Anxiety feeling short of breath

How To Tell If Shortness of Breath Is From Anxiety

  • Overview
  • Does anxiety cause shortness of breath?
  • Other causes
  • What anxiety does to your body
  • Managing anxiety
  • When to talk to your doctor
  • The lowdown

When you're having an anxiety attack, it can feel like you're struggling for air. You might start to worry: is there something seriously wrong with my body? You may even wonder if you are dying. Here's how to tell if shortness of breath is from anxiety, and when you should seek medical attention.

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Anxiety is associated with a range of both physical and psychological symptoms.

Physical symptoms may include:

  • Dizziness or feeling faint

  • Racing heart or heart palpitations

  • Hyperventilation (rapid breathing)

  • Chest pains

  • Headaches

  • Trembling or shaking

  • Sweating

  • Nausea or stomach aches

  • Frequent bowel movements

  • Muscle tension

  • Dry mouth

  • Throat tightness

  • Dyspnea (shortness of breath)

Psychological symptoms can include feeling:

While shortness of breath is commonly associated with anxiety, it can also be a symptom of severe medical problems, such as heart attacks or pulmonary embolisms. However, if it is anxiety that is causing you to experience shortness of breath,  it will usually go away once you've calmed down.

If you experience severe anxiety, it is also often possible for you to identify a trigger or cause that resulted in the onset of symptoms. Depending on the severity of the trigger, it may take several hours before you feel normal again. However, anxiety and panic can both occur without any known cause.

Anxiety is often exacerbated by:

  • Relationship problems

  • Stress or pressure at work

  • Life changes

  • Learning new skills

  • Dealing with other health problems

  • Concerns for friends or family

  • Financial worries

If you experience shortness of breath after dealing with a stressful event, it's probably due to anxiety. As you engage in relaxing activities, such as taking long deep breaths, yoga, or a gentle walk,  and separating yourself from the stress, your breath should return to normal. If it doesn't, or you find yourself becoming breathless multiple times a day, you should talk to your doctor.

Anxiety can put excessive stress on the body and make you vulnerable to other illnesses. Studies show¹ that anxiety disorder can negatively affect the immune, cardiovascular, digestive, reproductive, and sleep systems. Therefore, if your levels of anxiety are consistently high, you should talk to a mental health professional to get the support you need.

Apart from anxiety, shortness of breath has also been linked to chronic diseases and disorders, including:

While these can be serious conditions, rest assured that shortness of breath isn't the only symptom. Serious diseases don't just appear out of the blue. They are usually accompanied by other physical symptoms that you experience over a longer period of time. If you are concerned that your shortness of breath isn't caused by anxiety, ask your doctor for guidance.

Shortness of breath can also have other causes, including:

  • Allergies

  • Cold or other respiratory infections

  • Injuries like broken ribs

  • Frequent smoking

  • Extremely hot or cold temperatures

  • Adverse reactions to medication

  • Strenuous physical activity

When your body experiences anxiety, it goes into fight-or-flight mode to protect itself from an immediate threat. It releases adrenaline, a hormone that pumps blood to your muscles and causes your body temperature to rise. It also sends most of your oxygen to your muscles, which is why you may feel short of breath.

However, unlike an immediate danger, an anxiety trigger isn't always easily identified. This can make it more difficult for your body to know when the danger has passed, so it may take you a while to relax. Additionally, symptoms of anxiety, such as shortness of breath,  often lead you to feel more anxious, so it can become a cycle.

In the first instance, it may relieve some of your worries if you can rule out any serious diseases. Talk to your doctor about getting a physical exam, blood tests, lung function tests, or chest X-rays to check for any underlying issues. You can also talk to your doctor about medication to help ease the physical symptoms of anxiety.

Another way in which you can manage anxiety is through psychotherapy, such as cognitive-behavioral therapy (CBT). CBT teaches you how to deal with the thoughts, feelings, and behaviors that may be causing you to feel anxious. You will also learn effective coping mechanisms and how to de-escalate stressful situations. Joining a support group or group therapy program can also be helpful.

Social interaction is also one of the best ways to manage anxiety. Reaching out to friends and family to let them know how you are feeling can often lead to encouraging conversations and support. You may even learn that some of your loved ones are having similar struggles and you can support each other. You should also try to cut out as many unnecessary stressors from your daily life as possible, get adequate sleep, and eat a healthy diet to help you better deal with your anxious symptoms.

When anxiety sets in, take a deep breath by inhaling deeply into your stomach and exhaling slowly to slow down your breathing and lower your heart rate. Deep breathing activates your parasympathetic nervous system, which calms your fight-or-flight response. You may also benefit from meditation or other grounding techniques, like squeezing stress balls.

How To Deal With Anxiety, Manage It, And Overcome It

Most of the time, a wave of anxiety will pass on its own without medical attention. However, if you experience any of the following you should urgently seek help:

  • Extremely painful chest heaviness

  • Prolonged racing heartbeat

  • High-pitched wheezes when trying to breathe

  • Swollen feet or ankles

  • Blue fingers or lips

  • Inability to think clearly

  • Difficulty speaking

  • Pain in your left arm

Shortness of breath is one of the many uncomfortable physical symptoms of anxiety, but it's almost always temporary.  Therapy, meditation, breathing exercises, and making healthy lifestyle changes can help you to manage shortness of breath. However, if you are experiencing frequent anxiety attacks, which can affect your long-term physical health, contact your doctor as soon as possible.

Is My Shortness of Breath from Anxiety?

Anxiety can cause shortness of breath due to changes in heart rate. There are medications, breathing techniques, and mindfulness practices that can help.

Experiencing shortness of breath (dyspnea) or other breathing difficulties can feel scary. But it’s a common symptom of anxiety.

Many people worry that a symptom affecting their breathing must come from a physical issue. In fact, your mental health affects your physical health in a number of ways.

While anxiety can cause shortness of breath and other physical symptoms, it’s important to acknowledge that experiencing shortness of breath for other reasons may also create anxiety.

Here’s what you need to know about this symptom and when to see your doctor.

Anxiety is your body’s natural fear response. This is known as the fight-or-flight response. Your body reacts in physical and mental ways to prepare you to either fight or run from a threatening situation.

Shortness of breath is one of those responses. You may feel like you can’t catch your breath, tightness in your chest, or like you’re suffocating or hungry for air.

Studies have shown a strong association between anxiety and respiratory symptoms, including shortness of breath.

Other symptoms that can occur during this response and as a result of anxiety include:

  • faster breathing (hyperventilation)
  • chest tightness
  • breathlessness or a feeling of suffocation
  • feeling like you have a lump in your throat
  • muscle tension
  • heart palpitations (feels like a stronger, faster heartbeat)
  • feeling faint, dizzy, or unsteady
  • nausea or stomach discomfort
  • restlessness, irritability, or feeling on edge

Shortness of breath and other physical symptoms happen in the fight-or-flight response to protect you. With anxiety, you may not be running for your life. But your body still responds as if you are.

You experience chest tightening, shortness of breath, and faster breathing because your body is trying to get more oxygen to your muscles, preparing you to run. Your heart rate increases and you may feel hot as more blood pumps into your muscles, preparing you to fight.

All of these symptoms are normal body responses designed to save your life.

Of course, you probably aren’t often running or fighting for your life — from wild bear attacks or men with chain saws. But your body still reacts to your trip to the crowded grocery store, your work presentation, and other anxiety-provoking events as if you were.

When you’re experiencing shortness of breath from an anxiety attack, it may seem counterintuitive that your breathing is what you should focus on.

But by focusing on your breathing, you can get it under control and the right amount of oxygen into your lungs.

Experts recommend practicing diaphragmatic breathing. This is a type of breathing technique that uses your diaphragm — the most efficient breathing muscle we have.

When you’re experiencing shortness of breath, you’re generally breathing from your mouth or chest. But diaphragmatic breathing can:

  • slow your breathing rate
  • decrease your demand for oxygen
  • use less effort and energy to breathe

Here’s how to practice diaphragmatic breathing:

  1. Sit up comfortably in a chair or lie back on a flat surface, like your bed, with your head supported.
  2. Place one hand on your upper chest and the other below your rib cage. This will allow you to better feel your diaphragm as you breathe.
  3. Breathe in slowly through your nose so your stomach moves out against your hand.
  4. Tighten your stomach muscles. Let them fall inward as you exhale through your nose or your mouth (depending on what’s easier for you).
  5. Continue to take deep breaths in and out, feeling your stomach rise in and out. Do this for 5 to 10 minutes a day.

Tips: You’re less likely to experience shortness of breath or hyperventilation while breathing in and out through your nose. It’s also normal to get tired or feel like it’s a lot of effort when you first begin this breathing practice. With more practice, this breathing technique will become automatic and easy.

“The more you can slow down the physical sensations during periods of high anxiety, the more you can use your rational mind to assess what is going on.”

  • Elke Zuercher-White in “An End to Panic”

You can also try these anxiety-relieving techniques:

  • Grounding techniques. One type of grounding technique (progressive muscle relaxation) involves clenching muscles and slowly releasing them. Focus entirely on these sensations.
  • Mindful distractions. Find something to distract your mind from panicking to help you calm down. Try describing things around you to keep your focus on something else. What color is your couch? What is its texture?
  • Talk with yourself. Now that you know these symptoms are a part of your body’s automatic response, remind yourself of this. In the moment of panic or anxiety, tell yourself “I can’t breathe because my body is trying to get more oxygen” or “I’ve been evaluated and my heart is fine. ” Talking with yourself rationally can pull you out of the anxiety.
  • Exercise. It may seem strange to exercise in the midst of an anxiety attack, but going for a quick run or expending some of that built-up energy may actually work for you. Your body is preparing itself to run anyway — you might as well take advantage of it.
  • Self-care. You can practice self-care in simple ways. Drink herbal tea (but avoid caffeinated tea, as it can increase anxiety). Light candles with a pleasant aroma. Write down your feelings. Turn on some soothing music.
  • Shock yourself. Shocking your system by dipping your face in a bowl of ice water is actually a technique recommended by therapists to help pull you out of a thought spiral.

If you notice shortness of breath before experiencing a full-blown panic attack, learn to recognize it and don’t ignore it. Start focusing on your breathing before the anxiety escalates.

For long-term strategies, consider seeing a mental health professional. They can evaluate your needs and help teach you coping mechanisms that’ll work for you.

Practicing your breathing daily, other forms of mindfulness, and taking up relaxing yoga may also help.

The main way to prevent shortness of breath and other physical symptoms of anxiety is to practice techniques and learn your triggers when you’re not experiencing them.

You don’t prepare for an earthquake during an earthquake; you prepare beforehand. Anxiety is the same.

One of the most helpful preventive techniques is to maintain a thought log. In a thought log, you write down the automatic thoughts you had in your last moment of anxiety or panic. It’s helpful for discovering triggers as well as helping you reflect on your anxiety in a calmer state.

You can also write down what sensations you’re experiencing while you’re experiencing them. This can help your doctor understand what’s going on.

There are several types of thought logs. Check out this one focusing on dysfunctional thinking or a general anxiety tracker. You can even make your own by recording:

  • the date
  • the specific trigger (the situation or physical symptom, such as shortness of breath)
  • the automatic thought (what you think will happen due to this physical symptom or situation)
  • how strongly you believe this thought (1 to 100 percent)

If you’re experiencing shortness of breath, your automatic thought may be that you must have a serious health condition. At the moment, you may have believed it — almost 100 percent.

However, after challenging this thought now in your recording, you only believe it 20 percent. Recording, reviewing, and challenging these thoughts is an essential way to prevent future anxiety.

You can also use an app to track your anxiety.

Practicing regular meditation may also help you reduce your anxiety. Numerous studies have shown that meditation can reduce anxiety symptoms and help treat anxiety.

You can also practice mindfulness in everyday activities to help you become more aware of your body and what makes you anxious. Try a mindful eating exercise or a mindful walk around the block.

Finally, consider working with a mental health professional to come up with more strategies. They can help you work out negative thought processes that occur when you’re experiencing anxiety, especially if this anxiety is severe or causing you great distress.

Various forms of psychotherapy may be recommended to ease anxiety and reduce symptoms like shortness of breath, including cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Certain medications may also be beneficial, including:

  • Antidepressants. These medications affect levels of certain neurotransmitters to treat anxiety and depression. They are often used as a long-term solution, as it may take several weeks before you notice any benefits.
  • Benzodiazepines. This class of medication includes drugs like Xanax and Valium, which act as a sedative to calm you down when you’re feeling anxious. However, they are only recommended for short-term use, as they can also cause side effects like drowsiness.
  • Beta-blockers. Though typically used to treat high blood pressure, beta-blockers like propranolol can also reduce short-term physical symptoms of anxiety.
  • Buspirone. This medication is sometimes used to treat anxiety when antidepressants don’t work. Though buspirone is as effective as benzodiazepines and is associated with fewer risks and side effects, it may take 2–4 weeks to take effect.

Shortness of breath and other symptoms of anxiety can mimic other conditions. So, it’s a good idea to monitor your symptoms and get a checkup with your doctor to rule out any other conditions.

Getting a physical to ensure you don’t have any other issues can also alleviate some of your anxiety. For instance, in a panic attack, many people believe they’re having a heart attack. This fear only increases their panic.

Other causes of shortness of breath include:

  • exercise
  • altitude changes
  • tight clothing
  • a sedentary lifestyle

Other conditions where you may experience shortness of breath include:

  • asthma
  • chronic obstructive pulmonary disease (COPD)
  • heart failure or heart attack
  • pneumonia
  • low blood pressure
  • upper airway obstruction

If you experience shortness of breath consistently, or when unconnected to anxiety, see your doctor.

Seek emergency medical attention if you experience symptoms of a heart attack, including:

  • tightness or pain in the chest, neck, jaw, back, or arms
  • fatigue
  • lightheadedness, nausea, or vomiting
  • discomfort in your arm or shoulder
  • sweating more than usual without a logical reason

When is shortness of breath serious?

If shortness of breath is accompanied by other symptoms like pain or discomfort, tightness in the chest, lightheadedness, nausea, or vomiting, it’s important to seek medical attention immediately.

You should also talk with a doctor if you have experienced shortness of breath for over 1 month or if other symptoms like persistent coughing or swollen ankles are present, as it could be a sign of a more serious condition.

Is my shortness of breath an anxiety attack or Coronavirus?

Shortness of breath caused by an anxiety attack typically peaks within a few minutes and may be accompanied by other symptoms, such as nausea, heart palpitations, and sweating.

On the other hand, shortness of breath caused by COVID-19 lasts for a longer period of time and may be tied to additional symptoms, including fever, dry cough, chills, muscle pain, and a sore throat.

Why do I have shortness of breath and anxiety at night?

Many people experience panic or anxiety attacks at night, which can cause shortness of breath and may occur without any obvious triggers. Similar to daytime anxiety attacks, there’s no known cause, but a variety of factors could contribute, including stress and genetics.

It’s important to remember that anxiety attacks can’t kill you. You won’t suffocate, won’t stop breathing, and won’t die from an anxiety attack. An anxiety or panic attack won’t turn into a heart attack, either.

If you’re worried about your physical health, get checked out. Once you’ve been cleared of any physical reasons for your shortness of breath, hold onto that clean bill of health as a reminder when you’re back in an anxious moment.

See a mental health professional for further help and assistance with coping techniques.

Fear of suffocation during a panic attack. Fear of lack of air, phobia to suffocate

In order to analyze in more detail such a symptom of a panic attack - lack of air and a state of suffocation, let's remember what a panic attack is, as such, and what are its main symptoms.

So, as many people know, a panic attack is a sudden attack of anxiety and fear without any objective reasons. The state arises absolutely spontaneously, and also suddenly subsides. The main symptomatology lies mainly in the somatic field. According to statistics, 1 out of 20 people suffer from this psychosomatic disease, and young people and women experience it more often than the elderly and men.

Main symptoms:

As noted above, the symptoms of this psychopathy appear absolutely for no reason, in other words, nothing bad happens in the patient's life, the attack is not associated with a stressful situation or any real threat. In addition, unlike other similar destructions, the manifestations of a panic attack pass within 10-30 minutes and do not leave any reminders of themselves, as if they never happened. What are the basic sensations of the patient expressed in:

  • Pronounced anxiety , feeling of danger, fear of death and fear of suffocation, without any objective reasons or reasonable explanations
  • Tachycardia and dyspnea
  • Persistent anginophobia feeling short of breath and fear of suffocation
  • Feeling of a lump in the throat
  • Neuralgia , chest compression, body pain
  • Disorientation in space, dizziness
  • Nausea attack , pain in the gastrointestinal tract
  • Tremor and numbness of limbs
  • Increased sweating , flushing
  • Vision problems , veil before eyes
  • Feeling unreality of the situation (events can be perceived as in a dream)

One of the fundamental signs, as noted above, is anginophobia. We will talk about it in more detail in this article.

What is anginophobia

Anginophobia is a persistent fear of suffocation or the inability to breathe. In earlier interpretations, this term meant only the fear of suffocation against the background of a heart attack. In modern psychiatry, the anamnesis of anginophobia is expanded and includes the fear of suffocation or even choking, in general, to face any causes that can stop breathing. The cause of this phobia can be anything, moreover, that does not exist in real life: other people, poor ecology, unhealthy lifestyle, diseases that may not exist. It's important to notice. That anginophobia can also occur in people who are healthy from the point of view of somatics.

Signs and causes of anginophobia

General signs of this particular symptom of panic attacks do not differ much from the main list and include such manifestations as:

  • Vertigo disease (dizziness) and disorientation in space
  • Feeling sick
  • Tachycardia
  • Increased sweating
  • Gastrointestinal disorder
  • Trembling and numbness of limbs
  • Numbness, fear of losing speech or inability to say anything
  • Discoloration of the skin on the face or body
  • Coughing fit and general feeling of being unable to breathe
  • Loss of contact with reality , feeling faint

Causes of anginophobia:

It is worth noting that, according to the psychiatric community, anginophobia often comes in combination with such types of neurosis and neurasthenic disorders as anxiety, schizoid, bipolar and cardiophobic (fear of cardiac arrest).

Common causes include:

  • Hazardous working conditions and occupations with real life risks, altered environments and confined spaces. Work in mines, at depth, at height (high-rise workers, submariners, miners, firefighters). A subconscious sense of danger can lead to similar neurotic changes.
  • Wrong lifestyle and addictions: Alcoholism, drug addiction, substance abuse and even smoking. As well as deliberate provocation of the state of asphyxia, for example, a tendency to suffocate during intimate games.
  • Presence of bronchial asthma or allergies . Subconsciously, the patient is afraid that in the end he will not be able to breathe during the next attack.
  • Increased suggestibility and information rubbish. Some people attach too much importance to stories and what the media broadcasts.
  • Past psychotrauma associated with suffocation. Such a stressful situation can subsequently accompany a person all his life and manifest itself when, in fact, there is no real threat.
  • Real serious diseases related to the respiratory or cardiovascular system. Fear of attacks of the past.

How to overcome the fear of suffocation

With a mild course of the disease and moderate symptoms of an attack, a person is able to calm himself and reduce the symptoms to nothing in the shortest possible time.

It is in relation to panic attacks and any of their manifestations that the phrase “saving the drowning is the work of the drowning themselves” comes in very handy. In a situation of an attack, it is extremely important for a person to remember that breathing is a natural process, and by itself it cannot be interrupted. Even the presence of serious pathological changes, such as asthma, for example, cannot lead to suffocation if you monitor your condition and control the course of the disease. In order to minimize possible attacks, it is very important to treat yourself and your body with care and attention, lead a proper lifestyle, control your physical, and above all, your mental state. Quite often, people are able to anticipate the onset of an attack and calm themselves down on their own or take a number of actions that can help.

What to do during a panic attack. How to quickly relieve a symptom

In the event of an attack, it is important:

  • Move away from the edge of the road and from the main streams of people, ideally find a calm, least crowded place.
  • If medication is prescribed, take medication as soon as possible.
  • Independently shift the focus of attention from internal to external sensations, you can simply start counting up to 100 or look around and name the colors of the surrounding objects.
  • Concentrate on sounds and sensations, say out loud what you see, feel or hear.
  • Try to find tension in the body and relax.
  • Decentralize attention, for example, play a game on the phone

What to do if during a panic attack you suffer from suffocation and lack of air:

  • Work with breathing and try to stabilize it yourself. For 4 seconds a slow breath and for 4 seconds the same exhalation.
  • Optional bag breathing method to neutralize lung hyperventilation and carbon dioxide concentration.
  • Try to exhale as much as possible. Exhalation should be easy, which means that the feeling of the impossibility of inhalation is nothing more than a consequence of neurosis.

If a panic attack overtook a person next to you, the main task is to take him to a quiet deserted place and help stabilize his breathing.

As we already know, one of the most frightening signs for the patient is a feeling of lack of air. Most often, our patients describe this symptom as a state of complete destabilization of breathing.

Difficulty breathing during panic attacks

Shortness of breath is one of the most common and frightening symptoms. In a state of suffocation, it is important for the patient to remember that everything that happens and even real sensations in the body are a consequence of his neurotic state at the moment. The most dangerous moment is the possibility of a real attack of asphyxia associated with a physical condition, but even here there is a way to calm yourself. Take, for example, a disease such as asthma, which can actually be a symptom of suffocation. So, in this aspect, it is important to know that in a state of neurosis, a person, first of all, cannot inhale, although he does not feel any problems with exhalation, and there may also be a “lump in the throat.” So, with asthma, everything happens the other way around: inhalation is easy, but the asthmatic can no longer exhale or does it with great difficulty.

Is it possible to suffocate from a panic attack

No. If asthma attacks are associated specifically with a panic attack, then this is not dangerous to health. All symptoms disappear as soon as the patient manages to calm down.

Lack of air and the inability to breathe evenly affect the mental state, anginophobia and unregulated fear can prolong the attack and eventually lead to a more severe stage and chronic pathology, for example, develop a generalized disorder, the duration of an attack in which can reach up to 1 hour.

That is why it is extremely important to monitor your condition and try to prevent the development of the chronic form of various disorders.

What can I do to prevent a panic attack from turning into a panic disorder?

First of all. It is necessary to follow the rules of prevention, which we have already talked about in this article: control of one's own condition, the right lifestyle, accompanying body-oriented practices (meditation, yoga, massages, hydrotherapy), correct thinking and avoiding an overabundance of information. However, if the choking attack provoked by a panic attack has happened more than once, then you should immediately contact a specialist. Professional timely treatment can not only prevent the development of various disorders, but also completely nullify the symptoms.

How to treat panic attacks and when to see a specialist

In fact, it is necessary to see a specialist even if you are experiencing an attack for the first time. There can be a huge number of reasons for a panic attack, which can only be determined by resorting to professional diagnostics. Timely initiation of treatment can save a person from many further problems. It is also worth paying attention to the symptoms. If asthma attacks, accompanied by a feeling of inability to inhale, occur more than 1 time, then this is the sign in which you should immediately contact specialists: a psychotherapist, a neurologist and a psychiatrist. A psychologist will not help in this case, since he works exclusively in the mental field. A panic attack is a psychosomatic disease that affects not only the mental, but primarily the physical plane. Psychotherapeutic treatment includes an integrated approach consisting of medication and psychotherapy.

Definitely will be in the development of a treatment plan. The initial causes that led to the development of panic states, as well as concomitant diseases and individual characteristics of the patient's psyche, were taken into account.

Psychotherapeutic approach

Most often, the most popular method in psychotherapy is the method of CBT (cognitive - behavioral therapy), the main purpose of which is to correct the patient's behavior during an attack and change his perception of what is happening. In other words, this technique can be called fear management lessons. Next, classical psychoanalysis is applied, aimed at finding the underlying causes and possible psychotraumas that led to the current state. Also mandatory will be body-oriented practices that help to relax and learn to be aware of the processes occurring in the body. Quite often, psychotherapy also includes gestalt therapy, which can identify unmet needs and family sessions, in which the specialist works with the patient's relatives in order to teach them first aid and general support.

Drug therapy

A well-chosen course of drugs helps to reduce the frequency and intensity of panic attacks. Most often in modern drug psychotherapy drugs of the following clusters are used:

  • Cluster of tranquilizers . It is used for immediate relief of an attack. It is advised to use with caution and only in a situation of urgent need, since this group has a number of side effects: decreased attention, deconcentration.
  • Cluster of antidepressants . The use of course therapy is allowed. Aimed at improving mood, relieving anxiety and relieving symptoms of depression.
  • Cluster of beta-blockers . Aimed at stopping seizures with pronounced somatics: increased blood pressure, tachycardia, shortness of breath.
  • Nootropic Cluster . It has an anti-stress effect, activates the brain and increases the effectiveness of other medicinal groups.

Cluster of nootropics. It has an anti-stress effect, activates the brain and increases the effectiveness of other medicinal groups.

ALS Dyspnea - ALS Information Portal

  • Why does it feel short of breath?
  • How can dyspnea be relieved?
  • What to choose or how to combine?

Shortness of breath (dyspnea) is the most common and most disturbing symptom of ALS for patients and their loved ones. This experience of breathing discomfort is made up of various sensations described as tightness of the chest, the need for a deep breath, the appearance of rapid and / or shallow breathing.

Dyspnea may occur as attacks that begin spontaneously or are provoked by exercise, choking, strong emotions, and may be a permanent symptom. The feeling of lack of air significantly affects the state of health: patients usually suffer greatly both from the very feeling of lack of air and from the fear that they will suffocate - especially if there was an episode of suffocation in the patient's life.

Why is there a feeling of lack of air?

The mechanism of dyspnea is not fully understood. One theory claims that it is caused by a discrepancy between what complex information the brain receives about blood gases, the work of the respiratory muscles, chest movements and what it “expects” to receive. On the other hand, a number of studies have shown that dyspnea is not always directly related to the mechanisms of respiratory failure: it can occur at normal levels of oxygen and carbon dioxide (for example, in a patient on a ventilator) and, conversely, it may not be with prolonged hypoxia and hypercapnia, despite objectively rapid breathing and increased muscle work. The latter suggests that the human brain is able to adapt to the manifestations of respiratory failure.

Emotions play the most important role in the development of dyspnea .
Even healthy people feel short of breath when they panic.

In patients with respiratory failure, dyspnea and panic (or anxiety) are very interrelated: dyspnea, especially acute - suffocation, provokes panic, panic in turn increases dyspnea. Dyspnea is more pronounced when it occurs unexpectedly, develops quickly, in an inappropriate situation, or is perceived by the patient as life-threatening. Also, dyspnea is more pronounced in patients who have already experienced it before.

How can dyspnea be relieved?

There are three principal approaches to managing dyspnea in ALS:

  • respiratory support;
  • drug support;
  • non-drug methods.

Respiratory support in the form of non-invasive ventilation (NIVL) is an effective way to alleviate the symptoms of respiratory failure, including dyspnea.

Learn more in Non-Invasive Ventilation for ALS

Drug support aims to eliminate or reduce the subjective experience by acting on receptors involved in the development of dyspnea.

Opioids . The most effective drug for alleviating dyspnea is morphine, a drug primarily used for severe pain. Many studies have shown that morphine is effective in relieving dyspnea at lower doses than would normally be needed for pain relief. It can be used for a long time and, when used correctly under medical supervision, never leads to respiratory depression and earlier death. In Russia, morphine is allowed for use only for pain and cough, which makes it impossible to obtain it for the treatment of dyspnea. However, patients who use it for pain may also benefit from its additional effect - action on the feeling of severe lack of air.

Benzodiazepines . In many countries of the world, drugs from the group of benzodiazepines - lorazepam, diazepam are successfully used to eliminate or prevent dyspnea. The mechanism of their action with a feeling of lack of air is not completely clear, but most of this action is due to the anti-anxiety effect of - , the same, thanks to which they are able to relieve panic attacks and anxiety attacks. Meanwhile, their effect on dyspnea has also been shown in the absence of panic or anxiety.

The most common practice in the world - use of lorazepam (at a dose of 0.5 to 2.5 mg prescribed by a doctor) for dyspnea or choking, including choking on food or saliva, and also prophylactically before activities, habitually causing increased dyspnea (eating, rest from non-invasive lung ventilation, hygiene procedures, walking, communication). The duration of action of lorazepam - is 4-6 hours, it is usually taken up to 4-6 times a day. Large studies have shown that despite the ability of benzodiazepines to reduce dyspnea (respiratory rate), when administered in the correct doses, they never lead to a decrease in oxygen or an increase in carbon dioxide. It has also been proven that the use of benzodiazepines under medical supervision does not lead to premature death from respiratory depression.

Side effects of lorazepam include drowsiness and dizziness. Most often, after several doses, these side effects disappear, but if not, then it is usually possible to eliminate this effect by reducing the dose, while maintaining the effect on dyspnea.

Benzodiazepines are drugs that should not be stopped abruptly. If they have been used for more than 5 days, then dose reduction or cancellation should be carried out gradually - by 30% every 2-3 days, as directed by a doctor. In Russia, lorazepam and other benzodiazepines are sold only by prescription from a doctor (for example, a neurologist).

Lorazepam and morphine are recommended by the European Neurological Federation for the management of dyspnoea in ALS and are also used to treat dyspnea in other conditions associated with respiratory failure.

Find out more in the resource Medication for ALS Breathlessness

Oxygen . Often patients with complaints of shortness of breath are advised to use oxygen, but in ALS its use is dangerous and is a medical mistake . In the "classic" respiratory failure that doctors are used to dealing with, the lung tissue and gas exchange process suffer, while in ALS the lungs are healthy, and the lack of oxygen occurs due to muscle weakness. Developing respiratory failure in ALS has its own characteristics, and therefore the use of oxygen can lead to coma and respiratory arrest.

Non-drug support includes many physical and psychological methods that are not discussed in detail in this material. In addition to complex, specialized approaches such as Ericksonian hypnosis or music therapy, there are simple methods that anyone can use. For example, it has been proven that exposure to facial skin receptors can greatly reduce the feeling of lack of air - you can use a fan or fan for this.

What to choose or how to combine?

All the approaches described are in no way contradictory, but can be used simultaneously in a ratio that depends on the preferences of the patient and the decisions made by him. A common regimen is the use of NIV at night, and drug therapy and other methods - during the day. Comprehensive control of dyspnea gives patients and their loved ones confidence and calmness, reduces the fear of suffocation, thereby reducing the real risk of its development. In countries where drug and non-drug treatments for dyspnea are widely used, 90% of ALS patients die calmly and without suffering, against the backdrop of deep sleep and then coma. Many of these patients do not receive drugs in the last hours of life or receive them in low doses, but due to the lack of anxiety, the confidence that help is available, and the developed addiction to hypoxia, they do not experience suffocation, which is so frightening for all ALS patients.

If you have questions or need support, you can contact the ALS Helpline.

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