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Dealing with anxiety, fear, and panic during an acute exacerbation of asthma

Patient Education
Dec 21, 2011

Miles Weinberger, MD
Professor of Pediatrics
Allergy, Immunology, and Pulmonary 

It is frightening and anxiety-producing to be unable to breathe comfortably. For some, anxiety interferes with treatment of acute asthmatic symptoms. If you (or your child) fail to respond to an inhaled bronchodilator but then rapidly respond to similar medication given by inhalation or injection at a doctor's office or emergency room, a likely explanation is anxiety interfering with the proper technique needed for delivery of the aerosol to the airways. This occurs because anxiety causes more rapid and often shallower breathing that can both aggravate the asthma further and decrease delivery of an inhaled medication. It is therefore medically essential that anxiety be controlled at least sufficiently to permit effective use of the inhaled bronchodilator.

How do I control anxiety?

Just saying "Relax" will not do the job. For children, it is essential that parents (or baby- sitters) keep their cool. It is difficult for visibly panicky parents to deal effectively with anxiety in a child. For children or adults, anxiety is often controlled by focusing on some specific behavior such as rate of breathing.

Two techniques are used to slow respiration increased by anxiety:

  • slow drinking of any liquid
  • breathing exercises.

Sitting down with a glass of liquid ranging from water to any flavored beverage imposes a degree of relaxation by distracting patients from their discomfort. Additionally, breathing must slow down in order to drink. Once breathing is slowed, use of the inhaled bronchodilator is likely to be more effective.

Breathing exercises are a method of gaining control of respirations by "overriding" the anxiety-producing ventilatory drive. The technique is as follows:

  1. Sit down
  2. Take a long slow deep breath while pushing on your upper abdomen with folded hands.
  3. Let the air out slowly through "pursed" lips, i.e. the lips should be kept almost completely closed, sufficient to cause considerable resistance.
  4. Repeat the slow inhalation with abdominal compression and "pursed" lip expiration at least 2 more times.
  5. Try the prescribed inhaled bronchodilator again concentrating on the proper technique.
  6. Repeat procedures 1 through 5 if needed.

If difficulty breathing is so severe and sudden in onset that the above relaxation technique does not permit effective delivery of inhaled medication, a self-injecting adrenalin syringe (EpiPen or Twinject) provides a useful though rarely needed emergency measure for temporary relief. This can then permit the above procedure to be used. Discuss this with your doctor ifyou feel that your situation justifies this measure.