Panic Attacks vs. Asthma Attack

Question

I'm a clinician and I've been working with a young woman who has experienced panic attacks, but suffers mildly from asthma and has severe allergies. It has been a really long time since she has actually had an asthma attack and many years since she has needed to use her epi pen. However, she has been suffering from panic attacks. She will also experience intrusive thinking "What if I can't get a full breath" and then try really hard to take a full breath. " Or, "There is something stuck in my throat" and then try to clear her throat. It's just hard to know if the initial symptoms are related to her asthma/allergies, or come from panic and can be treated as panic. She has progressed well in treatment, it's really just those two lingering thoughts and the question is whether to tell her to let the thoughts be there and let them pass. I have stressed the importance of having a doctor approve the therapy protocol that we are doing, but she doesn't have much confidence in her doctors ability to adequately understand the situation. She does check in with her doctors regularly and is under the care of an allergist. Do you have any suggestions? I want to be responsible in how I treat her, At the same time I don't want to bring more fear to a fearful situation.

Answer 1

Sounds like there may be two issues with regards to panic attacks and physical symptoms: 1) shortness of breath and 2) lump in the throat. The shortness of breath from panic attacks only last for a few minutes, while with asthma, it can last hours. And with lump in the throat, it is a common anxiety side effect: https://anxietyboss.com/does-anxiety-cause-lump-in-the-throat/. Just continue to educate her that these physical symptoms are connected with anxiety, especially if they only last a few minutes. On the other hand, she will know when she has a full-blown asthma attack. So the work in therapy is helping her to understand the difference, and this psychoeducation can help her to distinguish between anxiety and asthma, then she can make logical choices from those attributions. It's like with my patients with seizures and panic...we spend a lot of time going over what is medical (loss of consciousness, urinating on self while convulsing), and what is psychological.