The feeling of not being able to fully breathe can be a symptom of both asthma and anxiety, and it can be tricky to tell the difference between the two.
Frank Courmier, MD, pulmonologist with Lourdes Physician Group Pulmonology in Lafayette, helps us untangle the complexity and shares what patients should know about these manageable chronic conditions.
How Asthma Presents
Although not common, asthma is not rare either. Asthma can be a finicky diagnosis, but asthma patients experience airways that narrow and swell, sometimes with extra mucous.
While there is some subjectivity in making an asthma diagnosis, there are tests to catch an “airway obstruction with reversibility,” meaning that an inhaler will help make symptoms better.
Although it can’t be cured, asthma symptoms can be controlled. Its symptoms are variable, and the classic presentation includes wheezing, shortness of breath and cough, with or without mucous. Symptoms are often worse at night.
How Anxiety Differs
Anxiety symptoms can be similar to asthma, but usually they are not worse at night and are less responsive to inhaler therapy.
Asthma is often triggered by certain exposures, but anxiety typically is not. Common allergens can trigger asthma, such as feathered bedding, workplace environmental exposures including cleaning solvents and chemicals, and even cat dander or pollen in the air.
Any treatment plan for asthma will include avoiding those triggers, but that wouldn’t help for someone who has anxiety. Shortness of breath may not be physiologically lung related. Allergy tests can help determine what might be behind asthma attacks.
How Providers Diagnose
A very careful history and very careful physical exam with testing are required to make an accurate diagnosis. It’s important that providers see patients while they’re having symptoms—shortness of breath episodes. Pulmonary function tests will likely be normal otherwise. Some of the tests attempt to induce symptoms, such as with exercise, another possible trigger for asthma.
Adult-onset asthma is much of what Dr. Courmier treats, and up to a third of his patients will have a history in childhood of asthma that returns later in life.
Removing the Stigma of Anxiety
Patients shouldn’t be afraid of a diagnosis that is not asthma if they are experiencing these types of symptoms. Getting care for anxiety can be more difficult than getting a prescription for an inhaler to treat asthma, but anxiety disorders are very treatable.
Psychotherapy and prescription medications are the most common anxiety treatments. Getting enough sleep, regular exercise, mindfulness and staying connected with other people can help manage anxiety symptoms.