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Anxiety and Asthma

What is anxiety?

If you are suffering from anxiety you are not alone. Anxiety is one of the most common conditions affecting mental well- being.
Anxiety is often a reaction to a difficult situation or experience. Sometimes it isn’t clear what has caused the anxiety. Feeling anxious can affect the way you think, the way you feel and sometimes the way you behave.
Most feelings of anxiety go away in time, or when the situation is resolved but sometimes feelings of anxiety go on for a long time and can start to interfere with day to day health and well-being.
Some people experience severe attacks of anxiety and these are usually known as panic attacks.

How anxiety affects asthma

For some people anxiety, stress and strong emotion are triggers for asthma. For others it is the asthma that causes the anxiety. Breathing problems can cause you to feel anxious because struggling to breathe is frightening. Sometimes people with asthma can be told that their symptoms are anxiety related and not asthma related.
Parents of children with asthma, or carers of adults with asthma, can feel anxious, particularly at the point of diagnosis, or if the asthma is poorly managed.
Anxiety and asthma can often occur together setting up a cycle where it is difficult to get back in control.
Keeping control of your asthma, with regular asthma reviews and the correct treatment, is one key way to break this cycle. If you have asthma and are going through a stressful time you need to keep a closer eye on your asthma symptoms.
If you are confident that your asthma is well managed it will be less a source of anxiety for you. Finding ways to overcome your anxiety is another way to break the cycle and the organisations we have listed at the end of this fact file will be able to give you advice and help.

How to know if it is an asthma attack or a panic attack

Sometimes it is difficult to tell the difference between an asthma attack and a panic attack particularly as asthma and panic can occur together and symptoms of both can overlap (see the chart below). When someone with asthma has a panic attack it can ‘mimic’ an asthma attack. Sometimes a panic attack can cause an asthma attack in someone who has asthma. Some people find that they have palpitations, trembling hands or feel a bit edgy or dizzy after repeated doses of their reliever inhaler which are all symptoms of anxiety too.
Some people may wrongly assume their asthma symptoms are anxiety symptoms and neglect to treat their asthma. Others may assume symptoms of anxiety are asthma related and not realise that anxiety can be treated successfully too.
The following diagram shows the main symptoms of asthma on the left, and those most likely to occur in panic (or hyperventilation) on the right. In the middle are symptoms common to both asthma and panic is an asthma attack or a panic attack

Asthma attack Common to both Panic attack
Cough Short of breath Dizziness
Wheeze Tight chest Tingling in fingers/lip
Low peak flow Feeling tense or anxious Nausea
  Palpitations Light-headedness
  Unable to complete a sentence Feeling faint Cramps

If you are not sure if your symptoms are anxiety or asthma related it is very important to talk to your doctor who can help you distinguish between the two. Your doctor can confirm whether or not you have asthma by offering you a breathing test and tryingout some asthma treatment as well as suggesting ways to control your anxiety.

If you have any reason to believe that your symptoms could be due to your asthma getting worse, then you should follow our asthma attack advice as detailed on the following page.

Asthma attack

1.    Take one or two puffs of reliever inhaler (usually blue) immediately
2.    Sit down and try to take slow steady breaths
3.    If you do not start to feel better continue to take two puffs of your reliever inhaler every two minutes, up to ten puffs.*
4.    If you do not feel better after taking your inhalers as above or if you are worried at any time – call 999
5.    If an ambulance does not arrive within 15 minutes then repeat step 3 while you wait
If your symptoms improve and you do not need to call 999 you still need to see a doctor or asthma nurse within 24 hours.
* Please note this asthma attack information is not designed for people using a Symbicort inhaler on the Symbicort SMART regime. If you are on the Symbicort
SMART regime please speak to your doctor or asthma nurse about this.

Panic attacks

Panic attacks are sudden attacks of anxiety which can be uncomfortable and frightening. A panic attack may make you feel dizzy or faint, or sick, or as if you can’t breathe. You may have heart palpitations or sweaty palms and you might shake. Panic attacks may happen in situations where you usually feel anxious such as in a crowded bus or train. Some people get panic attacks in social situations. Sometimes feelings of panic seem to come on out of the blue with no obvious trigger, including ‘nocturnal panic attacks’ which happen in the middle of the night for some people
with anxiety disorder.
Although a panic attack feels awful at the time it usually passes quickly, especially if you manage to slow down your breathing. It is a good idea to try and stay with whatever is causing the panic and to let the panic work its way out. Although at the time it might feel like the best and safest solution is to cut and run from a given situation you can quickly slip into the habit of avoiding all situations where you feel you cannot cope. This makes getting back to a panic- free life really difficult in the long-term.

Over breathing

One key symptom of a panic attack is hyperventilation or over breathing.Hyperventilation is not dangerous and the worst it can do is make you feellightheaded. You are unlikely to faint from an episode of over breathing. As hyperventilation is not dangerous the technique of blowing into a paper bag is no longer recommended for people suffering from panic attacks and is definitely not recommended for someone with asthma. Breathing into a paper bag does not help asthma and may delay getting the help you need in an asthma attack.
The best way to stop hyperventilation is to use a recommended therapy or technique for anxiety disorder and we have listed some of these below.

What you can do to overcome your anxiety

There is a lot of help and support available to help you deal with anxiety and a lot you can do to help yourself towards living your life free from anxiety.

  • Breathing control exercises can be helpful for anxiety and panic. They can also help to improve asthma control in addition to medication. Breathing control can be taught by a chest physiotherapist, and there are other therapists, such as yoga teachers and Buteyko teachers.
  • Progressive Muscle Relaxation (PMR) reduces anxiety by alternately tensing and relaxing the muscles. With practice someone can use this to relax the mind and body and avert a panic attack.
  • Cognitive Behavioural Therapy (CBT) is the recommended treatment for mostanxiety disorders, including panic disorder, and is the most effective at achieving long-term results. The basis of CBT is that what people think can affect how they feel and how they behave. CBT can help you to change how you think and what you do. To find out more about how CBT can help you contact the BABCP (see below).
  • Your doctor may suggest a short course of medicine or be able to refer you to primary care mental health services for therapy. Your doctor will also support you with anxiety around your asthma symptoms.
  • Talking therapies such as counselling or psychotherapy can help some peopleovercome their ongoing anxiety. Even talking to someone you know and trust, perhaps a friend or family member, can sometimes help and make you feel less alone with your feelings of anxiety. CBT (see above) is also known as a talking therapy.
  • Relaxation techniques such as meditation, taking a walk, gardening, and yoga can help. Alternative therapies such as massage and reflexology benefit some people with anxiety.
  • Distraction – for mild anxiety this can work very well – think of something else, put on some music, watch television or do something around the house.
  • Your local library will have books that tell you more about anxiety and panic attacks and techniques to help you deal with them.
  • The internet has information about organizations and charities which specialize in anxiety and panic disorder where you can get support and advice and share your experience of anxiety with others. Some useful website