How do I know which came first?

[sunny_afternoon]

Hello all, new forum member here. Sorry if this post is a bit long....I'm predicting it may be...

The question I have, is how do you know if you have anxiety/panic attacks caused by asthma, or does asthma cause the anxiety? I realize that it's a bit of a chicken and egg problem with no easy answer.

I'm 49 years old, male, non smoker, and until this year with the Covid restrictions, exercised fairly regularly. Apart from anxiety/panic attacks and tummy problems, I'm otherwise reasonably healthy.

But a year ago I had to quit my job because my anxiety became overwhelming. I also developed other GERD like symptoms that no amount of treatment has been able to fix. I am permanently bloated, belch hundreds of times a day (I'd be World Champion if there was such a contest), often get a dry throat, always seem to be nasally congested struggling to cough up mucus. I often get palpitations, either weird ectopic heartbeats or a raised pulse for no apparent reason.

In the last few days I've being feeling rather breathless, a bit like my lungs aren't quite working to full capacity. I'm not wheezing but it doesn't feel right. Sometimes I get to the top of the stairs and have to pause, either because my pulse has shot up or I need to gather some oxygen. I recover quickly but I just know deep down that this isn't right. The trouble is that it's easy to say it's anxiety or stress.

Anyway, the reason I've ended up on an asthma forum is after I recently stumbled across this article

ncbi.nlm.nih.gov/pmc/articl...

and it really got me thinking because the profile fits me so well. I recall many times in the past, over many years, when my chest has felt a bit 'off', a bit tight. Like I said, I never wheeze, but it's not a comfortable feeling. It often accompanies the palpitations. I always feel like I need to cough as the sensation is my throat and esophagus just feel a bit inflamed. Over the years I've had this sensation many times. It often passes. But I remember I've often experienced it out in the fresh air, often when the sun is out.

I also now remember 2 specific incidences - once playing cricket (this was 10 years ago) when I was batting and had to go for a third run after a mis-field. When I made my ground I suddenly just couldn't get enough air into my lungs and it felt like my chest was on fire. For a few frightening seconds I wondered if I was about to expire. If there had been the need for a fourth run I literally wouldn't have been able to do it. Or for the next delivery either (I'd already decided to fake a pulled muscle if I needed to run so soon afterwards).

Then last year, about January time, I was walking up a couple of flights of stairs whilst carrying a fair bit of kit at a snooker club and before I got to the top I suddenly thought "shit, there isn't enough air". At the top I had to wait and calm down. I prayed that nobody at reception came to talk to me because I knew I wouldn't be able to get any words out. At the time I wondered if it was a panic attack but now I'm not so sure.

I even remember going to the GP a few years back asking to have my breath tested because I'd experienced a spell of feeling odd with my breathing. She said everything was fine (in fact she was quite dismissive) and just said it must be anxiety.

But the weird thing is I showed that article to my Dad who is an ex surgeon, fully expecting him to fob it off, but on the contrary he thinks it's very plausible that I have until now undiagnosed mild asthma and that it could be causing the belching, tummy distension, weird heartbeats and the feeling of breathlessness.

I'm going to try and get an appointment tomorrow but with the way the NHS is right now I'm not expecting a referral for a very long time, which worries me should the GP agree that I may need one. Is it possible to get some private advice and in the meantime if I tried someone else's Ventolin inhaler would that be safe to do?

If you got this far, thanks. I'm hoping somebody may be able to reassure me or at least make me feel like I haven't lost the plot.

[twinkly29]

healthunlocked.com/asthmauk...

This post might help explore the differences although it is still a bit of a minefield!

[sunny_afternoon in reply to twinkly29]

Thanks, but what is SoB and PF? 😀

[EmmaF91 Community Ambassador in reply to sunny_afternoon]

Short of breath

Peak flow

[twinkly29 in reply to sunny_afternoon]

Yes what Emma said 😃

Peak flow might be something to ask a GP about monitoring for a week or 2 (including when symptomatic) to see if it changes at all.

[B_Asthma]

The study is an observational study detailing one individual and it is meant to suggest further research. Furthermore, it is not a double-blind study involving thousands of participants and the results cannot be generalised.

If you are not prescribed Ventolin then you should not be taking it.

As for asthma, you do not need a referral. Your GP can diagnosis it and treat it. The only time you are referred is after a bout of uncontrolled asthma you have progressed to the point your GP cannot prescribe any more medication because it requires a specialist prescription or you have been on repeated prednisone.

Finally there are mutiple explanations for shortness of breath when you walking up the stairs. It can be asthma, cardiac, the way you are breathing, anxiety, exposure to cold air, and a vast number of reasons. Without testing it is impossible to know. Best advice is to speak with your GP who can advise you further.

[Ts777]

Hi,

You poor thing!!

I suffer from diagnosed asthma and anxiety. I get panic attacks which don’t look like the standard breathe in the bag ones.

When it happens to me, my breathing pattern gets all messed up. I don’t breathe out fully. I breathe using just the top part of my lungs. Is it asthma or anxiety? I do mindfulness to tell the difference but if it’s really bad I pop a pill. If the anxiety doesn’t work then I know it’s asthma.

Of course, I do take ventolin as well. However, not too much as the asthma drugs can cause agitation and then it’s just an anxiety driven road to hell!

I went through the reverse path to you where the first thought was asthma, then the anxiety got much worse to the point where I got help on the nhs! It was a mental health worker who recognised the panic breathing.

I’m not sure if that helps?

I know that medics get very confused between asthmatic and panic breathing. If you display both and ask for help then some may run for their teddies and hide under a familiar bed. Don’t be too harsh, they can’t know everything.

If you suffer from anxiety they may be justified in not giving ventolin if they don’t believe it will help, due to it’s potential side effects.. you can look these up. The other name for ventolin is salbutamol.

I’m wondering if it’s worth asking the go for a breath test, eg a spirometery? My gps nurse does these. Maybe check it out.

I don’t know anything about the burping, it sounds awful though. You do have my sympathy.

I hope the gp has got you some support for the anxiety!! I can recommend Mind (the charity) and mindfulness. You may well be more expert than me though and I do know that we all find the things that work best for us 🙂🙂

[sunny_afternoon]

I managed to speak to a GP this afternoon. He listened carefully, which made for a pleasant change... He said that because of Covid the new protocol now for testing for asthma is to get the patient to do it themselves ! Meaning as of today I have a peak flow device and an inhaler to try out when I feel breathless (I'll do a few days of default readings first before I try Ventolin). I think if I only try the inhaler once or twice it won't do me any harm, or at least I'd like to think so, or he wouldn't have prescribed it.....?

He did say that from the sound of it, my breathing woes may be anxiety related but he was prepared to accept that I may have a mild asthma condition (I never wheeze, just feel tight and inefficient with my breaths) and therefore it's worthy of investigation.

[sunny_afternoon]

My average peak flow reading seems to be about 560. I'm 5ft 10, and will be 50 years old in 3 weeks. I have no idea if this is a good figure or not. I have nothing to compare it to!

I haven't tried the inhaler yet, I'm too chicken.

[twinkly29 in reply to sunny_afternoon]

Have a read of this which explains peak flow:healthunlocked.com/asthmauk...

Basically though your readings are only relevant to you. So keep doing them and you'll get a picture of what is good or not for you.

It would be really useful to do your peak flow, use the ventolin (honestly there's nothing to be scared of with it! You could take it daily and it won't do you any harm. You might notice a slightly raised heart rate but that will be short-lived and wear off) then wait 15 minutes (as it takes time to take effect and doesn't work instantly in asthma) and then redo your peak flow to see how it changes, or not, with the ventolin.

The patient doing it themselves thing is not actually related to covid really - it was common before and indeed is better in my opinion than spirometry at this stage as it shows things over time, not a one-off reading which might not be indicative of the general picture. So your continued peak flow scores (including those I've described above for before/15 mins after the ventolin) and your symptoms (also before/after it) will give the GP all he needs to know.

[sunny_afternoon]

OK thanks. I'll try and pluck up the courage to try the Ventolin. Like an idiot I read the label and it's put me off 😀

[twinkly29 in reply to sunny_afternoon]

They have to put every reported side effect on such things. It doesn't mean everyone gets them. Or any of them in fact.