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Anxiety, Panic Attacks, and Chronic Lung Conditions

Posted Feb 04 2013 12:33am

Being active in social media support would lead me to think the types of “support” people still learning to manage our chronic friend may need are fairly predictable.   Without a major clinical study, it was not hard to determine that for many, as it was for me, the unmet need is any kind of support for, or, even a brief mention that many experience depression or anxiety after receiving a diagnosis of “chronic illness.”  Dr. Sharma, the Ph.D, with COPD, is always a great resource for such issues.  I hope he helps you, as he did me….if you need it.

Then, a recent  nursing study, published in “Medscape.” On the same topic.: “Anxiety, Panic, and Loss of Control in COPD.”

Anxiety is common in patients with chronic obstructive pulmonary disease (COPD). As many as half of all patients with COPD have a clinical anxiety disorder. Anxiety is particularly severe during acute exacerbations and breathlessness. However, patients with COPD are known to experience anxiety at other times, and little is known about the emotions, triggers, impact, or management of anxiety in patients with stable COPD living in the community. The purpose of this study was to explore and describe these experiences.

If you have been recently diagnosed, you should be aware that depression and anxiety are difficult to avoid when you learn you will be living with a condition, that can get progressively worse (but, does not have to.)  Be prepared.   Talk to your doctor, get the medications, they help most people.  You probably think  “…not me, I got this”  That is what I thought.  I was wrong,

“Ways to Handle Anxiety, Panic Attacks”

stress pic

Vijai P. Sharma, Ph. D

In the past year, 10 to 12 % of people suffered from panic attacks, phobias, and other anxiety disorders. It is the number-one problem for women and in men it is second only to the alcohol and drug problem.

Anxiety disorders became the number one mental affliction in the 1980s. Stress keeps going up and so do the anxiety and panic attacks. The number of people who suffer a single panic attack is very large. In the past year, one in three persons experienced some sort of panic attack in response to a stressful situation, such as an examination, public speaking, or a call from the boss when layoffs are being rumored about at work.

Symptoms of an anxiety or panic attack are shortness of breath, smothering or choking feeling, heart palpitations, shaking and trembling, dizziness, sweating, hot flashes or cold chills, chest pains, feeling of unreality (such as being in a fog, in a cloud, detached from surroundings), and fear of dying, going crazy, or losing control.

A panic attack comes on unexpectedly, escalates rapidly, and subsides within 10 to 15 minutes. A panic attack has at least four of these symptoms. On average, a panic attack has six of the symptoms you just read. An anxiety attack, on the other hand, gradually builds up, it is not sudden and unexpected, symptoms are fewer and milder.

If you have any of these symptoms, you are not losing your mind and you are not different from the rest of the human race.

As you just read, anxiety disorders afflict a large number of people and surely such a big chunk of population is not becoming crazy. A panic attack is really an “emergency response.” Nature has provided us with a built-in emergency response to fight or run when we face a danger.

The problem is that once the alarm is set off, it keeps going off even when no real danger exists. It is like the two wires accidentally touch each other and the alarm sound goes off. We have to learn to shut it off.

"Never give up"

Things to do 1. Remind yourself repeatedly until you can really believe that your panic attack is a natural – emergency response and you will not turn in to a shaky, flaky weakling who is about to pass out any minute. Your whole system is in high gear. You are actually stronger, faster, and quicker. Believe it.
2. Constantly repeat to yourself that panic symptoms no doubt are unpleasant, but they are not dangerous.
3. Know that just as you have a natural emergency response, so you have a natural “calming response.” Yes, you can learn to calm yourself out of a panic attack.
4. Unpleasant symptoms of an anxiety/panic attack can be brought into control in just five minutes if you start calming down and do not pump more adrenaline in your blood by “panicking” about the panic attack.
5. Do not “fight” with the symptoms of a panic attack. Try to “flow” with the symptoms and allow yourself to become calm.
6. Learn a relaxation technique and practice it daily at least two or three times for 15 to 20 minutes each time. There are many self taught methods of relaxation available on tapes and books.
7. Learn to breathe from your diaphragm. Learn how the body breathes and how your abdomen, ribs and chest are involved in breathing. Try to breathe from your diaphragm all the time or as much time as you can by paying steady attention to your breathing.
8. Learn to notice the advance signs of an anxiety attack before it becomes severe. Step up on your relaxation to bring about the calming response.
9. In a panic or anxiety attack, start breathing slowly, through your nose, and allowing your diaphragm to take part in breathing.
10. Say silently inside your head something reassuring and calming, such as, “I am becoming calm….It will take a few minutes. .. .I can handle it as I have handled it before. . .I am calm and steady. ”
* This is an educational article for general information and not professional advice. Consult a professional for your specific case.

Anxiety, Panic, and Loss of Control in COPD

Laurie Scudder, DNP, NP

Willgoss TG, Yohannes AM, Goldbart J, Fatoye F

Heart Lung. 2012;41:562-571

Anxiety is common in patients with chronic obstructive pulmonary disease (COPD). As many as half of all patients with COPD have a clinical anxiety disorder. Anxiety is particularly severe during acute exacerbations and breathlessness. However, patients with COPD are known to experience anxiety at other times, and little is known about the emotions, triggers, impact, or management of anxiety in patients with stable COPD living in the community. The purpose of this study was to explore and describe these experiences.

This small qualitative study interviewed 14 patients (9 women and 5 men) recruited from pulmonary rehabilitation and community supports groups in England. Patients completed an anxiety and depression scale to determine the severity of their symptoms.

On the basis of anxiety and depression scale scores, 5 patients had clinically significant symptoms of depression, 6 had clinically significant anxiety symptoms, and 4 had both. Five of the patients with anxiety had a past clinical diagnosis of generalized anxiety disorder, for which 4 had been treated, although all had discontinued their treatment. The analysis found 3 global themes:

  • Relationships with breathing — anxiety was described as both a symptom and a cause of breathlessness. Although breathlessness was a trigger for both anxiety and panic for some patients, for others, episodes were idiopathic and could be trigged by many situations, such as social discomfort and misplacing medications. The relationship between anxiety and breathing was experienced as a vicious cycle by some patients. Living with anxiety was challenging, and patients voiced a fear of breathlessness that could be disabling.
  • Fighting for control — anxiety was a fight for control and associated with panic and helplessness at times. The process of taking control was described as logical and systematic, with self-talk an important and critical strategy. The battle for control was vital in preventing panic episodes. Medication was seen as an important component of controlling COPD, so having medication available was seen as controllable and integral.
  • Panic attacks as life changing — panic attacks were described as traumatic and isolating. Patients felt trapped or smothered, with some describing panic as “near-death experiences.” These episodes had a lasting effect and resulted in a persistent fear of recurrence with some describing “meta-worry” (worry about worry) that sometimes led to future attacks. Fear of anxiety caused some patients to become housebound.

This study, like many studies in the nursing literature, is limited by its very small and nonrandom sample. It is impossible to extrapolate the experiences of these patients to the larger population of all COPD patients. However, these researchers describe an important methodology for exploring a critical component of a very common chronic disease. Clearly more research is needed, particularly in defining the self-management skills described by some patients as important in controlling anxiety and preventing panic attacks. This information could lead to patient education strategies that will assist clinicians in teaching patients these important skills and improving the quality of life for a large segment of this population.

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