asthma, anxiety or both?

How can you tell the difference between the 2? I think it may be both but I'm not sure how to tell. my peak flow is constantly around 320-330 (before salbutamol), my best is usually 490/500. my inhalers seem to bring it up to 360-370. my only symptoms are chest pain/tightness which eases with salbutamol but doesn't fully go away.

[Hidden]

From what I understand anxiety and stress can make asthma worse. Generally I think if you are responding to the medication then you know its asthma.

[Hidden]

Have you ever had an anxiety attack? It always strange to me that medics get asthma and anxiety attacks so confused, I understand that both can make it feel hard to breathe but that is where the similarity ends, during my (fortunately very rare) anxiety things i am overwhelmingly anxious, and whilst i often get what feel like very real physiological symptoms during anxiety attacks, i know, in my heart of hearts that it is the anxiety causing 99% of the sensations, even at the time, im often crying to my mum, but saying ""why is my brain doing this!?!"" because i know it is my brain, and distraction techniques work well on anxiety but will do virtually nothing to asthma. I can see how the placebo effect could work on an anxiety attack with use of inhalers, but unless you feel ridiculously scared then i would say that its the asthma, asthma attacks are scary but its nothing like the overwhelming fear (and overwhelmingly irrational fear) of a panic attack. During an asthma attack there are very real and specific concerns which makes sense as its hard to breathe, and its well established that this is self-perpetuating as stress is a very real asthma trigger, but an anxiety attack is a complete ""OMG, i cant do this, not even for another second i dont even know how to be this scared"" kind of fear. Unless that is just my experiences of the difference between the two. I laugh when i get the ""were you a bit anxious"" comment from peope who didnt see me when i was unwell (i bounce back quick and people struggle to believe how ill i was sometimes) as i think it is disrespectful to the fear of an anxiety attack. During a panic attack no way could i force myself to be in hospital, it would be far too overwhelming and scary to do that to myself, frankly no-one is allowed anywhere near me when im really panicking as its too much for me to deal with. Asthma attacks are awful but in a very distinct way. My thinking is, unless you feel really anxious, it aint an anxiety attack. If you feel gererally stressed then that may well be causing your asthma to deteriorate. If you have the overwhelming anxiety but its not responding to distraction techniques then it may well be a combo of both. thats my thinking. Do you have a good GP? they can help you work through what might be going on much more clearly, i can only work on my individual experiences!

HTH

[Hidden]

I usually have panic attacks over severe (hospitalised kind of severe) asthma attacks, they appear to be ""good"" things - maintain my sats until I get to medical help, medical professionals calm me down and my sats drop a fair bit (8-12%) I feel ok, getting a tiny bit panicky if my inhalers don't seem to be fully working but that's about it. my gp is useless

thank you for the replies.

[Asthma-girl]

Hi Emma Louise,

If you GP is not helpful have you thought of changing your GP.

[Hidden]

Hi,

Like Soph says, I find I feel totally different during a panic attack to an asthma attack. I won't repeat what she says but for me the build up is totally different-during asthma my chest is the first thing I notice whereas in a panic attack I feel fear first (and I mean a very intense dark sort of fear) before the breathlessness. I think the emotions are also very different (there is a much deeper, irrational fear with a panic attack which, like Soph, I can feel and verbalise).

However, for a few month, many doctors and nurses told me my asthma attacks were in fact panic attacks and it took quite a lot of me explaining the above to convince them otherwise. Apparently a low pf can be caused by panic, being tachy is a classic sign of anxiety (and the only way my panic and asthma attacks are similar) and some did argue the placebo effect of inhalers. Fortunately, I have found an asthma nurse who was willing to listen and together we recognised that my asthma does bring on an element of anxiety (something I always thought) as I live alone and have bad asthma at night. I recently saw a physio who is helping to explore and break this cycle too.

Take care

[Hidden]

This is such a frustrating area. During admissions my bloods often show my O2 sats are good , but my resp rate is through the roof, around 43.

My chest is so tight I cannot get anything but very small breaths in, not moving much air. I also experience severe pain during asthma attacks, burning and flashing pain in my lungs. Pain increases on breathing in, so I literally feel like someone is tightening a steel band around my chest, can't get anything in so start hyperventilating. My ABG's show high oxygen, low carbon dioxide , blood alkalosis. My consultant then asks, ""did you panic.?"". I hate this question because it feels like they are saying I was having a panic attack. I get so fed up with it it makes me delay getting treatment, so I just nebulse back to back at home until I can't cope anymore and need atrovent. They always say, slow down, use your diaphragm, I know how to do all these things when I'm not having an attack, but I can't physically override what my chest is doing with an attack going on. Really gets me down .

[Hidden]

I get this thrown at me a lot as well. I've never had a panic attack, but I've also never had a severe asthma attack. I'm more of a 'slow burn' type and when I do get worse I don't get anxious about it, just rather quiet if really knackered (though as my GP pointed out, it's not unreasonable to be anxious if you can't breathe!) And an actual panic attack sounds horrendous so I am glad I've not had one.

I have however had my day to day SOB ascribed to anxiety - despite the fact that I am not generally an anxious person and there is almost no correlation, for me, between stressful periods and times when my breathing is bad. When stressed I get very tense shoulders and I can definitely feel that I'm stressed, but I DON""T get SOB - in fact some of my best periods recently breathing-wise have correlated with some really horrible and stressful events.

I have also had a physio point out that hyperventilation and anxiety are not the same thing; she said I breathe too fast at times but that she definitely did NOT think that bad breathing patterns had to be caused by anxiety or that anxiety was an issue for me. Sadly my consultant seems convinced that anxiety is the only reason for hyperventilation - also I get the impression that he thinks once you have it you're stuck with it, which I find odd as I can tell that the 'breathing pattern' portion of things has improved (it felt different) whereas breathing overall/number of flares hasn't. And I don't know a huge amount about anxiety but as far as I know it is actually treatable or can at least be controlled!

I do know that stress can be a trigger for asthma, but I also feel they can be a bit quick to jump to this at times: I imagine it must be a lot harder if you have had anxiety/panic issues in the past even though that means you're in a really good position to know the difference!