Panic Attack

Hello everyone, i'm another newbie. Something has been bugging me since beginning of year. Took a bad turn at work, thought it was asthma attack as ventolin seemed to be working for so long then went up to hospital and doctor said it was panic attack? Are the 2 types of attack linked somehow and can one lead to another? Thanks if you can resolve for me.

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Hi Claire,

Welcome to AUK, I hope you'll find that we're a friendly bunch and can offer you some support.

Basically, what most people mean by a panic attack, is a sudden and abrupt onset of intense feelings of anxiety and fear, with or without an anxiety-provoking trigger, and associated with a variety of physical symptoms. Symptoms can include shortness of breath, breathing rapidly (hyperventilation) and a feeling of being unable to take a full breath in. There are many other potential symptoms, including nausea, sweating, palpitations and dizziness, and the anxiety is often intense and associated with a desire to escape the situation you are in. Hyperventilation can cause dizziness, paresthesia (tingling, numbness and painful pins and needles) in the lips, face and hands, and, in extreme cases, clawing of the hands. All of these effects reverse when the breathing pattern becomes more normal. Obviously, if it is the first time someone has had these symptoms, they can be extremely scary in their own right (many people believe they are having a heart attack or otherwise dying) and this leads to increased panic and a positive feedback loop (a vicious circle, essentially).

Panic attacks should not cause wheeze or tightness of the chest, and the symptoms of a panic attack should not usually be relieved by salbutamol.

Asthma attacks and panic attacks can coexist by coincidence, as they are both relatively common conditions, and it is possible that if you are used to experiencing breathlessness due to an asthma attack, you might confuse a panic attack with an asthma attack if you are not used to the symptoms, although most people who suffer from both learn to tell the difference after a while.

Asthma and panic attacks can also coexist - asthma attacks can obviously be very frightening, and this can induce a panic attack in some people. Other people may not have an overt panic attack with an asthma attack, but may still be hyperventilating inappropriately during the attack. A degree of hyperventilation (breathing rapidly) during a moderate or severe asthma attack is necessary and appropriate, and is a normal unconscious physiological reaction, in order to maintain blood oxygen levels, but excessive hyperventilation can occur either due to panic, or because someone has got into the habit of doing this during an attack. Usually with excessive hyperventilation, the person will be anxious, and will be breathing extremely rapidly using the upper chest only, with little use of the diaphragm or movement of the stomach during breathing. Someone doing this might then experience the symptoms of tingling lips etc mentioned above. This is very common in asthmatics, especially when first diagnosed or after a first severe attack. Hyperventilation and panic during an asthma attack can make the attack worse, as the airways are often very twitchy, and breathing rapidly makes them more prone to close further. It is possible, therefore, for a panic attack to induce an asthma attack, as well as the other way around.

The treatments for these different things do vary - the treatment for an asthma attack is obviously bronchodilator medication like salbutamol (Ventolin) among other things, and the treatment for recurrent asthma attacks would be to increase your preventor medication. The treatment for regular panic attacks might include some form of counselling to learn techniques to deal with the attacks and to try to address any underlying issues causing the anxiety, and possibly medication as a last resort. The treatment for panic, 'panicky breathing' and inappropriate hyperventilation during an asthma attack involves assessment of breathing patterns, usually by a physiotherapist, and exercises to do regularly to retrain yourself to breath in the right pattern.

If you are experiencing breathlessness, of course you should use your reliever if you think that it could possibly be asthma-related, but a useful technique to assess and try to control your breathing pattern is to sit or lie comfortably, and place one hand in the centre of your upper chest, and the other on your abdomen. If you are breathing appropriately, you should see the hand on your stomach rise more than the one on your chest. Typically, someone who is panicking or hyperventilating inappropriately will see the hand on their chest rising more. Obviously, though, even if you believe this to be the case, if you are feeling more unwell, are not responding to your reliever, or are in any way worried, you should always seek emergency medical attention to be safe.

Anyone else who experiences any of the symptoms described above for the first time, without a diagnosis of panic attacks, should also seek emergency medical attention to rule out other potential diagnoses.

I'm sorry not to be more specific about your particular case, Claire - you haven't really given enough information to determine what really was going on in your case, and nor would it be very safe to do so without being able to see you. I hope, though, that this gives you a little more understanding of the basic events that take place in the two conditions, and how they can interact. I would suggest that you discuss this issue with your GP - he/she will be in a better position to determine what is going on.

Hope this helps

Take care

Em H

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thanks Em for the clear description of panic attacks and how to tell if I am breathing properly and fully. I find that after a period of being ill with my asthma when I start to go out again I get a little panicky and am almost looking for my breathing to play up. Even with my knowledge of breathing (yoga) it is still hard at the time when it happens to stay calm and breathe into the diagphram.

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I take both Panic and Asthma attacks.

I find if i have a panic attack it can bring on an asthma attack and if i have an asthma attack i bring on a panic attack which makes it worse.

I can tell the difference quite easily with the symptoms but if i am having both at once then the symptoms are horrible. Thats why i am sometimes to worried to call 999 for help as don't want to bother with panic.

Luckily there is more help for panic than for asthma.

L x

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Bumping this up for Al - info on the interaction between asthma and panic attacks or inappropriate hyperventilation.

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Bumping this up again