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!
Asthma
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.
Anxiety (chronic)
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.
Anxiety attacks
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;
That’s really interesting Emma. Thank you for sharing. That’s the best presented I have ever seen about the different aspects. Usually a doc just suggests possible anxiety in an accusatory fashion as if it is something you have chosen?! Chronic severe asthma in itself is enough to make anyone a little anxious especially when medics don’t fully understand what is going on, so a level approach as you have just given makes far more sense. Thankyou 💞Pam x
Yes and they usually don't seem to know very much about either anxiety or breathing pattern disorders! They're not the same thing even if there is an overlap, and also having them doesn't mean you automatically can't have asthma - it's not either/or.
I'm always amazed (and annoyed) when someone absolutely insists I have anxiety when I don't feel anxious, because of some overlap in symptoms (and when I have tried to explain no mine feel more like this not like that). Really helpful to have this explanation and the similarities and differences to make it easier to tell them apart.
Ha! Yes! Docs do like to randomly suggest things, with no explanation/reasoning then offer no support 🤦♀️.
I know a severe asthmatic who spent a year thinking she was having anxiety attacks because that’s what her GP kept saying (way after the fact)... she never felt any anxiety during the attacks, or strong emotions, or anything but her PF dropped to 30% and her sats would drop to high 80s... never got more help from GP cause ‘it’s anxiety’, never sought her own help cause she is young (was a child at the time) and everyone had her thinking it was anxiety so no point in a&e 🤦♀️🤦♀️🤦♀️. Now she’s having to retrain herself because after a very very long time in icu with multiple intubations in 18months, a specialist hospital has confirmed its severe asthma...
if it’s an issue, it needs treating, whether it is/isn’t asthma, whether it does/doesn’t trigger attacks! But identifying the issue yourself then going to the doc can be a lot better than hoping the doc can guess the right diagnosis (esp with overlapping symptoms!)
And I’ve heard from a few people now (med students, junior docs etc) that they are never really taught how to differentiate asthma attacks and anxiety attacks (most seem to think wheeze = asthma, no wheeze = anxiety... but you can wheeze with anxiety and not with asthma 🤦♀️🤦♀️) and yeah there’s still the underlying issue with MH problems.. that you can choose to have/not have them, that they don’t need support, and that you can stop them just by telling yourself to stop it 🙄.
Glad it made the differences a little bit clear for you anyway 😅
Also remembered I was told by a consultant my very slow walking, exhaustion, breathlessness and tachycardia (on no asthma meds) aged 25 was 'just anxiety' but I was offered no kind of help with that.
I found it was a ridiculous explanation for my symptoms, but if she did think it was anxiety, it would have been nice if she'd actually tried to refer me for help with that instead of basically saying it wasn't her problem and deal with it.
Their usual if you don’t tick standard asthma box is that it must be anxiety 🤷🏼♀️it is hard to know where to turn when you tick aspects of many different boxes but not all from any! You get left with every dept palming you off onto the next hoping someone else will tick that magic box that doesn’t seem to happen, whilst everyone adds their own drugs to the mix.
No wonder we end up confused 😐 currently awaiting neuromuscular appt that was postponed owing to COVID lockdown.
Ughh yep! And even with more recent understanding there is still this idea that asthma is quite a narrow and rigid definition and there is 'classic' with everything else 'maybe not asthma'. It really doesn't work that way, and it REALLY isn't defined by one symptom like the 'no wheeze no asthma' types think - I don't know how any Dr in the 21st century can still think that's how you define *any* disease.
My consultant mentioned how complex I was several times in my last phone appointment - I always worry he's on the verge of deciding it's me being unfit/dysfunctional breathing again. And he's doing some more tests in case something else is going on, which is fine and makes sense but also makes me really nervous as I feel like they don't capture the variability at all. I did say 'but an exercise test is totally dependent on how I am on the day!'
I feel like they always think that the way they see me in hospital after treatment when sitting still is the worst I get and I'm exaggerating.
Hope your neuromuscular appt is helpful - COVID definitely hasn't helped any of this!
You have totally hit the nail on the head there Lysistrata! I am actually welling up here that someone gets the concept!
My GP always refers to my being “complex” and even when I have a full diagnosis it is likely to be asymptomatic so to expect that 🤔🤷🏼♀️. I almost find myself apologising for not having the right symptoms, but all I can do is repeat what symptoms I do have, not what they want me to have and hope one day someone can help!
In the meantime I at least no longer have to have weekly IV magnesium sulphate in A&E resus, which is where I was last year, since they agreed to my having nebulised Magnesium sulphate it has been a game changer.
Ok, this is pretty much every other day for me, but it has kept me away from hospital admissions and A&E.
It's no fun being a unicorn! I am constantly doubting myself and just wanting to quit clinic entirely - and then when I have bad experiences in hospital it is very hard to remind myself I'm not making it all up. So true about the symptoms you have not the ones they want (but then I barely want to admit to any symptoms in case I get told I'm imagining it).
And I really hate the assumption that I'm overperceiving, when I actually tend to try and live as normally as possible and ignore being SOB because I want a life, but have landed myself in resus several times with an ambulance from work. But yes of course A and E were overreacting too (🙄I do genuinely get medics who weren't even there suggesting that sometimes).
Sorry for the rant!
Glad you have found something that helps that you can do at home - that does make a difference; in my case having normal salb nebs at home has helped for the times I am in limbo and need more than inhaler but am not acute (and I usually seem ok like that and so wouldn't get nebs, given how I present).
No need to apologise for a rant fellow 🦄 😉. Frustration bubbles along until that one thing pushes you over the edge and you snap - at which point you get the “anxious” thrown back at you and you are back full circle! I understand the symptoms bit and I too sometimes don’t reel them all off for fear of sounding like some sort of hypochondriac but then does that make it harder for a diagnosis🤷🏼♀️
I go through phases of just ignoring the symptoms since that is what docs seem to do, but reality is, if I become a statistic, to a doc that is all I would be, but to my family the impact is greater, so I owe it to myself and them to keep common sense in place.
Worst is when you scare yourself that actually you have ignored it too long - I remember last year when I was in majors one particular time and all of a sudden they grabbed my bed and literally ran me round to resus - now that was the one time I genuinely felt anxious wondering if I really had left it too late 🥺 (obviously not since I am here to tell the tale 🤣)
Yes, I definitely find it hard as I want to downplay it so they don't think I am exaggerating, then they think it isn't that bad. One time I automatically downplayed it to 111 (was told I sounded like I was reassuring them!) and they put the ambo as low priority. Several hours and the paramedic was NOT happy at the priority level when he arrived and saw me - one of my worse attacks! My work (I'm now freelance) were always very good at not letting me do that or faff around 'you have had x puffs and a neb, what are you waiting for? I am calling now'.
I know what you mean about the not wanting to be a statistic too (though the 'head consultant' in my mind always tells me that's an exaggeration). I have a bad habit of hating dealing with drs etc so much I would rather put up with the physical discomfort for too long - especially after years of being told that I was in fact no good at putting up with the discomfort and was getting help at the first sign of symptoms when I didn't need it (even when the person saying this wasn't there and had no idea what had happened nor did they know how I dealt with it). Anyone reading this - please don't do what I do, bad idea for anyone.
Oh my gosh I so hear you. Although I'm sorry you go through this too In a selfish way I'm also relieved I'm not the only one feeling like this! I bury my head ignore ignore ignore symptoms and carry on... so when I stop and say I'm sob I really am.
But they constantly make me doubt my symptoms- anxiety, dysfunctional breathing disorder? "Not the usual asthma symptoms" as no wheeze... it's that that makes me anxious because I think am I complex because I'm making it up! 🤦♀️🧘♀️🤣😂
Yup! Anxiety is definitely the catch all tho. Uncontrolled asthma? It’s anxiety! difficult asthma? It’s anxiety! Severe asthma? Nah, probs just anxiety! I swear the only thing I now get properly anxious about is doctors blaming my asthma on anxiety!
You end up playing pass the parcel if you’re complex or unusual! Luckily I’m more zebra than unicorn so I’m not passed around much, tho seem to get a lot of ‘x is because of y. No we won’t refer to look I to why y happens’ 🙄. They really need to do over views and look at the big picture... many of us don’t just have 1 condition, and different conditions get irritated by each other, yet get treated separately and docs don’t communicate to each other...
The friend mentioned above now has been (cautiously) diagnosed with (pending referral to local outpatients for official diagnosis but 90+% positive its a correct diagnosis by multiple docs/nurses); severe asthma (diagnosed), ASD with associated anxiety due to no support, EDS, POTS, multiple allergies, diabetes, a seizure disorder, PCOS/endometriosis, interstitial cystitis, probable AI and migraines... basically all are different departments, all can/have affected her asthma, yet no one realises how the issues interact until they see her in icu when they are all kicking off (ie they ‘forget to check bloods, because her lungs are bad, but give her sugar and lungs calm down...)... either one department palms her off to the next one and no one treats, or they treat the issue and don’t listen/understand that it adversely affects another issue... 🤦♀️🤦♀️
Hope you get the appt through soon and that you get some answers!
Would love to be a fly on the wall in the consulting room when they see one of the rent-an-advocate team saunter in!! Reckon they would learn pdq what true anxiety felt like 😂
That thought has just made my day! I will picture you on one shoulder and Lysistrata on my other at my next appt 😜
I absolutely love this idea! I have debated with a friend that we should just go to each other's appts, as neither of us can manage our own but are very assertive on behalf of other people. She's a nurse but says she can't apply work mode when it's her which I completely get.
So I would happily do it for someone else and would not be nuts but need my own advocate for mine. Emma would be great (she's called an ambulance for me so I know she is, I would have been trying to pretend it wasn't that bad and would have put it off). I think there's legs in this idea!
😂😂 I do it for my friend via text voice messages... I always wonder what the nurse/doc face is like the first time the phone starts talking to them 😂😂... - esp the couple of nurses I got suspended/investigated because of their actions towards friend... I explained the issue, they ignored, I warned them, they ignored, I warned a little louder, they ignored, I waited until a doc came it to deal with the now emergency, told the doc what actually happened if friend told me nurse was lying, or told doc i needed to ‘talk’ after emergency, nurse gets sent out, emergency dealt with, then asked for ‘my report’ from the doc who knows of me, and the nurse ‘dealt with’ appropriately...😅 (apparently the ‘bad nurses’ faces are a mixture of shock and anger that a) they are being reported (esp the one I called out for lying) and b) the doc actually listens to me, confirms with friend, then takes action!)
My friend when she’s well says that the phone suddenly talking to those not aware is always an hilarious image (usually I help her communicate problems cause of the ASD she has issues and when she can’t breathe she can’t talk...)... nurse comes in, looks at k, phone cheerfully explains the situation and what K needs and Explain why if they don’t believe (usually after explanation of asthma and why lack of wheeze doesn’t matter they will get neb)... actually had one come back and ask for more education on asthma... few months down the line same nurse told friend she was looking into being an asthma nurse...)
I’m happy to sit on your shoulder next appt... tho I may be a little heavy 😉😂
Love the idea of talking text! Do you sound a bit robotic or is it your actual voice? The talking bit is so hard when my asthma kicks off but I don’t wheeze - is like a cracked record! That’s it, maybe I should record all various answers and just play the relevant phrase as they are so predictable! Since you phrase things so well maybe we should crowd fund you to record key non standard asthma explanations Emma 🎉x
Voice messages... they are literally audio recording what I say and sent via text... my friend now has a couple of whatsapp chat groups just full of my messages for certain situations (ie her coming round from sedative, her ‘fighting’ the tube whilst still asleep etc) and even one of me reading her stories cause my essex accent voice is apparently calming to her 🤷♀️😂 (that’s the ASD and the fact she recognised my voice whatever the situation is now I think)
For me when I’m bad I try writing (if you can’t read it then docs know they need to do something 😅), but having a set of pre-recorded messages is a good idea! 😂😂
I should do this because sometimes I do feel like a stuck record (and I won't lie, I also have to fight off the tendency to get annoyed 'why am I explaining basic medical concepts to you? I am not at work (medical communications) and you're supposed to know this already, it isn't $%^&* hard'). Maybe one on wheezing, one on heart rate and one on sats for starters...
The writing one wouldn't work for me - I've always had the handwriting of an old school doc even when completely well; add a few nebs to that and they'll be asking me when I learned Sanskrit lol.
So agree with you Emma about medics saying everything is anxiety. I had real problems last year with my asthma which was resolved through a proper asthma treatment plan by a respiratory consultant. Various GP said “its anxiety not asthma”. Consultant completely disagreed. Now I’m anxious about having an attack that won’t be treated.
Thank you! That is very helpful. Some days I tick some boxes from each section - I'm just a mess! I suppose "temporary" (but still going on after 3 months) post-viral is another subject altogether?
Yeah post-viral is a different subject completely, and can be a lot more vague. After bad viruses and infections it can take 6+ months to fully recover and be back to normal, symptoms vary drastically, there’s usually an element of BPD which may resolve or may need physio, resp issues often responds to ventolin, but may not need more than that (but some might) and once it’s calmed not even that... others find it develops into a long term condition like asthma, but short term it’s often not diagnosed cause there’s the general believe things will sort themselves out in the end, you just need support through the blip...
Post viral is a complete can of worms 😅😂 (and can be associated with a lot of other symptoms like chronic fatigue, aches and pains etc)
You don’t need to tick all the boxes to ‘have’ a section, just they are some of the commonly found boxes... I usually suggest that if you think it applies to you, do a little research and see if you still think it does from the description/signs and symptoms!
Welcome... I just thought it would be useful to give some pointers to help differentiate problems (esp as we aren’t ever really taught how to, which can lead to both under and over treatment of both asthma and anxiety!)
Thanks for the post it’s really informative. It’s great to have refreshers like yours. I am a health professional calm, level headed, not a worrier but have had dreadful anxieties during the past 12 weeks. So relieved to be shielding but extremely anxious to be “on the list” now worried again as concerned that shielding will be lifted and I’ll be returning to work in the hospital. Also building up for going in for Mepo in the morning. Strange times indeed but very thankful for this forum lots of support and helpful ideas like yours on here. Keep safe everyone 😊
It’s one of the reasons for the post. Even those who don’t usually have anxiety, probably have an aspect of it rn, and if you do but don’t usually telling them apart can be tricky! Hope the mepo goes well! Stay safe and let’s see what Boris says about us shielders today!
Emma, do you happen to know whether breathing pattern disorders can be triggered by reflux? I’ve been suffering (off and on with varying degrees of severity) from the symptoms you describe since the beginning of December last year. We know reflux was involved rather than asthma simply because Ventolin didn’t help with it whilst gaviscon advance did, we also know it’s not purely down to stress as there was no cause for stress or anxiety when it first started (though I don’t suppose the issues surrounding covid helped when that all kicked off).
Things are much improved now, but it’s taken two lots of meds - cimetidine and Gaviscon advance - taken since the beginning of April to bring things back under control and I’m still on both, though at the point where things are good enough to start reducing dosages. My asthma, on the other hand, is still nowhere near as good as I would expect it to be at this time of year. I’m still on maximum levels of flixotide 250. Usually at this time of year I would half that. I’ve assumed that my lungs had been irritated by the reflux and that’s why I was having issues, but having read your info on BPD now now I’m not so sure.
BPD can be triggered by anything, and nothing 😅. If you had a period of poor control (ie reflux flaring asthma/giving SoB) then you could have ‘easily’ picked up a BPD. Basically they are bad habits that we usually don’t realise we have until someone points it out 😅. If you think you have one, and you’ve done a little more research than my very short synopsis then it’s worth doing the breathing training/exercises (tbh even if you don’t have one it won’t harm you!). I posted a could I found on google, but I think twinkly29 posted one she was advised to use by her team. Have a browse, try it out, and if it helps you know it’s BPD that’s the issue!
I’m glad you managed to get on top of your reflux, and I hope this helps calm the rest of what’s going on!
I’m supposed to be having a gastroscopy sometime (goodness knows when) after my gastro consultant was tipped off by my GP that I was still having problems. The first lot of cimetidine taken in December seemed to have done the trick but I started to get on and off chest tightness and coughing spells three weeks after I finished the course. I admit I put that down to a mild asthma flare (it was very wet at that time which we know can trigger a response) but things gradually got worse whilst my peak flow remained fine. I twigged it was reflux again and went on the cimetidine - it took six weeks for things to begin to get back to a more normal situation, as opposed to two weeks the first time round: predictably the cons wasn’t happy about that.
I’m so happy I’ve just read this because I’ve spent all week doubting that the tightness I’ve been experiencing was real and thinking it might be anxiety. But it’s all been around ribs and have been needing to sit forward and waking up in the night so pretty sure it is asthma.
Glad it helped! Keep an eye on it, use your reliever (if it helps then it basically helps confirm asthma) and inform your GP when you can just in case they think you need something more. Follow your asthma plan (and if you don’t have one ask for one!). Hope you feel better soon
Reliever helps but sometimes need more than 2 puffs or it doesn't last long enough. I know that's normally a sign for A&E but for me it's not as I only have moderate tightness and shortness of breath and no wheeze so know A&E wouldn't do anything. That's what makes me doubt that it's asthma because I don't seem to fit the normal presentation.
It does sound like you’re flaring. Remember you can take up to 10 salbutamol through a spacer (if that’s your reliever), tho you need to see your GP if you do that. And if 10 doesn’t last 4hrs the hospital should help (urgent care etc if you don’t want to go to a&e) and they should give you something (even if it’s just a short course of pred).
Look after yourself and be sensible!
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