influenza cohort were admitted to ICUs between 2014 and 2019.

Patients required appropriate International Classification of Diseases, Tenth Revision (ICD-10) codes for the diagnosis of influenza or COVID-19 for inclusion. Age, sex, and simplified acute physiology score II (SAPS-II) were recorded at admission, and the Charlson comorbidity index was calculated. Patients with medullar aplasia, solid organ transplants, agranulocytosis, or cancer treatment were deemed immunocompromised.

During hospitalization, the team recorded the use of non-invasive (NIV) or invasive ventilation, extracorporeal membrane oxygenation (ECMO), high-flow nasal cannula (HFNC), prone positioning, and vasopressors. Additionally, they documented if patients developed venous thrombosis events or underwent renal replacement therapy.

The study outcomes were ICU/hospital stay, ventilation duration, and vital status at discharge. Vaccination status was obtained beginning in 2021. Chi-squared or Wilcoxon tests were used for comparisons between influenza and COVID-19 patients. The team identified risk factors using the Fine-Gray model. First, they estimated the sub-hazard ratio for invasive ventilation in univariate analysis.

Subsequently, a multivariable analysis was adjusted for a predefined set of confounders such as age, infection type, sex, heart disease, diabetes mellitus, cancer, immunosuppression, modified SAPS-II, hematologic malignancies, arterial hypertension, and chronic kidney disease. The association between infection type and in-hospital death was also determined.


The study included 105,979 COVID-19 and 18,763 influenza patients. Most COVID-19 patients were males and had lower SAPS-II scores at admission than influenza patients. Diabetes mellitus, solid tumors, arterial hypertension, and chronic kidney disease were more common in the COVID-19 cohort.

In contrast, cirrhosis, malignancies, chronic respiratory diseases, and congestive heart disease were more common in the influenza cohort. Around 34%, 18%, and 6% of COVID-19 patients required invasive ventilation, HFNC, and NIV, respectively. By contrast, most influenza patients (47%) required invasive ventilation.

COVID-19 was associated with a reduced likelihood of invasive ventilation and an increased in-hospital mortality risk without invasive ventilation. Prone positioning was used for 19% and 12% of COVID-19 and influenza patients, respectively, whereas ECMO was used for 1% of patients in each cohort. The COVID-19 cohort was less likely to require vasopressors and renal replacement therapy than the influenza cohort.

COVID-19 patients were more likely to develop pulmonary embolism than influenza patients. In-hospital deaths were more in the COVID-19 cohort than in the influenza cohort. Notably, for patients aged <60, in-hospital deaths were higher among influenza patients than in the COVID-19 cohort. On the contrary, for patients aged 60 or above, mortality was higher in the COVID-19 cohort.

The adjusted Fine-Gray model revealed a higher risk of in-hospital mortality in COVID-19 patients than in influenza patients, particularly for patients aged 65 or older. This finding was consistent among the sub-group of patients requiring invasive ventilation. The hospital stay was longer for COVID-19 patients than for influenza patients. ICU stay was longer for COVID-19 patients, albeit the difference was not relevant clinically.

However, in the subgroup of patients with invasive ventilation, COVID-19 patients had a significantly longer ICU stay than influenza patients. The researchers performed sensitivity analyses restricting COVID-19 patients admitted in 2021 and found that COVID-19 patients had an elevated mortality risk relative to influenza patients, irrespective of the COVID-19 vaccination status.


To summarize, the researchers observed significant differences in ICU management and clinical characteristics and outcomes between critical COVID-19 and influenza patients. COVID-19 patients were less likely to require invasive ventilation. Regardless, COVID-19 patients, especially older adults (≥65 years), showed a consistently higher mortality risk than influenza patients independent of invasive ventilation or vaccination status.

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Phlegm, also known as sputum, is a thick secretion from the airways. It's thicker and comes from deeper in the respiratory tract than the thin secretions you may experience with a simple runny nose. Coughing up phlegm, known as a productive cough, is commonly due to viral respiratory infections that the body may clear on its own, but sometimes it can signal a more serious problem.

Read on if you're coughing up phlegm and looking to learn about possible causes and treatments.

The Good Brigade / Getty Images

What Causes Productive Cough?

Mucus is a normal part of the respiratory system that plays an important role in lubricating the airways and defending us against irritants and pathogens. However, inflammation from various causes results in an increase in mucus production and a thicker consistency. This results in the familiar symptoms of runny nose, congestion, and coughing up phlegm.

Respiratory infections are a common cause of inflammation resulting in a productive cough. Bronchitis and pneumonia are two types of infections that typically lead to a productive cough.

In bronchitis, the branches of the airways become inflamed and produce thicker mucus. In pneumonia, the lung tissue is infected. Respiratory infections can be due to viruses or bacteria. The cough is typically accompanied by other symptoms, like fever, chills, sore throat, muscle aches, fatigue, and a general ill feeling.

Possible Causes Unrelated to Infection

While infection is a common cause, there are several noninfectious causes of phlegm production. These include:

Some environmental and lifestyle factors can also increase phlegm. These include:

  • Smoking
  • Exposure to air pollution
  • Alcohol use

What Does the Color of Phlegm Mean?

While diagnosing the cause of a productive cough does not rely on phlegm color, it can suggest certain causes. Normally, mucus is clear, but phlegm can come in a range of colors that may point to the underlying cause:

  • Clear or white phlegm may be seen with allergies, viral infection, underlying lung disease, GERD, and heart failure.
  • Green phlegm may be seen with a bacterial infection.
  • Pink phlegm suggests fluid in the lungs, known as pulmonary edema, such as in heart failure.
  • Red phlegm indicates the presence of blood and may be seen with lung cancer or pulmonary embolism.
  • Black phlegm can occur with pollutant exposure, such as from cigarette smoke or air pollution, smoke from fire, or fungal infection.


Treating a productive cough depends on the underlying cause. Medications and supportive care at home can help treat a productive cough.


Treating the underlying cause of productive cough may include medications, some of which require a prescription from a healthcare provider. These include:

The Issue With Antibiotics

If you are coughing up phlegm and have symptoms of infection, like fever, chills, and fatigue, you might expect to receive antibiotics to treat it. But if your healthcare provider recommends a trial of supportive care instead of antibiotics, know that it's for a good reason. Most infectious causes of cough are due to viruses and not bacteria. Antibiotics treat bacterial infections, so they won't necessarily be effective in the case of a viral infection. Viral infections, like the common cold, will often be cleared by the body on their own and do not require specific medical treatment beyond supportive care at home. Importantly, antibiotics can have significant side effects, and overuse of antibiotics contributes to antibiotic resistance.

How to Encourage Coughing Up Phlegm at Home

Supportive treatment for productive cough includes measures to encourage coughing up the phlegm. This can help rid the body of phlegm and underlying irritants.

The following measures can help your body get rid of phlegm:

  • Drink plenty of fluids
  • Use a humidifier
  • Take a hot shower
  • Try a teaspoon of honey
  • Use over-the-counter (OTC) medications (like guaifenesin and bromhexine) such as expectorants and mucolytics that loosen mucus to make it easier to cough up

When to See a Healthcare Provider

if your cough isn't getting better after 10 days, it's time to discuss your symptoms with your healthcare provider. Other concerning symptoms should be reported to your healthcare provider for further investigation. These include:

  • Difficulty breathing
  • Fever, especially if lasting more than four days
  • Weight loss
  • Coughing up blood
  • Signs of heart failure, such as swollen legs and difficulty breathing when laying flat


Phlegm is a thick mucus from the lower airways due to lung inflammation or injury. Infection is a common cause, but other conditions like allergies, lung disease, and GERD can cause a productive cough. Treatment depends on the underlying cause and includes supportive care and medications. Your healthcare provider can help determine the underlying cause and recommend a treatment plan if you are experiencing this unpleasant symptom.

By Angela Ryan Lee, MD

Angela Ryan Lee, MD, is board-certified in cardiovascular diseases and internal medicine. She is a fellow of the American College of Cardiology and holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography. She completed undergraduate studies at the University of Virginia with a B.S. in Biology, medical school at Jefferson Medical College, and internal medicine residency and cardiovascular diseases fellowship at the George Washington University Hospital. Her professional interests include preventive cardiology, medical journalism, and health policy.

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Chest pain when breathing deeply may indicate several conditions, including COVID-19, pneumonia, and pleurisy. The potential causes vary in severity, and all require different treatments.

There are many possible causes of chest pain when breathing deeply. Causes of chest pain are not always serious.

However, chest pain is occasionally a symptom of conditions that require urgent medical attention, such as a heart attack. A person should call 911 if they experience:

  • chest pain or discomfort
  • jaw, neck, or back pain
  • shortness of breath
  • lightheadedness or vomiting
  • arm or shoulder pain or discomfort

Treatment for chest pain when breathing deeply differs depending on the cause of the chest pain. Doctors usually consider all of a person’s symptoms to make a diagnosis.

This article explains some potential causes of chest pain when breathing deeply, including other symptoms a person might experience and typical treatments.

Pleurisy is inflammation that affects the pleura. The pleura is a layer of tissue that separates the lungs from the rib cage. Pleurisy can arise for many reasons, such as infection or cancer.


The characteristic symptom of pleurisy is pain in the shoulder or chest. This may worsen with:

  • breathing
  • coughing
  • sneezing
  • torso movement

Pleuritic chest pain may be dull, sharp, burning, or aching.


There is no single treatment for pleurisy. Doctors treat its underlying cause. Possible treatment options include:

  • surgery
  • needle aspiration
  • medication

COVID-19 is an infectious condition. It develops from infection with the coronavirus SARS-CoV-2 and causes respiratory problems. There is evidence that COVID-19 can cause chest pain.

Research from 2022 also suggests that chest pain can develop in people with long COVID.

In both cases, chest pain may indicate that COVID-19 has led to cardiac problems.


There are several symptoms of COVID-19, including:

These symptoms may also persist in long COVID. Additional long COVID symptoms include tiredness, weakness, and lethargy.


A variety of medications can help treat COVID-19. These include:

  • antiviral drugs
  • anti-SARS-CoV-2 monoclonal antibodies
  • anti-inflammatory drugs
  • immunomodulators

For mild cases of COVID-19, over-the-counter pain or cold medications can help alleviate symptoms. For severe cases, oxygen therapy and ventilator support may be necessary.

Pericarditis is inflammation of the pericardial sac. This sac is a protective lining that surrounds the heart.

According to the American Heart Association, a sharp, stabbing chest pain is a common symptom of acute pericarditis.

However, chest pain may be absent in people with chronic pericarditis.


The chest pain can be fairly central or affect the left side of the chest. Some people may also experience shoulder pain.

A person can experience sharp, stabbing chest pain that typically develops quickly, or it can feel like a dull, aching pressure.

Taking deep breaths and lying down can worsen pericarditis chest pain. It sometimes improves if someone is sitting upright and leaning forward.

Some people with acute pericarditis may also experience:

  • fever
  • difficulty breathing
  • weakness
  • heart palpitations
  • coughing

If a person experiences heart palpitations with chest pain, they should make an appointment with a doctor, as this can indicate a problem with the heart.


According to the American Heart Association, there are several treatment options for pericarditis, including:

  • rest
  • anti-inflammatory medications
  • colchicine, a medication that treats inflammation and pain
  • steroids

If pericarditis stems from a bacterial infection, antibiotics may be necessary.

Chronic obstructive lung disease (COPD) is a condition involving limited airflow within the lungs, causing breathing difficulties.

According to a 2018 study, 22–54% of people with COPD experience chest pain. This may worsen when breathing deeply.


COPD can cause several symptoms. These include:

  • muscle wasting
  • respiratory distress
  • prolonged expiration
  • breathing with pursed-lips
  • wheezing


COPD treatment aims to improve quality of life, manage symptoms, and reduce the risk of death. Treatments include:

  • lung rehabilitation
  • smoking cessation, if applicable
  • medications, such as:
  • surgery, such as:

Doctors may also recommend preventive steps, such as regular vaccinations against conditions affecting the lungs.

A pulmonary embolism is when a blood clot blocks an artery within the lungs. It can deprive the lungs of oxygen, causing breathing difficulties and other complications.

Pulmonary embolisms can cause chest pain that worsens with breathing.


Other than chest pain, pulmonary embolisms have other common symptoms. These include:

  • shortness of breath
  • coughing
  • coughing blood
  • feeling faint
  • losing consciousness

Less commonly, pulmonary embolisms can cause cardiac symptoms, such as an irregular heart rate.


Treatment for a pulmonary embolism aims to manage complications and cure the condition. The principal means of treating pulmonary embolism are as follows:

Treatment also aims to help prevent future pulmonary emboli.

Pneumonia is an inflammation of the lungs. It arises from infections within the lungs, which may be viral, bacterial, or fungal.

Pneumonia can cause chest pain, which may worsen with breathing.


There are many possible symptoms of pneumonia. These include:

  • feeling unwell
  • chills
  • appetite loss
  • muscle aches or pain
  • abdominal pain
  • cough

In some cases, pneumonia can lead to coughing blood.


Doctors have several ways of treating pneumonia. Treatments aim to cure or manage the underlying cause using antibiotic medication. Those medications can include:

  • fluoroquinolones
  • beta-lactam antibiotics
  • macrolides
  • doxycycline

Lung cancer is when cells within the lungs begin to grow uncontrollably. Between 20 and 40% of people with lung cancer experience chest pain. It may worsen with deep breathing.


As lung cancer develops, it can create various forms of organ dysfunction. This can lead to several symptoms, including:

  • coughing
  • shortness of breath
  • coughing blood
  • dilated neck veins
  • swelling in the neck, face, or arms

If lung cancer spreads, it can cause symptoms in other body parts. For instance, lung cancer can spread to the bones, causing bone pain.


Doctors may treat lung cancer using the following methods:

Some people may receive a combination of treatments.

Anyone who has chronic or severe chest pain when breathing should contact a doctor, especially if they have any of the other symptoms listed above.

Such pain could indicate a serious condition, such as lung cancer or pulmonary embolism.

Several conditions can cause chest pain when breathing deeply.

These include inflammatory conditions, such as pleurisy, pericarditis, and pneumonia. COVID-19 can do the same, as well as COPD and pulmonary embolism. Lung cancer can also cause chest pain when breathing deeply.

Chest pain can also indicate a medical emergency, such as a heart attack.

Treatment for chest pain depends on the underlying cause. If a person has any concerns about chest pain when breathing deeply, they should reach out to a doctor.

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MirchiMirchiUpdated: 44 min ago
6 Ways to enhance oxygen levels in your body

Maintaining optimal oxygen levels is crucial for overall health and well-being. Adequate oxygenation supports cellular function, boosts energy levels, and enhances cognitive performance. Let us explore 6 practical and effective ways to improve oxygen levels in your body, promoting vitality and vitality.

1) Engage in regular physical exercise


Physical activity is an excellent way to enhance oxygen levels. Regular exercise helps improve lung capacity, allowing for more efficient oxygen uptake. Engaging in aerobic exercises such as brisk walking, jogging, cycling, or swimming stimulates deep breathing, increasing oxygen intake. Additionally, strength training exercises, like weightlifting or resistance training, boost the efficiency of oxygen utilization by improving muscle function and promoting cardiovascular health.

2) Practice deep breathing techniques

deep breathing

Deep breathing exercises can significantly improve oxygenation. Techniques such as diaphragmatic breathing or belly breathing focus on expanding the diaphragm to draw in more oxygen. Take slow, deep breaths through your nose, allowing your abdomen to rise, and exhale slowly through your mouth. Deep breathing not only increases oxygen levels but also promotes relaxation, reduces stress, and enhances mental clarity.

3) Maintain proper posture

proper posture

Good posture plays a vital role in optimal lung function. Slouching compresses the lungs, limiting their capacity to expand fully. To improve oxygen levels, practice maintaining an upright posture while sitting, standing, or walking. Keep your shoulders back, chest lifted, and head aligned with your spine. This open posture allows for unrestricted breathing, enabling a better exchange of oxygen and carbon dioxide.

4) Increase indoor air quality

Indoor air quality can have a significant impact on oxygen levels. Ensure proper ventilation in your living spaces by opening windows or using air purifiers to remove pollutants, dust, and allergens. Consider incorporating indoor plants such as snake plants, peace lilies, or spider plants that naturally purify the air by absorbing carbon dioxide and releasing oxygen. Regularly clean and vacuum your living areas to minimize dust and keep the air fresh.

5) Stay hydrated

stay hydrated

Adequate hydration is vital for optimal oxygen levels. Water helps thin the blood, allowing for better circulation and oxygen delivery to cells. Aim to drink at least eight glasses of water per day and increase your intake during exercise or when in dry environments. Limit the consumption of dehydrating beverages such as alcohol and caffeine, as they can contribute to dehydration and hinder oxygenation.

6) Maintain a balanced diet

balanced diet

Nutrition plays a key role in oxygenation. Include foods rich in iron, such as leafy greens, lean meats, beans, and nuts, as iron is essential for hemoglobin production, which carries oxygen in the blood. Omega-3 fatty acids found in fatty fish, chia seeds, and flaxseeds promote lung health and efficient oxygen exchange. Antioxidant-rich fruits and vegetables, such as berries, citrus fruits, and spinach, protect lung tissue from oxidative stress, maintaining their functionality for proper oxygen absorption.

But there also are various factors that can contribute to a drop in oxygen levels, leading to potential health complications. Check some of those factors now-

1) Respiratory conditions

Respiratory conditions are a primary cause of decreased oxygen levels. Chronic obstructive pulmonary disease (COPD), asthma, pneumonia, and bronchitis can impair lung function, limiting the exchange of oxygen and carbon dioxide. These conditions lead to narrowed airways, inflammation, and decreased lung capacity, making it more difficult for oxygen to reach the bloodstream. Patients with respiratory conditions may require supplemental oxygen or specific medications to alleviate symptoms and improve oxygenation.

2) High altitude

At higher altitudes, oxygen levels in the air decrease, which can result in a drop in blood oxygen saturation. This reduction in oxygen availability is due to decreased atmospheric pressure. People who live in or travel to high-altitude regions may experience symptoms like shortness of breath, fatigue, and dizziness. The body can adapt to high altitudes over time, but in severe cases, supplemental oxygen may be required to maintain adequate oxygen levels.

3) Anemia

Anemia is a condition characterized by a decrease in red blood cells or hemoglobin, impairing the blood's ability to carry oxygen. Hemoglobin binds to oxygen in the lungs and transports it throughout the body. Deficiencies in iron, vitamin B12, or folate can lead to anemia. Common symptoms include fatigue, weakness, and shortness of breath. Treatment involves identifying and addressing the underlying cause of anemia, such as nutritional deficiencies or chronic conditions, and may include iron supplementation or blood transfusions.

4) Heart conditions

Heart conditions can contribute to decreased oxygen levels. Conditions such as congestive heart failure, coronary artery disease, and arrhythmias can weaken the heart's pumping ability, reducing blood flow to the lungs and other organs. This can result in inadequate oxygenation of the tissues. Symptoms may include shortness of breath, chest pain, and fatigue. Managing heart conditions through medications, lifestyle changes, and, in some cases, medical interventions like angioplasty or bypass surgery can help improve oxygen delivery to the body's tissues.

5) Lung disorders

Certain lung disorders can significantly impact oxygen levels. Conditions like pulmonary fibrosis, lung cancer, and pulmonary embolism can interfere with the lung's ability to absorb and transfer oxygen to the bloodstream. In pulmonary fibrosis, for instance, lung tissue becomes thickened and scarred, impairing oxygen exchange. Timely diagnosis and appropriate treatment, including medication, surgery, or radiation therapy, can help manage these conditions and potentially improve oxygen levels.

Understanding the causes behind decreased oxygen levels is crucial for early detection and appropriate intervention. Seeking medical attention, adopting lifestyle changes, and adhering to prescribed treatments can help restore and maintain optimal oxygen levels, promoting overall health and well-being.

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On April 28, a Reddit post on the subreddit r/covidlonghaulers revealed that medical staff at Stanford Medicine had stopped masking when seeing Long COVID patients face-to-face as part of an ongoing clinical trial. The poster said that his wife quit and walked out of the study as a result. At least one other participant is confirmed to have also walked out on the trial. 

Clinical lab scientist Selam Bihon processes upper respiratory samples from patients suspected of having COVID-19 at the Stanford Clinical Virology Laboratory on Wednesday, Feb. 3, 2021, in Palo Alto, Calif. (AP Photo/Noah Berger)

“… Not only does it demonstrate a complete lack of regard and understanding for the illness in question, in my opinion it calls into question the legitimacy of the entire study,” the user said in the reddit post. “We’ve been traveling hundreds of miles for months in order to try to participate in their study and provide THEM with data about the illness, and this is what they think of us.”

The clinical trial, which is sponsored by Stanford University in collaboration with Pfizer and run by Stanford Medicine, seeks to compare the effectiveness of Paxlovid (nirmatrelvir and ritonavir) with that of a placebo (and ritonavir) in treating post-acute sequelae of SARS-CoV-2 (PASC), more commonly known as Long COVID. The study includes 200 participants with Long COVID who were randomly assigned to receive either Paxlovid or the placebo. Participants would take their drug for the first 15 days and come into the study clinic five times over the course of the next 15 weeks.

In early April, Stanford Medicine announced that masks are no longer required for staff, patients or visitors across the whole hospital system. Hospitals across the country have similarly been dropping mask mandates despite the spread of the new Arcturus variant.

The notion that hospital systems would remove mask mandates in health care can only be understood within the larger context of the abandonment of all COVID safety measures in the US and around the world to ensure the continuing enrichment of the ruling classes. In the US, this bipartisan policy has been spearheaded by the Biden administration and followed by state legislatures no matter which party is in control. 

On Thursday, the White House ended the national COVID-19 public health emergency, which means that the CDC will no longer track COVID-19 transmission at the “community level,” uninsured Americans will now have to pay full price for vaccines, tests, and other treatments, and millions of people are now at risk of losing their health coverage through the “unwinding” of Medicaid. This was preceded by the World Health Organization’s announcement formally ending the COVID-19 Public Health Emergency of International Concern (PHEIC), a decision with no scientific basis that serves to justify the ending of public health measures by governments around the world. 

The ending of masking, especially in a health care setting, puts society’s most vulnerable at risk. In addition, health care workers, burned out and already bearing the brunt of the mismanagement of the virus, are now facing increasingly unsafe conditions as even the nominal protection from masks is taken away.

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Chronic lower respiratory disease, primarily chronic obstructive pulmonary disease (COPD), is the fourth leading cause of death in the United States.1,2 Almost 15.7 million Americans (6.4%) have been diagnosed with COPD.1 More than 50% of adults with low pulmonary function are undiagnosed and unaware that they have this disease. Once thought to be a disease predominantly affecting men, more women than men are currently living with (and dying from) COPD in the United States.1,3 Best practices for the diagnosis and management of COPD are evolving, as reflected in the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report.

The GOLD Science Committee updated the definition of COPD to reflect the heterogeneous nature of this condition, stating that COPD is characterized by chronic respiratory symptoms (dyspnea, cough, sputum production, exacerbations) caused by abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that result in persistent, often progressive, airflow obstruction.4 The 2023 GOLD report also updated risk factors and revised treatment guidelines.4

Etiology and Risk Factors

Chronic obstructive pulmonary disease is caused by a combination of genetic predisposition, inflammatory changes in the airways, immune reactivity, and environmental factors.4 Although tobacco smoking is a leading cause of COPD globally, the 2023 GOLD Report also emphasizes the role of inhalation of smoke from biomass fuel or ambient particulate matter from household and outdoor air pollution in the risk for COPD.4 Exposure to indoor smoke from biomass fuels is estimated to account for 35% of COPD cases globally.5 Occupational exposures are also associated with COPD. A study based on the Third National Health and Nutrition Examination Survey (NHANES III) reported that occupational exposure was attributable to COPD in 31.1% of nonsmokers, reflecting an increased prevalence of COPD among nonsmokers in certain industries and occupations.6 For example, different occupational dust and fumes, industrial and agricultural, have been associated with COPD and respiratory symptoms.4

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Alpha-1 antitrypsin deficiency (AATD) is also a rare genetic disorder that causes COPD.4 Alpha-1 antitrypsin (AAT) is a serine protease inhibitor that protects lung tissue from proteolytic damage by inhibiting elastase, an enzyme secreted by white blood cells. The disorder is caused by a single genetic variant and clinical manifestations include panacinar emphysema, airway hyperresponsiveness, and bronchiectasis.7

Clinical Manifestations

Chronic obstructive pulmonary disease causes a range of symptoms that lead to a daily burden and limitations of daily activity in the affected individual. The most common symptoms are dyspnea, cough, and sputum production.4 Patients also experience wheezing, fatigue, chest tightness, and chest congestion.4 Many persons report breathlessness that varies daily, weekly, or seasonally. Of the patients who report seasonal variability in their COPD symptoms, 56% report their symptom burden is greatest during the winter months.8 Winter is associated with an increased risk of COPD exacerbations and it is thought that the cold, damp environment prevailing during the winter months as well as increased exposure to respiratory viral infections at that time of year may partly explain this seasonal association.9

Physical findings that are associated with COPD include cyanosis, enlarged chest diameter, prolonged exhalation phase in breathing, and breathlessness with exertion. Cyanosis may be observed particularly in the lips and mucous membranes in persons with severe COPD and hypoxia. A large amount of retained air in the chest can create a barrel shape. Patients tend to have orthopnea; difficulty breathing in the supine position. Sitting forward or tripoding eases breathing. When auscultating the chest, diminished breath sounds, prolonged exhalation, and wheezing are found. Patients with cor pulmonale can have bilateral crackles and signs of right ventricular failure such as jugular venous distension and ankle edema.10

Diagnosis of COPD

Although COPD may be suspected based on findings from the history and physical examination, the diagnosis must be confirmed by spirometry to detect airflow obstruction and its severity, according to the GOLD 2023 Report.4 Spirometry measures 2 key factors: forced expiratory volume in 1 second (FEV1) and expiratory forced vital capacity (FVC). Chronic obstructive pulmonary disease is diagnosed when the postbronchodilator FEV1/FVC ratio is less than 0.7. Accurate assessment of the patient’s maximal effort is important, and testing should be repeated at least 3 times to get the best results.

The GOLD 2023 Report also recommends a comprehensive assessment of the patient with COPD based on spirometry postbronchodilator. The recommended bronchodilator is 400 mcg of a short-acting β-agonists (SABA), 160 mcg of a short-acting muscarinic antagonist (SAMA), or the 2 agents combined. The FEV1 should be measured 10 to 15 minutes after administration of the SABA or 30 to 45 minutes after the SAMA or combination is administered. Appropriate reference values should be used based on age, height, sex, and race.4

Patient Questionnaires Added to Assessment

In addition to spirometry, the patient’s self-assessment of their condition is considered an important factor in the management of COPD. The modified Medical Research Council (mMRC) dyspnea scale was the first questionnaire developed to measure breathlessness, which is a key symptom in many patients with COPD, although often unrecognized. The mMRC includes a question about the level of activity that causes breathlessness for the patient on a 0 to 4 scale. Zero indicates that the patient only experiences breathlessness with strenuous exercise, whereas a 4 indicates that the patient experiences too much breathlessness to leave the house or when dressing and undressing.4

COPD impacts patients in more ways beyond dyspnea. For this reason, multidimensional questionnaires are recommended. The most comprehensive disease-specific health status questionnaires such as the Chronic Respiratory Questionnaire (CRQ) and St. George’s Respiratory Questionnaire (SGRQ) are important research tools (but are too complex to use in routine practice). Shorter comprehensive measures, such as the COPD Assessment Test (CAT) and The COPD Control Questionnaire (CCQ) have been developed and are suitable for use in the clinic. The CAT tool is a Likert scale that asks questions about level of activity, episodes of cough, chest tightness, sleeping ability, with scores from 0 to 40.4

The GOLD 2023 diagnostic guidelines recommend use of the mMRC and CAT tools in the assessment of the patient.4

Other Laboratory Tests

Other tests that are useful in the clinical diagnosis of COPD include arterial blood gas test, which can reveal chronic hypercapnia and may prompt evaluation for oxygen therapy in select patients. A 6-minute walk test should be ordered in patients with progressively worsening dyspnea or lung function to assess for hypoxia on exertion and determine the need for long-term oxygen therapy. Eosinophil count on a complete blood count with differential can help guide the decision to initiate or discontinue inhaled corticosteroids (ICSs). Patients with high eosinophil counts (>300 cells/µL) respond to ICSs added to the regimen. Obtaining a chest computed tomography (CT) scan is important to rule out pulmonary embolism and assess for the presence of other coexisting pulmonary abnormalities including bronchiectasis, interstitial lung disease, and lung mass.4

Once the diagnosis is established, the FEV1 is used to define the severity of lung function impairment. The GOLD Report classifies the severity of airflow obstruction in COPD as4:

  • Mild: FEV1 ≥80% of predicted (GOLD Grade: 1)
  • Moderate: FEV1 of 50% to 79% of predicted (GOLD Grade: 2)
  • Severe: FEV1 of 30% to 49% of predicted (GOLD Grade: 3)
  • Very severe: FEV1 <30% predicted (Gold Grade: 4)

2023 GOLD Report COPD Treatment Guidelines

The goals of COPD treatment are to manage symptoms and prevent exacerbations. Classes of pharmacologic agents used to treat COPD are shown in the Table. Because most COPD pharmacotherapies are inhalers, patients need instruction on the proper inhaler technique. The choice of inhaler device needs to be individualized based on access as well as the patient’s ability and preference. Demonstration of the inhaler technique is critical and should be assessed at each visit. Studies show that improper inhaler technique is common and responsible for inadequate treatment.4

Table. Common Medications Used to Treat COPD

Class Drug (brand name)
SABAs Albuterol/salbutamol
LABAs Formoterol
SAMAs Ipratropium bromide
Oxitropium bromide
LAMAs Aclidinium bromide
Tiotropium Umeclidinium
Combination: SABA + anticholinergic agents Fenoterol/ipratropium 
Combination: LABA + LAMA Formoterol/aclidinium
Glycopyrrolate/formoterol Olodaterol/tiotropium
Combination: LABA + ICS Formoterol/budesonide 
Methylxanthines Theophylline
Phosphodiesterase-4 inhibitor Roflumilast
ICS, inhaled corticosteroid; LABAs, long-acting β2-agonists; LAMAs, long-acting muscarinic antagonists; SABAs, short-acting β2-agonists; SAMAs, short-acting muscarinic antagonists

In general, long-acting agents are preferred for initial treatment of COPD except in patients with occasional dyspnea in whom short-acting agents may be used. Short-acting agents can also be used for immediate symptom relief during acute exacerbations in patients taking long-acting bronchodilators as maintenance therapy.

The 2023 GOLD Report updated its recommended treatment strategy to an ABE plan based on the control of the patient’s disorder, exacerbation frequency, scores on the mMRC and CAT assessment tools, and eosinophil count (Figure)4:

  • Group A: bronchodilator is recommended
  • Group B: long-acting muscarinic antagonist (LAMA) plus long-acting β2-agonist (LABA) is recommended and may be available in a single combination canister
  • Group E: LAMA plus LABA is recommended and may be available in a single combination canister. If the patient has a high eosinophil count >300 cells/µL, an ICS should be added to the regimen.
Figure. 2023 GOLD Report tool for assessing COPD exacerbations and initiating pharmacologic treatment. Adapted from: Global Initiative for Chronic Obstructive Lung Disease.4

Other Treatments for COPD Exacerbations

Between 30% and 50% of COPD exacerbations have a bacterial cause (Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Chlamydia pneumoniae).10 The majority of patients can be managed with antibiotics and stepped-up bronchodilator and corticosteroid therapies; however, some patients may require hospitalization.

The GOLD Report recommends antibiotics in patients with COPD exacerbations who meet one of the following criteria:

  • Have all 3 cardinal symptoms of exacerbation: dyspnea, increased sputum volume, and increased sputum purulence.
  • Have increased sputum purulence plus one other cardinal symptom (dyspnea or increased sputum volume)
  • Require mechanical ventilation (invasive or noninvasive)

The selection of the antibiotic agent should be based on local bacterial flora and the recommended duration for outpatient treatment of COPD exacerbations is 5 days or less.4 The recommended initial empirical treatment is an aminopenicillin with clavulanic acid, macrolide, tetracycline, or quinolone. Azithromycin or other macrolides should be avoided in patients with a prolonged corrected QT interval on electrocardiography and cardiac arrhythmias. Care should be taken to monitor patients for the development of bacterial resistance in sputum and for impaired hearing.

The role of antitussive agents in the treatment of COPD is inconclusive and the Gold Report does not recommend vasodilators for pulmonary hypertension in this population.4 Low doses of oral or parenteral long-acting opiates may ease dyspnea in patients with severe COPD, according to the report.4

In patients with FEV1 less than 50% and chronic bronchitis, clinicians may consider adding the selective phosphodiesterase-4 inhibitor roflumilast or a macrolide to the treatment regimen.4

Pulmonary rehabilitation is recommended after a COPD exacerbation and should be considered an important component of integrated patient management in combination with pharmacologic therapies.11 Findings from a Cochrane review of 65 randomized controlled trials involving 3822 patients show that pulmonary rehabilitation can relieve dyspnea and fatigue, improve emotional function, and enhance the sense of control that patients have over their condition.11

Supplemental Oxygen Therapy

All patients with COPD should be evaluated for hypoxemia at rest. In patients with oxygen saturation that is lower than 88% or partial pressure of arterial oxygen (PaO2) less than 55 mm Hg while the patient is breathing ambient air at sea level on 2 occasions over a 3-week period, supplemental oxygen is indicated. 4

In patients whose oxygen saturation is less than 90%, arterial blood gases should be measured while the patients are breathing room air. In those with hypoxemia without hypercapnia, low-flow oxygen is indicated to achieve a PaO2 value of 60 to 65 mm Hg (oxygen saturation, 91 to 94%).12 Oxygen supplementation should be titrated to maintain the patient at an SaO2 of 90% or more.12

Patients should also be considered for oxygen therapy if they have persistent hypercapnia with a pH of less than 7.35 but more than 7.15.14,15  

Indications for Hospitalization

Patients that have worsening resting dyspnea, decreased oxygen saturation, high respiratory rate, drowsiness, or confusion may need hospitalization. The primary care provider should look for signs of low oxygenation such as cyanosis and the effort of the patient to breathe. Assess if accessory muscles are being used and if wheezing has increased. If the patient has comorbidities, worsening peripheral edema can indicate heart failure. If an exacerbation is not responding to treatment or if there is inadequate home support, the patient commonly needs hospitalization.4

Lifestyle Changes and Vaccinations

Basic lifestyle modifications include smoking cessation, reducing exposure to pollutants and infection, regular physical activity, healthy diet, and preventive vaccinations. Treatment to assist the patient cease smoking includes varenicline, sustained-release bupropion, nortriptyline, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patches, and are recommended in the absence of contraindications.16 

Given that COPD exacerbations are often triggered by viral infection, COVID-19, influenza, and pneumococcal (PCV13 and PPSV23) vaccinations are recommended to decrease the risk of infection.4 The Centers for Disease Control and Prevention (CDC) recommends 1 dose of the 20 valent pneumococcal conjugate vaccine (PCV20) or 1 dose of 15 valent pneumococcal conjugate vaccine (PCV15) followed by 23 valent pneumococcal polysaccharide vaccine (PPSV23) in persons with COPD.17 The CDC also recommends Tdap vaccination for adults not vaccinated in adolescence as well as shingles vaccination for those 50 years and older.18


Primary care clinicians are often the primary health care provider for patients with COPD. All clinicians should consult the GOLD 2023 Report for up-to-date recommendations on the diagnosis and management of COPD patients.

Theresa Capriotti, DO, MSN, CRNP, RN, is a clinical professor at Villanova University M. Louise Fitzpatrick College of Nursing in Villanova, Pennsylvania. Rose Tomy and Mia Morales are BSN Honor Students at Villanova University M. Louise Fitzpatrick College of Nursing.


  1. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. Basics about COPD. Centers for Disease Control and Prevention: June 9, 2021. Accessed April 28, 2023.
  2. Xu J, Murphy SL, Kockanek KD, Arias E. Mortality in the United States, 2018. NCHS Data Brief. 2020;(355):1-8.
  3. Aryal S, Diaz-Guzman E, Mannino DM. Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes. Int J Chron Obstruct Pulmon Dis. 2014;9:1145-1154. doi:10.2147/COPD.S54476
  4. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, 2023 Report. Global Initiative for Chronic Obstructive Lung Disease.
  5. Safiri S, Carson-Chahhoud K, Noori M, et al. Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019. BMJ. 2022;378:e069679. doi:10.1136/bmj-2021-069679
  6. Hnizdo E, Sullivan PA, Bang KM, Wagner G. Association between chronic obstructive pulmonary disease and employment by industry and occupation in the US population: a study of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 2002;156(8):738-46. doi:10.1093/aje/kwf105
  7. Strange C. Alpha-1 antitrypsin deficiency associated COPD. Clin Chest Med. 2020;41(3):339-345. doi:10.1016/j.ccm.2020.05.003
  8. Kessler R, Partridge MR, Miravitlles M, et al. Symptom variability in patients with severe COPD: a pan-European cross-sectional study. Eur Respir J. 2011;37(2):264-72. doi:10.1183/09031936.00051110
  9. Donaldson GC, Wedzicha JA. The causes and consequences of seasonal variation in COPD exacerbations. Int J Chron Obstruct Pulmon Dis. 2014 6;9:1101-10. doi:10.2147/COPD.S54475
  10. Sheikh K, Coxson HO, Parraga G. This is what COPD looks like. Respirology. 2016;21(2):224-36. doi:10.1111/resp.12611
  11. Celli BR, Wedzicha JA. Update on clinical aspects of chronic obstructive pulmonary disease. N Engl J Med. 2019;381(13):1257-1266. doi:10.1056/NEJMra1900500
  12. Lacasse Y, Casaburi R, Sliwinski P, Chaouat A, Fletcher E, Haidl P, Maltais F. Home oxygen for moderate hypoxaemia in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2022;10(11):1029-1037. doi:10.1016/S2213-2600(22)00179-5
  13. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;2015(2):CD003793. doi:10.1002/14651858.CD003793.pub3
  14. Wedzicha JA, Calverley PMA, Albert RK, et al. Prevention of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017;50(3):1602265. doi:10.1183/13993003.02265-2016
  15. Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50(2):1602426. doi:10.1183/13993003.02426-2016
  16. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013;2013(5):CD009329. doi:10.1002/14651858.CD009329.pub2
  17. Centers for Disease Control and Prevention. Pneumococcal vaccine recommendations. Updated February 13, 2023. Accessed May 2, 2023.
  18. Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: updated recommendations of the Advisory Committee on Immunization Practices — United States, 2019. MMWR Morb Mortal Wkly Rep. 2020;69:77-83. icon

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Pregnancy is an exciting and life-changing experience, but it can also be a challenging time for women. One of the symptoms that women may experience during pregnancy is shortness of breath. Shortness of breath during pregnancy can be caused by a number of factors, and it is important for women to understand the causes and what to do in case it happens.

What causes shortness of breath during pregnancy

Breathing is one of the most important functions of the body. It helps deliver oxygen to the organs and tissues and removes carbon dioxide from the body. Despite its importance, many people take breathing for granted and don't think about it until they experience a problem.

Shortness of breath is one such problem that can be concerning for expecting mothers. While it is a common symptom, it can also be caused by underlying medical conditions. Here are five causes of shortness of breath during pregnancy:


High progesterone levels

One of the main causes of shortness of breath during pregnancy is high levels of progesterone. This hormone is produced in higher amounts during pregnancy, and it can cause the muscles that control breathing to relax. This relaxation can lead to a feeling of breathlessness.

Additionally, the growing foetus can put pressure on the diaphragm and lungs, making it more difficult to breathe.


Women with asthma or other lung conditions may experience shortness of breath more frequently during pregnancy. The hormonal changes that occur during pregnancy can worsen asthma symptoms and make it more difficult to breathe.


Anaemia is a condition that occurs when the body doesn't have enough red blood cells to carry oxygen to the body's tissues. This can cause shortness of breath, especially during physical activity or exertion.

Heart conditions

Women with heart conditions may also experience shortness of breath due to the increased strain on the heart during pregnancy. Conditions such as arrhythmia or congestive heart failure can make it more difficult to breathe.

Blood clots

Pregnant women are at a higher risk of developing blood clots, which can cause shortness of breath. Blood clots can form in the legs and travel to the lungs, causing a pulmonary embolism. This can be a life-threatening condition and requires immediate medical attention.

It is important for pregnant women to be aware of the causes of shortness of breath and to discuss any concerning symptoms with their healthcare provider. By understanding the underlying causes, women can take appropriate measures to manage their symptoms and ensure a safe and healthy pregnancy.

4 tips for managing shortness of breath during pregnancy

Shortness of breath during pregnancy can be a common and uncomfortable symptom. However, there are steps that pregnant women can take to manage their symptoms and breathe (and sleep) more comfortably. Here are four tips for managing shortness of breath during pregnancy:


Change your position

Changing your position can make it easier to breathe. Sitting up straight or leaning forward slightly can help alleviate the feeling of breathlessness. You can also try propping yourself up with pillows while sleeping to improve your breathing.

Practice good posture

Good posture is essential for pregnant women to avoid putting unnecessary pressure on the lungs and diaphragm. Avoid slouching or lying on your back for extended periods of time, and try to maintain a comfortable position when sitting or standing.

Try breathing exercises

Breathing exercises can be helpful for pregnant women experiencing shortness of breath. One effective exercise is diaphragmatic breathing.

To perform this exercise, sit comfortably and place one hand on your chest and the other on your stomach. Breathe in slowly through your nose, feeling your stomach rise as you inhale. Then, exhale slowly through your mouth, feeling your stomach fall as you exhale.

Talk to your healthcare provider

If you are experiencing shortness of breath during pregnancy, it is important to talk to your healthcare provider. They can help determine the underlying cause of your symptoms and recommend appropriate treatment options.

By following these tips, pregnant women can manage their shortness of breath and breathe more comfortably throughout their pregnancy.

5 reasons to call your doctor if you have shortness of breath


Shortness of breath during pregnancy is common, but it can also be a cause for concern. Here are five reasons to call your doctor if you experience shortness of breath:

  1. Severe shortness of breath: If you are experiencing severe shortness of breath, it could be a sign of a more serious condition. Seek medical attention immediately if you have trouble breathing or feel like you can't catch your breath.
  2. Chest pain: Chest pain or discomfort can be a symptom of a heart or lung problem. If you experience chest pain with shortness of breath, contact your doctor immediately.
  3. Rapid heartbeat: If you have a rapid heartbeat or palpitations along with shortness of breath, it may be a sign of an underlying medical condition. Call your doctor right away.
  4. History of lung or heart conditions: If you have a history of lung or heart conditions, or if you experience shortness of breath frequently, it is important to discuss these symptoms with your healthcare provider. They can help determine the underlying cause of your shortness of breath and suggest additional treatment options if necessary.
  5. Preeclampsia: Shortness of breath can be a symptom of preeclampsia, a serious pregnancy complication. If you experience shortness of breath along with high blood pressure, headaches, or changes in vision, contact your doctor immediately.

Remember, it's always better to err on the side of caution when it comes to your health and the health of your baby. If you're concerned about shortness of breath during pregnancy, don't hesitate to contact your healthcare provider.

ALSO READ: Lads, here's how you can pamper your exhausted, pregnant wives

This article was first published in theAsianparent.

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We’ve all experienced that sickening, sinking feeling in chest that comes on suddenly. The moment you realize you’ve forgotten your keys in the car can be just as devastating as receiving bad news or hearing your name called out in a conference or class. It’s normal for humans to feel this way, and you shouldn’t fret over it.

It’s important to note that certain health issues may have symptoms similar to the sensation of a sinking feeling in the chest. Hey there! Just wanted to let you know that health problems can affect your physical and mental well-being. Feeling a sinking feeling in your chest when feeling sad is completely normal. If you’re experiencing that sinking feeling often, it might be worth listening to your heart and checking if everything is okay.

This article has covered you with all the information you need about why we sometimes get that sinking feeling in our chest and some tips on getting rid of it.

Sinking Feeling in Chest: What It Means?

sinking feeling in chest

Feeling your heart drop out of your chest is a common symptom of anxiety, cardiac difficulties, intense melancholy, or stress. It can indicate a more generalized sense of foreboding or that something is amiss.

Palpitations, or flutters in the chest caused by high heart rate, are another possible reason for a sinking feeling in the chest, which can be brought on by anything from a physical ailment to the physical manifestation of psychological tension and worry.

Most individuals would use the expression “sinking feeling in chest” to express apprehension about an impending disaster, and they could even specify the source of their apprehension.

Suppose you feel like your chest is sinking. If your heart is pounding erratically or your breathing is laborious, you should seek medical attention, especially if you are at risk for a heart-related problem.

If you’re feeling anxious, it’s always a good idea to seek professional help. Even if you don’t think you’re at risk for a heart condition, taking care of your mental health is important. A healthcare professional can help you manage your anxiety and prescribe medication. Don’t hesitate to reach out for help!

Different Types of Sinking Feeling in the Chest

We’ve compiled a helpful list explaining why you might experience a sudden sinking feeling in your chest. This way, you’ll know what to expect and be better prepared. Check it out below!

  • Acid reflux causes an unusual sinking sensation in the chest.
  • When attempting to fall asleep, the chest sinks quickly.
  • A sinking sensation in the chest while dozing at night.
  • A sensation of heaviness in the chest due to depression.
  • When lying down, the chest and midsection have a sinking sensation.
  • After consuming, a sinking chest and dizziness may occur.
  • A persistent sensation of sinking in the chest after a breakup.
  • A hollow, sinking sensation in the chest, close to the heart.
  • A sinking sensation in the chest causes dizziness.
  • A sensation of abdominal heaviness during pregnancy.
  • A sinking sensation in the chest after drinking.

You May Find Interest in: Cold Icy Feeling Inside Chest

Setting the Stage: Anatomy of the Chest

anatomy of the chest

To understand that sinking feeling in the chest, it’s important to know about the heart, lungs, and muscles. These important parts work together to make the complex dance of life-sustaining processes in the chest area happen.

The rib cage is an amazing piece of architecture that holds up our critical organs. This skeletal framework protects and supports the heart and lungs, making it easier for the chest to expand and shrink during breathing.

Stress and Anxiety: the Mind-Body Connection

How the mind and body work together greatly affects how well we feel physically. Stress and worry can cause several physical symptoms, including the strange feeling of your chest sinking. This psychosomatic reaction is how the body tells us that something is wrong.

Fear and panic can bring on a fight-or-flight reaction, which makes adrenaline rush through our bodies. This adrenaline rush can cause several physical changes, including a sinking feeling in the chest and a physical reminder of our vulnerability.

Sinking Feeling in Chest: Possible Causes

It is unclear what causes the sinking sensation in the chest. No one knows for sure what caused it. However, since these feelings are linked to emotional states, it’s likely a neurological issue.


cardiac Arrhythmia

Sometimes the heart can beat irregularly, which may cause skipped or extra beats, or the heart to beat out of rhythm. Palpitations are often the way people experience arrhythmias.

You might feel a pounding, sinking, or fluttering sensation in your chest. Hey there! It’s commonly thought that these arrhythmias are responsible for that uncomfortable sinking feeling we experience in our chest.

Did you know that a system of specialized cells in the heart regulates the production of heartbeats? Pretty cool, right? Hey there! Did you know that our heart has special cells that create a regular rhythm of contractions? These cells are called nodes, and they send electrical signals to different parts of the heart, causing it to beat in a coordinated way. Pretty cool, huh? Heartbeats are the result of regulated and rhythmic contractions that we can detect.

Parasympathetic Response

That’s a fascinating theory! It suggests that the sensation of a sinking feeling in the chest might not be related to the heart. Hey there! Just wanted to let you know that sometimes our brains can create an illusionary perception when we experience sudden or intense emotions. It’s just a side-effect of how our brains process things.

Some people believe that the anterior cingulate cortex of your brain causes the sinking feeling in your chest. Pretty interesting, right? This part of the brain is crucial in various cognitive functions, such as managing impulse control, emotions, and stress.

The anterior cingulate cortex can become very active when we experience extreme stress or intense emotions. Stimulating the vagus nerve can have some great benefits. It’s the main component of the parasympathetic nervous system and carries important signals from organs like the heart and lungs.

When the vagus nerve is stimulated, it can send signals to the brain that might feel like pain, heartache, or a sinking feeling in the chest.

Angina Pectoris

angina pectoris


Chest pain is one symptom of angina pectoris, a heartbreaking story of diminished blood supply. Lack of oxygen-rich blood causes the heart muscle to work harder, conjuring that sickening feeling as a grim reminder of the heart’s relentless fight for survival.

The low feeling could also indicate that something bad is about to happen, like a heart attack. Knowing the warning signs, including chest pain, shortness of breath, and feeling sick, can mean the difference between life and death.


When you have asthma, your lungs become inflamed and narrow, which can make it hard to breathe and make your chest feel tight. This constant fight for air may make you feel like you’re falling, an unpleasant sign of the body’s constant fight for air.

Pneumonia and Bronchitis

Both pneumonia and bronchitis are diseases of the lungs that can make the chest sore and inflamed. As the body fights off these microbial invaders, the sinking feeling may be a scary warning of how hard it is to stay healthy.

Pulmonary Embolism: the Hidden Blood Clot

A pulmonary embolism is a stealthy foe that happens when a blood clot becomes trapped in the lungs’ arteries and prevents blood from flowing normally through those arteries. This precarious circumstance might bring on chest pain and shortness of breath, conjuring that sinking feeling that is a jarring reminder of the body’s susceptibility to dangers that were not anticipated.



The cartilage that connects the ribs to the breastbone can become afflicted with an inflammatory condition known as costochondritis. This inflammation at the intersection of the rib cage can cause chest pain and a sinking feeling, which is a striking illustration of how interrelated the body’s systems are.

Rib Fractures and Bruising

Fractures and bruises to the ribs can cause severe pain and a feeling of heaviness or sinking in the chest. These jarring collisions serve as a sobering reminder of our physical vulnerability and the importance of constant attention.

Muscle Strain

Overuse injuries like muscle strain are typical in overworked warriors, especially when the chest muscles are overworked. A sinking sensation may result from this stress, a tangible reminder of the importance of moderation and balance in physical activity.

Acid Reflux

When acid from the stomach flows back up into the esophagus, it causes heartburn and other unpleasant symptoms. When this happens, it can remind you of the volatile nature of your digestive system and cause a sinking feeling in your chest.

Related Read: Is Coconut Milk Good for Acid Reflux?

Esophageal Spasms: the Unpredictable Contractions

Esophageal spasms

Esophageal spasms are involuntary contractions that disturb the normal flow of food and liquid through the esophagus. These spasms can cause chest pain and a sense of sinking. The unpredictability of these spasms serves as a jarring reminder of the delicate balance necessary to keep our bodily functions functioning properly.

Sinking Feeling in Chest: Diagnosis

There are 3 available ways to diagnose the sinking feeling in chest. 

  1. Electrocardiogram (ECG)
  2. Chest X-ray
  3. Blood tests and biomarkers

Electrocardiogram (ECG): Capturing the Heart’s Electrical Activity

An ECG is a noninvasive diagnostic instrument that records the heart’s electrical activity. This activity can provide useful information regarding the possibility of cardiac irregularities. This essential information assists medical practitioners in determining the underlying reason for the sickening sensation that a patient may be experiencing.

Chest X-ray: A Picture is Worth a Thousand Words

X-rays of the chest provide a visual picture of the chest cavity, allowing for the identification of any abnormalities that may exist inside the lungs, heart, or rib cage. This visualization may be quite helpful in determining the cause of the mysterious sinking feeling.

Blood Tests and Biomarkers: the Unseen Evidence

Blood tests and other biomarkers offer much information, revealing previously overlooked facts that may hold the key to solving the enigma of the sinking feeling. These tests can identify underlying problems such as inflammation, infection, and others contributing to the experience.

Treatment Options: The Road to Recovery

Medications, lifestyle changes, and therapy are possible treatment options for sinking feelings in the chest. But you must consult with your doctor before taking any treatment options.


Several drugs can reduce the sinking feeling by addressing pain and treating the underlying issues. Pharmaceutical interventions, which can range from anti-inflammatory medicines to antacids, can provide the much-needed respite that patients require and help speed up the healing process.

Lifestyle Changes: A Commitment to Better Health

Alterations to one’s way of life can significantly reduce the sinking sensation one experiences. Adopting a diet that is good for the heart, regular exercise, and prioritizing stress can all help enhance general well-being and reduce the frequency of episodes of chest discomfort.


People struggling with the overwhelming sense of hopelessness that stress, anxiety, or fear can bring often find great relief through therapy. Regaining command and relieving chest pain can be achieved by focusing on and mastering stress management strategies.

Yoga and Meditation: The Quest for Inner Peace

best yoga poses at home for beginners

Both yoga and meditation, which are becoming increasingly popular due to their therapeutic properties, can benefit one’s physical and mental health. These activities can help minimize the sinking feeling and promote a sense of inner serenity by encouraging relaxation and fostering awareness, respectively.

Herbs and Supplements: Nature’s Remedies

Herbs and supplements can be a great way to support your health and well-being. They may even help with inflammation, boost your immune system, and improve your overall mood. It’s always a good idea to check with a healthcare professional before trying out any new remedies to ensure they’re safe and effective.

Sinking Feeling in the Chest: How to Manage It?

Getting rid of the feeling that your chest is sinking requires a multifaceted method that addresses the physical and emotional causes of the feeling. Here are some things you can do to deal with and lessen the gloomy feeling:

  • Find the cause: It’s important for successful management to find out what’s causing the sinking feeling. Talk to a doctor to ensure you don’t have anything dangerous and to devise a personalized treatment plan.
  • Stress reduction: Stress-reduction methods, such as deep breathing exercises, progressive muscle relaxation, and mindfulness, can help relieve chest pain caused by stress and anxiety.
  • Maintain a healthy lifestyle: Maintain a heart-healthy lifestyle by eating well, exercising regularly, and putting stress management at the top of your list. This will improve your general cardiovascular health and make chest pain less likely.
  • Seek therapy or counseling: If the sinking feeling is caused by worry, anxiety, or fear, therapy or counseling can help you deal with these feelings and give you ways to deal with chest pain.
  • Medication management: If an underlying condition causes a sinking feeling, take the medicine as recommended to relieve symptoms and treat the cause.
  • Look into nontraditional therapies: Consider using acupuncture, yoga, meditation, or herbal supplements in addition to traditional treatments to help with the sinking feeling.
  • Regular checkups: Set regular checkups with your doctor or nurse to monitor your health and deal with any problems immediately.
  • Make a group of helpful people: Connect with others who know what it’s like to feel like your chest is sinking and share your experiences, thoughts, and ways to deal with it. A network of people who care about you can give you important mental support and encouragement.
  • Educate Yourself: Learn more about the feeling of your chest sinking. Keep up with the latest studies and treatment options. Staying informed can help you choose your health and well-being in your best interest.
  • Be patient and keep trying: It may take time and effort to get rid of the feeling that your chest is sinking. Stay with your treatment plan, and don’t be afraid to try different things until you find what works best. Remember that the road to healing may not be straight, but if you work hard and don’t give up, you can get over that sinking feeling and improve your life.

Interesting Read: The Ultimate Guide to Manage Hunger Pain in Chest

How to Stop Sinking Feeling in Chest?

If you’re getting a sinking feeling in your chest, it can be related to anxiety, stress, or other things. Here are a few things you can do to feel better:

  • Calm your nervous system with some slow, deep breathing. Inhale for four counts, hold your breath and exhale for four counts. Repeat this cycle for a few minutes.
  • To calm down, tense your muscles to your toes and let them go. Tension in the body can be reduced by doing this.
  • Focus on the here and now and pay attention to what’s happening to help you feel more grounded. Use your senses to ground yourself at the moment, such as touching a nearby object, listening to sounds around you, or smelling something close.
  • Talking positively to yourself can help you get through this difficult time. Say to yourself soothing things like “I am safe,” “I can handle this,” and “This feeling will pass.”
  • Distract yourself by doing something else, like reading, watching a movie, or putting together a puzzle. If you’re feeling down, this might help.
  • Share your emotions with someone you trust, such as a close friend, family member, or mental health professional. They are there to lend encouragement, insight, or listen.
  • Moderate exercise, such as walking, swimming, or yoga, is recommended. Natural mood-lifters called endorphins are released during physical activity.
  • Create a daily regimen incorporating healthy habits like exercising, getting enough sleep, and eating well-balanced meals. Emotional wellness is greatly aided by adopting a healthy lifestyle.

Final Words

As we’ve already said, a sinking feeling in your chest isn’t a reason to worry. But you should be worried about your mental health and well-being. You don’t have to suffer in silence from stress and worry.

Talk to a licensed psychologist or therapist to determine the best way to deal with your feelings and thoughts. Remember to talk to your doctor first if your chest hurts.

This piece should have given you what you need to know about feeling like your chest is going down. You can manage stress and maintain your mental health using the tips above.

Frequently Asked Questions

  1. What to do when you feel like your heart is sinking?

To relax, take a calm, deep breaths. Focus on the present and surrounds to ground oneself. Think, “I can handle this” or “This will pass.” Distract yourself or seek support from a trusted person. Moderate exercise can improve your mood, as can regular sleep, exercise, and healthy eating. Consult a doctor if the sinking feeling persists or worsens.

2. Can anxiety cause sinking feeling in chest?

Anxiety might produce a sinking feeling in the chest. Anxiety can cause chest pain, increased heart rate, and shortness of breath. Muscle tension or anxiety-induced heart rate fluctuations may generate a sinking feeling. Relaxation, exercise, and support from friends or mental health specialists can reduce anxiety.

3. Can stomach gas cause heart palpitations?

Stomach gas can induce chest discomfort or heart palpitations. This discomfort could be palpitations. Gas and bloating increase diaphragm pressure, which may indirectly impact heart rate and rhythm. However, stress, anxiety, coffee, and medical disorders can trigger heart palpitations.

4. Is heart sinking dangerous?

Heart sinking is painful but not hazardous. Anxiety, worry, or physical discomforts like muscle tightness or intestinal difficulties may cause it. If the sinking feeling is accompanied by chest discomfort, shortness of breath, or fainting, it may indicate a heart attack or arrhythmia.

5. How can you tell the difference between gas and heart pain?

Gas and heart pain symptoms are similar, making it hard to distinguish. Gas pain is a dull aching or cramp in the belly, whereas heart pain is a tightness, pressure, or squeezing in the chest that may radiate to the arms, neck, jaw, or back. Shortness of breath, sweat, nausea, and lightheadedness may accompany heart pain.


Disclaimer: This content is for informational purposes only and does not replace professional medical advice, diagnosis, or treatment. This information is not comprehensive and should not be used to make health or well-being decisions. Consult a qualified healthcare professional with questions about a medical condition, treatment options, or health regimen. This website or the content should never replace professional medical advice.


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Exercise rehabilitation may confer functional improvements to patients struggling to breathe following a pulmonary embolism (PE), a randomized controlled trial found.

Patients with persistent dyspnea in the two-center study who were assigned to rehabilitation scored significantly higher on the Incremental Shuttle Walk Test (ISWT) compared with controls (difference 53 m, 95% CI 17.7-88.3, P=0.0035), reported Øyvind Jervan, MD, of the Østfold Hospital Trust in Grålum, Norway, and coauthors.

Whether that between-group difference "is clinically relevant, can be debated," the group wrote in CHEST, but added that "previous studies have pointed at mean group differences of 40-62 m as clinically meaningful."

Rehabilitation patients also had higher scores on the Pulmonary Embolism Quality of Life questionnaire (PEMB-QoL) than their control group counterparts (difference -0.04, 95% CI -0.09-0.00, P=0.041).

"In patients with persistent dyspnoea following PE, those who underwent rehabilitation had better exercise capacity at follow-up than those who received usual care," the group wrote. "Rehabilitation should be considered in patients with persistent dyspnoea following PE, though further research is needed to assess the optimal patient selection, timing, mode and duration of rehabilitation."

There were no significant differences seen between the two groups on the Endurance Shuttle Walk Test (ESWT), the generic quality of life (QoL) test, or in their dyspnea scores.

"This is to date the largest randomized trial assessing the effect of rehabilitation after PE, demonstrating a positive effect on exercise capacity and QoL in subjects with persistent dyspnoea," Jervan and colleagues wrote. "Several recent studies have shown promising results of rehabilitation after PE. However, most of these studies have been small or have not included a control group, and there is great variation regarding time, mode, and duration of intervention. The present study adds to the growing evidence of the benefits of rehabilitation after PE."

A 2020 study also attested to the safety of exercise post-PE, demonstrating the importance of physical activity following PE.

Due to the limited evidence, current guidelines from the European Respiratory Society and the American Society of Hematology make passing mention of personal exercise following acute PE. Some may recommend that exercise begin slowly and gently, comprising mainly walking, and gradually build in the weeks post-PE, according to the North American Thrombosis Forum.

In the present study, rehabilitation consisted of two 1-hour exercise sessions per week, for a total of 8 weeks. Rehabilitation sessions featured a warm-up, endurance training, resistance training, and a cool-down at a supervised outpatient location. An at-home exercise regimen was also given to patients, to complete one to two times a week. Patients also attended a single educational session that discussed PE and its associated anatomy and physiology.

A total of 211 patients were included in the study. Median patient age was 57 years, and the study population was 56% male.

Dividing patients by the time from PE diagnosis, groups starting rehabilitation 6 to 12 months post-PE and those diagnosed at a time earlier than that (up to 72 months post-PE) both showed significant improvements on the ISWT.

Researchers did note that patients in the rehabilitation group were somewhat younger than those in the control group (55 vs 60 years), but had worse performance on their baseline ISWT (680 vs 730 m). ISWT scores improved to 790 and 760 m, respectively, following the intervention.

The researchers who conducted the ESWT and ISWT were blinded to the patient's assigned treatment group.

However, the authors noted that ISWT data were "subject to a considerable ceiling effect" and that patients had varying time differences between their PE and the start of the trial. Several patients either did not complete or withdrew from the study.

Investigators also included possible gaps in hospital records, limits on the types of rehabilitation used, and sample size as limitations of the study.

  • author['full_name']

    Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow


The study was funded by Østfold Hospital Trust and grants from Stiftelsen Elsa och Gustav Lindhs fond and the National Association for Heart and Lung Disorders, a Norwegian patient organization.

Jervan had no disclosures to report. Coauthors reported several relationships with industry and government organizations.

Primary Source


Source Reference: Jervan Ø, et al "The effects of exercise training in patients with persistent dyspnoea after pulmonary embolism: a randomized controlled trial" CHEST 2023; DOI: 10.1016/j.chest.2023.04.042.

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cough is a natural reflex that protects your body's airways and lungs from damaging irritants like mucus, germs, dust, and smoke. 

A dry cough does not produce or bring up mucus and has many possible causes, including a chest cold, asthma, and acid reflux. At night, a dry cough may worsen for many reasons, including gravity, exposure to dry air, or increased airway sensitivity.

This article will review what might bring on a dry cough and why it may worsen at night. It will also explore how to manage a dry cough and when to see a healthcare professional.

dowell / Getty Images

Reasons a Dry Cough Is Worse at Night

There are a few possible reasons why your dry cough may worsen at night.

For many nighttime coughs, gravity is a pivotal contributor. When you lie flat to sleep at night, mucus and other fluids can pool together in the throat.

The mucus may be draining from the nose and sinuses (if you have allergies or a cold), or stomach acid may move up the esophagus (the hollow tube that carries food to your stomach) and collect in the throat if you have acid reflux. Ultimately, the pooling of mucus and other fluids creates a tickling throat sensation that can trigger the cough reflex.

Environmental factors can also contribute to a worsening cough at night. For example, breathing in dry air can worsen a cough by aggravating the nose, throat, and airways due to moisture loss.

Also, exposure to allergens, namely dust mites in your bedding or pet dander (if you sleep with your pets), can irritate your airways, triggering a dry cough.

Hormone and lung function changes and increased airway sensitivity may also be behind a worsening cough at night. These nighttime changes have been reported in individuals with asthma.

What Brings on a Dry Cough at Night?

There are many potential causes of dry cough at night. Four common ones include:

Viral Bronchitis

Bronchitis develops when the bronchi (the tubes that transport air to the lungs) suddenly become irritated and inflamed, causing a persistent cough that may be dry or wet.

Most cases of bronchitis are acute—they come on suddenly and go away within one to three weeks—and are caused by the common cold or another viral upper respiratory infection (URI).

How Does COVID-19 Cause a Cough?

A COVID-19 infection can cause a dry cough, especially early on, as the virus inflames the vagus nerve, which regulates the cough reflex. An infection with COVID-19 can also progress into viral bronchitis, causing a dry or wet cough.


Asthma is a chronic lung condition associated with inflammation and narrowing of the airways. It's a prominent cause of chronic cough in adults and the most common cause in children.

Asthma symptoms include an intermittent cough, wheezing (a high-pitched whistling sound), trouble breathing, and chest tightness.

Some individuals with asthma only experience a cough, typically dry. This form of asthma is called cough-variant asthma.

Various factors trigger asthma symptoms, such as viral infections, cold or dry air, dust, mold, cigarette smoke, perfumes, and air pollution.


GERD occurs when stomach contents move back up the esophagus. The main symptom is heartburn, a burning sensation behind the breast bone. A dry cough may also occur if stomach acid is inhaled into the lungs.

Postnasal Drip

Postnasal drip describes excess mucus from the nose and sinuses that drips down the back of the throat, causing an itchy sensation that can trigger a cough. Postnasal drip has many causes, including allergies and colds.

Allergies occur when your immune system mistakes a harmless substance for something foreign and harmful and reacts abnormally. Symptoms include runny nose, sneezing, and dry cough from airway inflammation.


While not an exhaustive list, other possible, albeit less common, causes of a nighttime dry cough include:

How to Ease Dry Coughing at Night

Easing a dry cough at night depends on the underlying cause, which includes:

  • Viral bronchitis: Viral bronchitis slowly resolves on its own. Home remedies like fluids, saline nasal spray or drops, taking a spoonful of honey (avoid in babies under 1 due to the risk of botulism), and running a cool-mist humidifier are often helpful.
  • Asthma: The primary treatment is the daily use of inhaled corticosteroids. They reduce the airways' swelling and decrease symptoms over time.
  • GERD: Lifestyle modifications, such as elevating the head of your bed, weight loss (if overweight or having obesity), and quitting smoking, are recommended. Drugs like Pepcid (famotidine) or Prilosec (omeprazole) may also be used.
  • Postnasal drip: Elevating your head at night can reduce mucus drainage. Additional therapies depend on the specific cause. For example, a steroid nasal spray and allergen avoidance (e.g., allergen-proof bedding if allergic to dust mites) are advised if allergies are responsible.

What About OTC Cough Medicine?

Under the guidance of a healthcare provider, you might consider trying an over-the-counter (OTC) cough medicine for viral bronchitis, such as the cough suppressant Robitussin or the expectorant Mucinex, both containing dextromethorphan and guaifenesin and either a pain or nasal decongestant. OTC cough medicines should not be given to children under age 6, as they can cause harmful side effects.

Signs of a Dry Cough Getting Worse

Most dry coughs from viral bronchitis clear up on their own and, therefore, can be managed at home.

Sometimes though, a case of viral bronchitis can turn into pneumonia (a lung infection) or resemble a more serious condition, like bacterial bronchitis, a pulmonary embolism, lung cancer, or heart failure.

With that, be sure to see a healthcare provider if your cough is not improving or is associated with concerning features, such as:

  • Difficulty breathing or chest pain
  • A high or prolonged fever or fever that starts after days of coughing
  • Blood or mucus that was clear and turned into a yellowish-green or rust color.
  • Rapid heartbeat (tachycardia)
  • Unintended weight loss
  • Weight gain and/or swelling in ankles and legs (edema)

Dry Cough at Night for Weeks: What to Do

A dry cough at night for weeks could indicate chronic health problems like asthma, GERD, or allergies. These chronic health conditions cannot be treated at home.

They require guidance from a healthcare provider and a well-devised treatment plan that often includes a combination of lifestyle modifications and medication.

See a healthcare provider if your nighttime dry cough is lingering for more than three weeks or if you are experiencing recurrent episodes of dry cough.

It's also essential to see a healthcare provider in the following scenarios:


Dry cough is a common symptom and may worsen at night for many reasons, including the pooling of mucus or fluids in the throat and exposure to dry air or nighttime allergens. Stopping a dry cough at night involves addressing the root cause, whether that cause is a chest cold, asthma, acid reflux, or postnasal drip, among other conditions.

While many cases of dry cough can be treated at home, don't delay seeing a healthcare provider if your cough is worsening, persisting for more than three weeks, or is associated with worrisome features like high fever or trouble breathing.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Colleen Doherty, MD

 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.

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