It’s a very stressful time at the moment, with some people shielding, others worried about work and how to apply the new rules and regs, and still others struggling with after effects of covid etc etc. There are a million and one things people may be anxious over and stressing about right now (which is completely understandable!), and as many of you know anxiety/stress can both trigger your asthma as well as mimic an asthma issue! We aren’t living life normally either, and with underlying stress +/- covid recovery/asthma issues, a breathing pattern disorder can also develop (again something that can mimic asthma issues, as well as be a side effect/contributing factor of asthma flares... it’s common to develop after bad viruses or attacks, and is often seen in anxiety, but anxiety is not needed to have a BPD!).
Due to this I thought some helpful hints might be useful to help you work out what’s going on! As always this is just a rough guide, and if you are concerned seek help!
Cough, wheeze, breathlessness (sob), chest tightness (usually starts around lower ribs/bra strap level), fast heart rate (HR) at later stages. Typically Worse at night/early morning, typically worse lying on back, better sitting/standing leaning forwards. Initially presents with expiratory issues which then develop into inspiration/expiration issues. A drop in PF if that’s a reliable indicator for you. Usually an obvious trigger.
All relieved by reliever (salbutamol or MART) in the early stages, later stages reliever may not have the same bounce back/length of time it lasts, but should have some effects (at this point you call an ambulance). Will not really resolve without treatment, tho it may calm you’ll still have ‘twitchy’ lungs. If you frequently need the reliever (and its helping) you need to call your GP and inform them you are struggling to head off it developing into a bigger issue.
Low level, underlying chest tightness (usually more upper band/central behind sternum). Gentle butterflies in stomach. May be Slightly more highly strung than usual, background worries that you can struggle to ignore, brain struggling to stop. Can give constant mild SoB (ie faster breathing, but no overt in/out preference), relaxed position is best (lying down, slumping etc). PF doesn’t vary, and reliever doesn’t help.
SoB, tightness (upper/central, maybe into throat), can have a wheeze/cough. Inspiratory issues, most comfortable position feels best (variable in everyone- sitting leaning back or forwards, lying down, standing up everyone’s different). No obvious external trigger, PF doesn’t really drop, Sats 99/100, fast HR. Usually ‘short lived’ - 20-60mins, tho can last longer, but can fully self-resolve with no medical intervention. Feels anxious/panicked, during and often before the issue. Less likely to wake you in the middle of the night. Dizziness, Nausea, palpitations (pre inhaler), sudden sweats and P&N very early on in attack. Reliever doesn’t help.
Breathing pattern disorders
Usually a constant thing and different in everyone. Mouth breathers, fast breathers, upper chest breathers, breath holders (both in and out). May have sats that randomly drop with no symptoms at all (typically expiratory holders), and then resolve themselves in the next breath! Can cause SoB, tightness, wheeze, cough, Sighing, yawning and throat clearing. Usually no PF drop, not helped by reliever. Helped by breathing exercises.
Any and all of these are things that should be reported to your GP if you discover them, and ‘can’t get a handle’ on them. A lot of people may self-manage underlying anxiety with mindfulness and meditation, however some people may find medication is needed to help calm it down. Anxiety attacks demonstrate how stressed you are and that it’s possibly just got a bit too much, so again, if you haven’t already, speak to your GP and let them know what’s going on. If you think you have a breathing dysfunction, mention it and see if your GP will refer you to a resp physio so they can review and give you personalised exercises. If you are finding you’re constantly SoB you should let your GP know, and if you get to the point where you can’t walk/talk/eat/sleep due to your symptoms then you should always head to hospital, but hopefully this post will help people work out and differentiate what’s going on! As I said before, BPD and anxiety whilst they can stand alone, they can also trigger asthma issues so identifying them early can stop the escalation into an asthma flare.
If you do decide you want to look into mindfulness, meditation or breathing exercises, here are a few links;
Hope this helps someone!