Im talking about the other A word…. ANXIETY

As a Respiratory Therapist and a lifelong asthmatic, I know all too well that anxiety and breathlessness usually go hand in hand. Still, I often catch myself getting a little defensive when a medical person abruptly brings up the A word and asthma in the same sentence, or if I see the word pop up somewhere in my medical records.

Let’s face it, no one wants to be labeled as “Anxious” when they’re having very real breathing discomfort. Just remember(and I’m guilty of forgetting this at times), that being called “anxious” isn’t the same as being called “crazy”. It doesn’t mean that it’s all in your head. Unless you’ve been diagnosed with a generalized anxiety disorder (what they call GAD), it’s the breathlessness that causes the anxiety, not the other way around.

For those who might not know, breathlessness, or what they call “dyspnea”, is an uncomfortable and distressful subjective sensation of one’s own breathing .It causes anxiety because the breathlessness feels out of proportion to the degree of effort exerted. By contrast, an athlete who is exercising, for example, would not complain of dyspnea because a certain degree of respiratory difficulty is expected. If you have asthma or chronic lung disease, you’re gonna experience some degree of anxiety.. that’s just the way it is. Unfortunately, sometimes medical people aren’t very tactful when using the A word, which of course can make a person they’re treating for breathing problems even more anxious.

So why do medical people bring up the A word in the first place?
Well, because it’s their job to, and they have to cover all bases. People show up all the time in Emergency rooms complaining that they can’t breath, when in fact, they’re actually over-breathing. These people don’t have lung problems at all. For whatever reason, their anxiety gets out of control, they start to panic and sometimes hyperventilate. An experienced clinician can usually tell the difference. If for example the patient appears to be in distress, but their lungs sound totally clear and their sats are 100%, chances are there’s a component of anxiety fueling the distress.

So how do you NOT become anxious when you feel like you’re suffocating to death?
First and foremost, try not to freak out. Easier said than done I know, but along with using and/or increasing your rescue meds, try to stay as calm as you possibly can. Slow your breathing down if your able, and try to use purse- lip breathing. Try to objectively assess what it is that’s causing your shortness of breath. Did it come on suddenly or has it been gradually getting worse? If you have a PF meter, use it to see if the numbers jive with how you’re actually feeling at the moment. If your PFs are dropping, then you’re probably experiencing true bronchospasm ( a tightening of the airways). If your PFs are normal you could be experiencing the symptoms of air trapping and/or hyperinflation of the lungs, both of which are very common in chronic asthma.

Whether it’s abdominal breathing exercises that seemed to help in the past, or a certain relaxation technique that you’ve learned (personally a deep shoulder and neck muscle massage works wonders for me), every person with lung disease should have an anxiety action plan in place. The goal being whatever it takes to stop the vicious dyspnea-anxiety cycle from snowballing. If you’ve been prescribed short acting anti anxiety medication, then by all means take it. If you’ve tried everything, but the work of breathing becomes overwhelming, call your doc or better yet, go straight to the ER. Better safe than sorry. Anxiety or not, asthma still kills a lot of people.

Below is an introduction letter written by one of my doctors back in 2008. When I first read it I was little offended by the mention of the A word. Heck, I dont consider myself the anxious type. But, looking at the letter now, it makes to total sense to me. I agree with his assessment 100%! Honestly, how could any person with severe breathing problems not have at least a little anxiety.

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15 thoughts on “The “A” word

  1. SR says:

    I think the reason us asthmatics hate the “A” word, is because we connect it with panic attacks. Used to hate it if a doctor asked me if I had any anxiety during the day. To me, that meant he was accusing me of having a panic attack, as opposed to an asthma exacerbation.

    1. I understand why they have to ask these types of questions, especially if they dont know you, but I also dont wont want them getting side-tracked with a condition I dont have.

      1. SR says:


  2. Scott Coston says:

    Stephen… this was very insightful… thanks for posting it!!

  3. Judy says:

    I get upset at the word because I’ve had a PCP not give rescue meds, assuming a panic attack even though peak flows were low. Once I got rescue nebs, the peak flow went back up. I associate “anxiety” with “we aren’t giving you anything, even though you have low peak flows”.

    1. Time to find a new doc.

  4. Zim says:

    Now we all in Poland are little afraid, because we don’t know what will be in next days in Ukraine – if will be war, probably in Poland also. Fortunately I have supply of my medicines 🙂

    1. The world has been closely watching the terrible events unfolding in Ukraine. I sincerely hope violence can be avoided and that you will be safe in your country.

      1. Zim says:

        Today I saw airplane of NATO in my city. I’m hope all will be good or at least will happen only in Crimea… Thank You for good word.

  5. Ben says:

    I’ve always had an aversion to the “a word” as well. When I was a kid I remember going to the ER for asthma problems and nurses yelling in my face to “JUST CALM DOWN.” That didn’t really help either. Fortunately people seem to be better trained these days about trying to help people chill out when in respiratory distress.

    1. There were times when I would actually get the opposite reaction from medical staff. They would accuse me of looking to calm to be having breathing problems. Seems you can’t win.

  6. Liz Bernard says:

    I thought I was alone in fearing the “A” word. I had a doc tell me during a flare up that my peak flows were “worse than some of his asthma patients” and “you can do better”. Ummm, WHAT? I always feared (and still do) that as soon as that word is introduced, my breathing problems are ignored by health professionals. Which, funny enough, creates the anxiety they claim is there. So frustrating!

  7. Olivia Clark says:

    My mom has “A” all the time. She is always anxious when she feels a pain surging in her body. The worst case was when I was enjoying myself out in the mall she called me and I can’t even make a word of what she’s saying because she kept on crying and catching up with her breath. I immediately knew what’s happening to her. When I arrived home she was crying hard and was hyperventilating in her chair while my father was massaging her hands. I just kept a calm and firm voice reassuring her that she is not having a heart attack and that she just needs to breath and gather her thoughts on what pain she is feeling. I gave her a glass of water and let her breath deep until I felt her calm down. Then she said her tooth was aching so bad. She couldn’t think straight, she haven’t taken any meds for pain relief and she hypertension problems which made things worse for her. It’s become a usual happening for her which is very unhealthy. Even her doctor had told her about her panic issues. Everyday I just kept reminding her and not succumbing to her usual issues.

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