Asthma and anxiety

A good asthma history must include finding out about anxiety.

If you are used to treating severe asthma, you might underrate how scary moderate attacks can be - any child who has had a significant asthma episode is likely to have been scared that they might die. Subsequent tightness or night-time wakening might be accompanied by fear, leading to physical feelings that can be indistinguishable (by the child, the parents and even doctors) from asthma.

Symptoms of panic/anxiety include:

shortness of breath (usually associated with hyperventilation +/- tingling around the mouth or in the fingers)

• sweatiness; pallor; palpitations; butterflies
• fear of dying or going crazy.

Although the signs of panic are different from an asthma attack, misdiagnosis does occur. Lesser forms of anxiety can also create confusion.

Ask patients about their physical experience of anxiety ('What does it feel like in your body when you worry or get anxious?', 'How is that different from when you get asthma?')

Rule of thumb: Assume that all asthma is overlaid by anxiety and aim to tease out the relative contributions.