Rajkumar Dasgupta, MD, is the associate program director of Internal Medicine Residency at Huntington Health in Pasadena, California, and associate professor of medicine at the University of California Riverside School of Medicine. In this Q&A with Medscape Medical News, Dasgupta discussed what he’s seeing in patients with persistent breathlessness after COVID, when to refer to a specialist, and how to help patients navigate a recovery that’s often frustratingly slow. The interview has been edited for length and clarity.

What are you seeing most often among patients who continue to experience breathlessness months or even years after COVID?

Many patients still feel short of breath, especially when they’re active. Even when their lungs look fine on scans, they may have weak breathing muscles, poor fitness, or lingering airway irritation. Some also have nerve or heart rhythm issues that make breathing feel harder.

Are you seeing any patterns in which patients are more likely to experience long-term breathlessness — for example, based on age, initial illness severity, or preexisting conditions?

Older adults, people who were very sick with COVID, and those with lung or heart problems are more likely to have ongoing shortness of breath. But even young, healthy people who had mild COVID can experience it too.

How do you approach these patients when imaging and pulmonary function tests appear normal?

If tests look normal, I look for other causes like anxiety, muscle weakness, or poor breathing habits. I often check how they breathe during activity and how their oxygen levels respond. Pulmonary rehab and breathing retraining can help rebuild strength and confidence.

To what extent do factors like anxiety, deconditioning, or breathing pattern disorders contribute to persistent symptoms?

These factors are very common. Anxiety can make normal breathing feel uncomfortable. Weak muscles and shallow breathing habits also make it harder to catch your breath. It’s often a mix of physical and emotional factors that need to be treated together.

What red flags should prompt a primary care physician to refer a patient to pulmonology or order additional testing?

If someone’s breathing suddenly gets worse, they have chest pain, very low oxygen, or extreme fatigue, that’s a red flag. Also, if symptoms last for months without improving, they should see a specialist. We can look for small airway or heart problems that might be missed early on.

What practical steps can clinicians take in the primary care setting to help patients manage ongoing dyspnea?

First, reassure patients that their symptoms are real. Encourage gentle movement and breathing exercises. Treat things like asthma, reflux, or anxiety if they’re making breathing worse. Regular check-ins help track progress and keep patients motivated.

What role does mental health care play in managing these ongoing symptoms?

Anxiety, stress, and depression can make breathlessness feel worse. Mental health support, such as counseling or mindfulness, can help patients manage their breathing and feel better overall.

How should clinicians counsel patients about recovery timelines and prognosis?

Recovery takes time — often months, sometimes longer. Most patients do get better, but progress can come in waves. Setting small, realistic goals helps patients stay positive and notice improvements.

What misunderstandings or myths about post-COVID breathlessness do you most often have to correct?

Many people think long-term breathlessness means permanent lung damage. Often, the lungs are healing, and symptoms are due to weak muscles or changes in breathing patterns. Another myth is that nothing can help, but exercise, rehab, and breathing techniques often improve symptoms.

What do patients often say about their experience with post-COVID breathlessness that surprises you?

Many say they never thought breathing could feel like hard work. They’re frustrated when tests look “normal” but they still feel off. That can be discouraging, so it’s important to listen and validate what they’re feeling.

Are there any strategies or small victories you’ve seen that give patients hope during a slow recovery?

Yes, things like walking a bit farther, climbing stairs, or doing light chores again. Breathing exercises, mindfulness, and tracking progress help them see that they’re improving, even if it’s slow.

How do you help patients stay motivated and engaged when progress is nonlinear?

I remind them that healing isn’t always a straight line and shouldn’t be treated as such. Setbacks happen, but that doesn’t mean they’re going backward. We celebrate every small win and focus on long-term improvement.

Have you noticed any unexpected positive habits or lifestyle changes patients adopt as part of their recovery?

Many start walking more, practicing yoga, or meditating. They also pay more attention to sleep, diet, and stress. Some say they’ve learned to slow down and take better care of themselves.

How do you see care for post-COVID respiratory symptoms evolving in the next few years?

Care is moving toward clinics that combine lung doctors, heart doctors, rehab specialists, and mental health support. Patients get personalized programs to help them recover, and telehealth is making follow-ups easier. Over the next few years, treatment will focus more on early support to prevent long-term problems.

Dasgupta reported having no disclosures.