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Very confused...

Hi :)

So I have had asthma problems for about a month now - wheezing, coughing, breathless etc. I have had to call an ambulance 4 times this month, three of those have been this week, and I swear they're getting fed up of me in A&E! The first two times the ambulance came I was told my chest was wheezy so I went to my GP and was given pred and antibiotics for a possible infection. Since starting them earlier this week I have had two more severe attacks, but both times have been told my chest is clear and it's a panic attack. I am a bit confused...I don't ever feel like I'm panicking and my breath control is usually very good - the attacks recently have been brought on by a lot of coughing which I assumed was due to the infection. My peak flow is also down, which is unusual for me because I am a woodwind player and so my peak flow usually stays the same, even when I'm having asthma problems. I guess I'm really asking how to tell the difference between an asthma attack and a panic attack as at the moment they feel exactly the same to me! Anyone else have this issue?

Thanks, musicgeek x

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hi Musicgeek,

Usual disclaimers of this is a forum, I'm not a doctor etc...but: maybe there IS no difference and they're all attacks, given you are clearly not well controlled? So if you still feel you're struggling then don't just accept the 'panic attack' diagnosis - be persistent, get help again.

Quite a few people on this forum don't wheeze at all, or only sometimes, when they have asthma symptoms, and it's not that uncommon from what I've read here for 'non-wheezers' to get told they are having a panic attack or 'just' hyperventilating when their chest is clear. I'd have thought if you were coughing and your PF is down then it's more likely to be asthma. Also, I don't know much about panic attacks and have not had one myself but as far as I understand it some degree of panicky feeling is required. I've had the arguments with drs telling me it must be anxiety and me saying 'yes, but I don't actually feel remotely anxious at the moment and I've had plenty of times when I am stressed or worried about something and not had breathing issues!' They don't always listen though some are really good.

All asthmatics apparently tend to hyperventilate and breathe badly at times though some are worse than others. I'm an oboist too and I sing, and I thought I had pretty good breath control and knew how to breathe from the diaphragm etc. Turns out the asthma has messed that up - so I know the principles but don't always apply them, and mostly don't even notice when I'm doing it wrong because I tend not to get any obvious hyperventilation symptoms - it takes the physio to tell me I'm not doing it right. The physio and dr have assured me it has nothing to do with panic attacks or anxiety in my case and in a lot of cases, it's just that the asthma has somehow screwed with my ability to breathe 'properly'. So you may be the same, but it doesn't mean you're having a panic attack or don't need urgent help in these situations!

If it helps, I personally tend to find (and it took me ages to work out what was going on), that when it's bad breathing (which I mostly seem to feel when doing breathing exercises...must be doing something wrong there...) my chest will feel unconstricted and kind of empty, like I can't get the air IN. If it's asthma, my chest will feel tight, especially at the back, and generally squeezed and I have more trouble getting air OUT.

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Thank you so much Philomela! I feel a lot happier since reading your post, and less of a fraud...it's odd, because my chest constantly feels tight and achey at the moment, I assumed because of asthma and chest infection, and as this has been getting better since I started antibiotics my GP agreed with me. It's just been because my chest has been clear that the paramedic said it was panic and not asthma (even though I said I wasn't feeling panicky or particularly worried about anything), but he did say that I was probably having asthma problems too because I was wheezing earlier this week. Being an oboist, I'm pretty good at deep breathing from my diaphragm but today the paramedic said I was breathing TOO deeply - new one for me! I think I'm going to give it a few more days, for my antibiotics to finish, and then if I'm still feeling breathless with a tight chest I'll give my GP another ring. For now I'll just not move around too much and try to stay out of A&E!

Thank you again, you've cheered me up a lot :)

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Glad I could help and you're feeling better about it! Believe me, I really do know that feeling - I went for ages being told my asthma wasn't asthma but was all in my head, anxiety etc and it was so frustrating and demoralising - partly because it meant the doctors saying it gave me no help at all with the asthma when I was struggling (it wasn't urgent, more day to day) - and they could be quite dismissive about it as well and make me feel really awful. I can imagine how scary it would be to have a paramedic say that when you've rung an ambulance and really feel you need help; it's really put me off the idea of A&E which is bad I know, though luckily I haven\t needed it yet.

It didn't help not knowing about poor breathing control and how it can be much more subtle than you'll find on the internet or hearing from a lot of drs. My current physio is a real expert in this area and she's said definitely that there may be overlap with psychological symptoms but it doesn't at all mean everyone with breathing pattern issues has psychological issues as well (though I'm lucky not to as I can see how you'd get anxious if you can't breathe and how it might start affecting other things as well, and it must be horrible.)

She has said breathing too deeply isn't great and that I do it sometimes. This really confuses me because I'm always getting told off by doctors for not breathing deeply enough when they want to listen - I try, but it's never quite deep enough! So not really sure what I'm doing wrong at times - I'll have to ask the physio about that one when I see her on Monday.

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I thought you could tell the difference between asthma and chest infection by the colour of the mucous you cough up

asthma produces a clear phlegm

chest infection produce yellow or when severe green phlegm

I didn`t know a panic attack makes a person cough

musicgeek, is your cough a dry cough or phlegmy cough?

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Hi Joan :) it was really phlegmy, but the phlegm was always clear. However, since I've been on antibiotics it's turned more into a dry cough - I've had a dry cough almost all my life (was finally diagnosed as an asthma symptom when I was 14 and started having attacks) but it isn't normally this bad. I find at the moment that when I have a coughing fit I have to really focus to get my breathing back under control - that's what I was doing this morning but still had a really tight chest and was struggling to breathe, so that's why my flatmate called an ambulance. The paramedic was really lovely, but I think he was a bit confused as to why I was having problems because there was no obvious trigger...personally I think it's the remains of a chest infection that I just need to clear, but I'm not exactly an expert as I've never had a chest infection before! I'm going to leave college early for christmas - there's only one week left now anyway - and try and just relax and recover at home :) thank you for all your help, it's great not to feel like the only one with these problems!

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hope you feel better soon and have a lovely Christmas :)

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Sounds like a good idea! Hope you feel better soon.

btw I remember you mentioning you thought learning a new breathing technique for playing set you off - wasn't circular breathing was it? Because I can imagine that could not necessarily be the best for your breathing right now based on various things my physio has said; also have seen some wind players say they think it's not really necessary as stopping for a breath, even a quick one, is usually musically desirable anyway. Bit random but just a thought!

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Good thought Philomela! It isn't circular breathing but it does involve breathing very deeply and fully from the diaphragm right round to the back of the chest. It's sort of like inflating like a balloon :P I'm not sure it's the best type of breathing for asthma...I've never seen a physio! At the moment I'm struggling to take any deep breaths so playing is right off the cards for now, hopefully if this infection clears up in a few weeks I will be able to try again and see what happens!

Merry Christmas to you and Joan too!

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Totally random thought here, but my asthma diagnosis was confused early on because when I did a pulmonary function test, apparently I was doing too well and had more air capacity than I ""should"" for someone my size. I pointed out to them that I was a music major and USING my lungs a LOT in my daily practices. Of COURSE I have better capacity than your average person my size.

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musicgeek I just had a thought about your deep breathing

hyperventilation

patient.co.uk/doctor/hyperv...

`Hyperventilation syndrome is where hyperventilation occurs chronically or in recurrent episodes and is associated with somatic (respiratory, neurological, intestinal) or psychological (anxiety) symptoms.`

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redsparklyshoes (love the name btw), I can't tell you how many times I've had that same conversation! It was one of the main reasons it took me so long to get diagnosed and why they kept on about anxiety etc. as mostly they never listened when I pointed out it was possible I might just have a better 'best' than other people my age and size Luckily now they seem to have accepted that my 'best' numbers are just going to be higher and now go on what I can do not what I 'should' do.

musicgeek - good luck with playing, and Merry Christmas to you and everyone! Though we may see you on here before that...

Joan - I've been told all asthmatics do that, but have also found it can be more subtle and varied than a lot of sites and even drs suggest. Though musicgeek's breathing technique doesn't sound the best thing to discourage breathing too much. Probably too early to tell musicgeek if the asthma's still acting up, but you may end up with a physio and they can be useful, perhaps especially for a wind player given breathing correctly is such a big part of what you do.

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Thanks everyone :)

Redsparklyshoes, yeah I've had the same conversation about my best being better than most people my age and size! Took my drs a while to realise that my breath control is usually pretty good, and I just don't feel anxious very often - I'm really quite a calm person!

Joan, thank you for that article, it seems to agree with what the paramedic said today - he thought I was hyperventilating because that's the way my body automatically copes with an asthma attack, and isn't necessarily linked to panic. I'm open to that argument - I think when I have an attack I revert to oboe mode lol and try and deep breathe, which is obviously not helping!

Thanks again Philomena, I have a feeling I may be back on here before then! I'd just like to shake whatever it is that's left over from the infection, I am fed up of being breathless when I try and walk anywhere or talk to anyone!

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Sorry I can't help with the difference between an asthma attack and panic attack, I've been told ""you look very calm considering your peak flow's 40%"".

I guess the infection is getting better if your chest is sounding clear, but in my experience it can take a while for asthma to settle down after the infection. I think thisis why you're still suffering with the cough and low peak flow. I find there doesn't have to be a trigger, lungs are just very twitchy after an infection.

I hope you're feeling better soon. x

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Thank you Lou :) It's nice to know that asthma can take a while after an infection, it explains why I'm still feeling very chesty anyway! I was worried about what was triggering it as well, but if I just need time to recover then that's alright :)

Thanks to all who replied today, you made a difficult day easier!

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I only just started using the RedSparklyShoes moniker. Usually I'm more boring and do something like RebeccaL or RebeccaG etc.

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musicgeek, I have the perfect solution for you

take up the piano i248.photobucket.com/albums...

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