Asthma and Anxiety: Which Comes First?

Because one can cause the other, it can be tricky to tell the two apart.
By Dr. Rob for MSN Health & Fitness

Q: I think I have asthma that is triggered by cold air, exercise, and my allergy to hay (I live on a farm). I am also a very emotional person and experience chest tightness and have difficulty taking deep breaths during times of high stress. Are these feelings signs of panic attacks or symptoms of my asthma?

A: If your symptoms during times of high stress are similar to what you experience when you are around hay, exercising, or out in cold air, they may be related to your asthma. However, panic attacks may also trigger chest tightness and breathing difficulty, so the two may be interrelated. Either way, the key is in knowing your asthma triggers (stress, allergy, etc.) and taking actions to decrease or prevent the cascade of symptoms from occurring.

Is it asthma?

Asthma is a respiratory problem that constricts the muscles surrounding the airways and causes the tissues in those very same airways to become inflamed and swollen. This two-pronged attack causes the airways to narrow and reduces the available space for airflow to occur. While some people do not have any symptoms and become used to this restriction (unless it gets worse), others may experience symptoms that include but aren't limited to:

• Difficulty when taking a deep breath
• Chest tightness
• Coughing, especially late at night or early in the morning
• Wheezing
• Trouble "catching their breath"

In determining whether or not you have asthma, it would be helpful to provide the answers to the following questions:

• What are your symptoms (coughing, wheezing, chest tightness, etc.)?
• Did you experience these as a child?
• Have you ever been hospitalized for a respiratory condition?
• When do the symptoms occur (after exercise, at night, during the pollen season, after a respiratory infection, after eating certain foods, when you are upset, etc.)?
• How often do they occur (daily, weekly, a few times per month)?
• Where do the symptoms occur (at work, home, when outside, anywhere)?
• Were your parents or siblings affected by asthma?
• Have you been checked for medical conditions such as gastroesophageal reflux disease (GERD), allergic rhinitis, anxiety disorder, sleep apnea or chronic sinus disease?

Next, your physician will perform a thorough examination and listen to your heart and lungs. Depending upon the results, tests may be ordered to either confirm or rule out the diagnosis of asthma. These include but aren't limited to:

• Spirometry—Measurement of how much air moves in and out of your lungs, as well as the speed at which you can exhale.
• Peak flow meter—This tool measures how well air is moving out of your lungs. This is a hand-held device that may be used to help decide what medications are needed if you have flare-ups of asthma.
• Broncho-provocation test—Checks the sensitivity of your airways to common occurrences such as during exercise or exposure to cold air.
• Allergy testing (sensitivity to sulfites in foods or drinks, allergens such as pollen or mold, etc.).
• Chest X-ray and/or computed tomography (CT) scan of the sinuses.
• Upper gastrointestinal study or endoscopy to check for GERD as a possible contributor to the "asthma-like" symptoms.

If asthma is the diagnosis, preventive measures are a key step toward decreasing the flare-up of symptoms. For example, in those with exercise-induced asthma, medications may be advised prior to exercise. If allergies are the trigger, antihistamines, anti-inflammatory inhalers, allergy shots and/or allergy avoidance measures may be advised.

Is it a panic attack?

These very scary and real feelings may come "out of the blue" or be triggered by a specific event (trouble breathing, personal loss, illness, etc.). They tend to last several minutes (although they seem to last forever) and can sometimes cause the affected person to be so fearful that they literally don't leave their home or environment unless they know they can "control the situation."

The symptoms vary with the individual, but often include one of a combination of:

• Difficulty breathing
• Chest tightness
• Tingling or numbness in the hands or fingers
• Rapid breathing and heart rate, increased perspiration
• A feeling of lightheadedness or that you are about to pass out
• Fear of dying or of not being able to "get out" of the situation, triggering a "need to escape"
• Symptoms of another illness you are trying to avoid (stomach cramps, dizzy feeling, chest pains, etc.)

Anxiety and asthma

Emotional stressors can be a triggering factor for asthma flares. Given that you may have a panic-anxiety reaction or possibly be affected by panic-anxiety disorder itself, treatment techniques aimed at decreasing your stress-induced breathing response will go a long way toward improving your quality of life. This makes it important to speak with your doctor and ask for a referral to a behavioral health specialist (psychiatrist, psychologist, or other mental-health professional) trained and skilled in the diagnosis and treatment of panic anxiety disorder. Approaches that may help include:

• Cognitive behavioral therapy—Treatment that focuses on the thinking pattern (worry about a future event, thinking the worst possible scenario will occur, etc.) and behaviors that stimulate the panic attack, then re-trains your thinking to know that the anticipation of the worst possible outcome (can't breathe, etc.) will usually not occur. This technique is often very successful in stopping the "irrational" thoughts that trigger the panic reaction, while facilitating a more rational (and calming) thought process.
• Exposure therapy—"Facing your fears" by being exposed to situations that trigger your response, then learning healthier techniques to help you cope.
• Medications—Antidepressants, anti-anxiety medications.
• Biofeedback, yoga, and/or meditation—These can help to control the breathing response as well as strengthen your ability to "relax."

It may also help to avoid tobacco, excess alcohol and caffeine, as these products may put you at a higher risk for an anxiety-triggered stress response. Even certain medications (beta-agonist inhalers that are used to control asthma, stimulants, energy supplements, etc.) may cause a jittery or anxious feeling in some individuals and should be discussed with your physician.

Asthma control may bring peace of mind

Anyone who repeatedly experiences asthma symptoms may get anxious in anticipation of the next time they can't breathe. This has the potential to set up a pattern of behavior where the worry and expectation of these breathing difficulties may actually trigger the very same symptoms you want to avoid.

Needless to say, asthma is personal and is best approached by developing an asthma action plan with your doctor. This helps to identify (and possibly avoid) your asthma triggers, selects the proper medication(s) to control the severity and frequency of the asthma flares, and prepares you to use "rescue" medications if symptoms become more severe. And, by taking control of your asthma with the knowledge your breathing will be okay, you may be armed with the reassurance you need to prevent your asthma related stress response from playing havoc with your day.