Anxiety is the body's way of responding to being in danger. Adrenaline is rushed into our bloodstream to enable us to run away or fight. This happens whether the danger is real, or whether we believe the danger is there when actually there is none. It is the body's alarm and survival mechanism. Primitive man wouldn't have survived for long without this life-saving response. It works so well, that it often kicks in when it's not needed - when the danger is in our heads rather than in reality. We think we're in danger, so that's enough to trigger the system to go, go, go! People who get anxious tend to get into scanning mode - where they're constantly on the lookout for danger, hyper-alert to any of the signals, and make it more likely that the alarm system will be activated.

Vicious Cycle of Anxiety

We all feel anxious some times. A certain amount of anxiety helps us to be more alert and focused. For example just prior to an exam, a few exam nerves have a positive effect - motivating us, helping us focus our thoughts on the job in hand, making us more alert. Too much anxiety, or constantly being anxious, is unhealthy and detrimental to our lives and relationships.

Vicious Cycle of Anxiety: Taken from Get Self Help

Thoughts Feelings Behaviours

Thoughts that often occur relate to our overestimating or exaggerating the actual threat and underestimating or minimising our ability to cope:

  • I'm in danger right now
  • The worst possible scenario is going to happen
  • I won't be able to cope with it

Download 'Alarming Adrenaline' for examples of feelings linked to anxiety. Including:

  • Hard to think clearly
  • Eyes widen
  • Dry mouth
  • Sweating
  • Heart beats faster
  • Relaxed bladder
  • Stomach churns
  • Fast & shallow breathing

Might include:

  • Avoiding people or places
  • Not going out
  • Going to certain places at certain times, e.g. shopping at smaller shops, at less busy times
  • Only going with someone else
  • Escape, leave early
  • 'Safety behaviours'.

COPD & Anxiety

It can be very difficult to distinguish whether the breathlessness you are experiencing is related to an underlying medical condition such as COPD or due to anxiety. Often people with underlying health conditions which lead to breathlessness will develop or experience anxiety resulting in an increased feeling of breathlessness. This can then lead to a vicious cycle exacerbating the feelings of struggling to breathe.

Anxiety-Breathlessness Cycle:  Adapted from the British Lung Foundation

The above figure demonstrates how a triggering event can result in a cycle of breathlessness leading to worrying leading to increasing breathlessness and so on.

It is likely that when you feel breathless it will be a combination of any underlying lung condition you have and an element of anxiety.

In order to determine whether COPD or anxiety are playing the larger role in your breathlessness try to look for additional features as well as the circumstances of the event that results in you feeling breathless.

Typically the breathlessness of COPD

  1. Will have some form of trigger for example occur during exertion or be associated with a change in the weather such as a hot day.
  2. May have additional features for example in the context of an exacerbation you may notice a change to your normal sputum production or hear that your breathing has become more “wheezy”.
  3. Will be reproducible, for example you get short of breath after walking a certain distance or when performing a certain activity. Typically you will be able to predict that you will become breathless from doing this.
  4. You may notice the development of new symptoms along with the breathlessness for example new or worsening swelling of your legs, waking up at night unable to breathe or not being able to lie as flat as previously due to your breathing.

Typically any symptoms due to COPD that are bought on by exertion should settle with rest. If you find they get worse when you stop then it may be that you have “entered” the cycle mentioned above, especially if you are aware of worrying thoughts. Trying the techniques you have been taught may help to break you out of this cycle and return your breathing to normal.

It is important that if your symptoms are rapidly increasing, especially if you develop chest pain or appear to be developing a blue appearance to your skin that you seek urgent medical attention.

What Can Help?

How to deal with the physical sensations of anxiety

Counteract the body's adrenaline response - it's readiness for action, by using that energy healthily.

  • Visualisation: Breathe in blue (for calm), breathe out red
  • Exercise if you are able to - Go for a walk or do some gardening.
  • Practice calming or mindful breathing - this one act alone will help reduce the physical sensations, emotions and intensity of thoughts. 
  • Breathing exercises can help improve breathlessness.

More About Breathing Exercises

If you are out of breath it may help to gently breath using minimal effort, with your shoulders supported. 

If you are more active you may wish to try:

  • relaxed, slow, deep breathing
  • breathing through pursed lips, as if whistling
  • breathing out hard when doing an activity that needs a big effort
  • paced breathing, using a rhythm in time with the activity, such as climbing stairs

If you have a chesty cough that produces a lot of phlegm, you may be taught a specific technique to help you clear your airways called the active cycle breathing technique.

The Association of chartered Physiotherapists in respiratory care produce a series of leaflets that can be viewed here - 'How to Cope With Being SOB (Short Of Breath) - Positions' has got good feedback from other patients.

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