Asthma and Anxiety and Vice Versa

"Are you sure you aren't just anxious?"

I am no stranger to hearing that question, whether it be during outpatient pulmonology visits, emergency room trips, or inpatient hospital admissions. That is the first thing anyone tends to ask me, regardless of my lung function, symptoms, or general presentation. I remember vividly being carted into the emergency room via an ambulance straight from swim practice (still in my swimsuit naturally) and the biggest concern was my "anxiety" over my low oxygen saturation. Correct me if I am wrong, but I think anyone who cannot breathe is going to be a bit stressed out.

For a long time, I felt ashamed of struggling with anxiety on top of asthma. It always seemed that my mental health diagnoses were a scapegoat for my very real and very severe lung issues. I neglected to take care of my mental health for a long time, afraid of the stigma and stereotyping doctors seemed so excited to impart on my case. One day at school though, I was given an entirely new perspective.

Examples that shaped my perspective

Anxiety provoking exercises: underwater training and fun competitions

We were watching a documentary in Anatomy and Physiology about the body's stress response. This documentary was covering the training Marines undergo during Bootcamp to best prepare for their duties. Part of this training took place underwater, where the Marines were deprived of oxygen and learning how to control their body's stress response. The whole purpose of this was to allow the soldiers to be able to respond appropriately if they were presented with a situation like this when on duty. Learning how to survive and thrive when going through such a physiologically and psychologically stressful encounter allows them to better react to both similar and drastically different demands.

Something that really stuck with me from this documentary was how the narrator mentioned this part of the Bootcamp is one of if not the most stressful and anxiety-provoking parts of their training. Why was this the case? Because they could not breathe. I love research as much as the next guy (maybe a little more...) but I also learn a lot from personal experience.

Take childhood pool days, for example. I am sure I was not the only one who had breath-holding or handstand contests underwater to see who would come out victorious. Though I have not participated in one of these in a while (growing up would be more fun if my lungs weren't a precipitating factor!) I vividly remember how these "contests" ended. I would try to stay submerged for as long as possible, but eventually being underwater became more challenging because I really needed to take a breath. My heart rate would increase and I would get a bit stressed out while gathering the courage to break my winning streak and answer the biological call for oxygen.

Need another example?

Look at the TV show Friends. One episode opens with Phoebe telling Chandler that Joey has been holding his breath for "almost four minutes." Unbeknownst to Phoebe, Joey was merely puffing his cheeks out, claiming that he was holding his breath. Chandler is skeptical, coming over to Joey to plug his nose. As soon as Chandler has been closing off Joey's airways for a few seconds, Joey's eyes become very large and he is clearly growing anxious. Though Joey's bulging eyes were an occurrence for other surprising events during the show, this one illustrated how anxiety-provoking not being able to breathe can become, even if just for a short period of time.

It makes sense for me to be anxious because of my asthma

Our biology wins, over and over again. When we need hydration or nourishment, we get thirsty or hungry and our body tells us we need to get something to eat or drink. When we need to release waste, our bodies nudge us toward the bathroom. When we need oxygen, our bodies force us to breathe (more rapidly too if our bodies are really in desperate need.) Biology wins, even if we do not want it to or try to prevent it. I don't know about you, but if I have a really full bladder, that's all I think about until I can get to the bathroom. A full bladder is not very conducive to a low-stress demeanor, just as not being able to breathe is the same way.

Asthma is chronic. If not being able to breathe for a short period of time is anxiety-provoking, how are we not supposed to be anxious if breathing difficulties are our underlying theme? Just as I shouldn't be upset when my biology prevails in other domains, I shouldn't be upset if my chronic illness symptoms cause additional anxiety. Watching that documentary was a game changer; now, I am not afraid to speak up for myself. My favorite response to this article's opening question has become, "Wouldn't you be anxious too if you couldn't breathe?"

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