What Pulmonary Long COVID Really Is
When you hear 'long COVID,' you might think of fatigue or brain fog. But for many survivors, the real battle happens in the lungs. Pulmonary long COVID affects roughly one-third of all long COVID cases, according to 2025 research from the Centre for Heart Lung Innovation. This condition isn't just about lingering coughs-it's a complex inflammatory process that damages the lungs' smallest airways long after the virus is gone. About 12.6% of hospitalized patients develop permanent lung scarring called post-COVID pulmonary fibrosis (PCPF), and 30.4% still struggle with breathing three months after discharge.
The Hidden Damage in Your Lungs
Traditional scans like chest X-rays or CTs often look normal, but that doesn't mean your lungs are fine. Advanced imaging with hyperpolarized xenon MRIAn advanced imaging technique that visualizes oxygen transfer in the lungs' smallest airways where traditional scans fail. reveals what's really happening. This technology shows how oxygen moves through tiny air sacs, exposing problems invisible to standard tests.
Researchers at the University of British Columbia's Heart Lung Innovation Centre discovered something shocking: neutrophils-immune cells that normally fight infection-keep triggering inflammation even after the virus is gone. They act like 'dirty bombs' in the lungs' smallest airways, causing lasting damage. This neutrophilic inflammation explains why many patients feel breathless during simple tasks like climbing stairs or carrying groceries.
Why Standard Tests Miss the Problem
Doctors often rely on spirometry tests measuring FEV1 (Forced Expiratory Volume in 1 second), but these can show normal results while patients still struggle. A 2025 study in the International Journal of Chronic Obstructive Pulmonary Disease found hospitalized patients had significantly lower FEV1 measurements (2.03 ± 0.60 L) compared to outpatients (2.56 ± 0.72 L), yet many still felt fine during routine checkups.
The mMRC dyspnea scaleA tool measuring breathlessness severity during daily activities, where scores ≥2 indicate significant respiratory dysfunction. provides better insight. Patients scoring 2 or higher on this scale at one month post-infection are 1.49 times more likely to have persistent breathing issues. This simple questionnaire helps doctors spot problems early when standard tests say everything's normal.
How Rehabilitation Programs Help
Specialized pulmonary rehabilitation isn't just for COPD patients-it's crucial for long COVID lung recovery. Programs typically start 4 weeks after acute infection and last 8-12 weeks with sessions 2-3 times weekly. These multidisciplinary programs combine breathing exercises, aerobic training, and strength work tailored to individual limitations.
For example, diaphragmatic breathing teaches patients to use their diaphragm properly instead of shallow chest breathing. Pursed-lip breathing helps keep airways open longer during exhalation. A 2025 Lung Foundation Australia review found patients who completed full programs saw measurable improvements in FEV1 and diffusion capacity, along with better 6-minute walk distance results. One participant, a 45-year-old teacher, went from struggling to walk 100 meters without stopping to completing her daily commute without breathlessness within 10 weeks.
Special Considerations for Pre-existing Conditions
People with existing lung conditions face higher risks. Those with COPD who catch COVID-19 have 4.6% higher mortality rates and experience twice as many acute exacerbations compared to non-COVID COPD patients. Their rehabilitation requires extra caution-doctors monitor heart function closely since 20% of hospitalized COPD patients develop heart failure complications.
Medications also play a role. The Korean study of 688 patients found remdesivir use was linked to reduced PCPF risk, while baricitinib increased risk. However, researchers noted this might reflect underlying patient differences rather than direct cause-effect. Always discuss medication choices with your doctor before making changes.
What's Next in Research
The RECOVER InitiativeA major NIH-funded research program tracking long COVID's impact across multiple body systems. is leading new studies. Their September 2025 update highlighted connections between pulmonary complications and kidney disease, with a 1.65 hazard ratio for chronic kidney disease in long COVID patients. Clinical trials testing neutrophil-targeted therapies are underway, building on the discovery that persistent neutrophil activity drives lung damage.
Hyperpolarized xenon MRI is expanding beyond research labs. Duke University and University of Kansas Medical Center are now using it clinically to track treatment responses. Early data from these centers shows promise for personalized rehab plans based on individual lung function patterns. While 12.6% of hospitalized patients develop permanent fibrosis, most see gradual improvement over six months with proper care.
Frequently Asked Questions
Can standard lung tests detect pulmonary long COVID?
No. Traditional tests like chest X-rays, CT scans, and spirometry often show normal results even when patients struggle with breathing. Hyperpolarized xenon MRI reveals gas exchange issues in small airways that standard tests miss. Doctors now use the mMRC dyspnea scale to assess breathlessness severity during daily activities.
How long does pulmonary rehabilitation take?
Most programs last 8-12 weeks with sessions 2-3 times weekly. Improvements in lung function and daily activities typically appear within 4-6 weeks. Patients with pre-existing conditions like COPD may need longer programs with closer monitoring.
Are there specific exercises for lung recovery?
Yes. Diaphragmatic breathing (using the diaphragm instead of chest muscles), pursed-lip breathing (inhaling through nose, exhaling slowly through pursed lips), and gentle aerobic activities like walking or cycling are common. Physical therapists customize these based on individual limitations and goals.
Does vaccination affect long-term lung effects?
Current data suggests vaccinated individuals have lower risks of severe lung complications. A 2025 study in the European Respiratory Journal found fully vaccinated patients were 40% less likely to develop persistent respiratory symptoms compared to unvaccinated counterparts. However, breakthrough cases can still cause pulmonary long COVID, especially in immunocompromised people.
When should I see a specialist for lung issues?
See a pulmonologist if you experience ongoing shortness of breath during light activities, chest pain, or persistent cough after 4 weeks. Early intervention improves outcomes-don't wait until symptoms worsen. Your primary care doctor can refer you to a rehabilitation specialist if needed.
