Expert: Marc Rubin, RPh Asthma Educator - 12/26/2007

Question
Lately, my asthma has been acting up for the first time in several years. However, this flare up is different from the others. My "episodes" are accompanied by panic attacks, pain in both arms and occasionally the chest (from tachycardia, and this is before I take my albuterol), insomnia, loss of appetite (or increased appetite if I'm more stressed than usual), and almost an. . . altered sense of consciousness. The lights become very bright and I feel as if I'll fall into a fit if I don't get away from them.

I know that asthma can change over the years and I've had mine for about ten years now. However, I can't find any articles online that would suggest my symptoms would accompany asthma. So is this normal with an adult asthma flare up? Or could it be a side effect of the rescue inhaler?

Answer
You need to follow up with your physician ASAP for a review. Should you have a recurrence of the chest discomfort with arm pain before getting in to your doctor, immediately have it checked out at the local emergency room. It is essential to rule out a heart condition vs. panic attack. Now for some education.
First, as you get older, we must rule out any cardiovascular issue: changes in heart rhythm, blood pressure, circulation (including the brain). This is to address any physical issue. Second, this is the time of year that depression hits the hardest, and there is a term for it: seasonal affective disorder. It's a combination of less sunlight, added to issues we deal with as we get older: lost loved ones you miss during the holiday season, bills building up, etc. that lead to depression. Hand in hand with depression goes anxiety, which may be the source of your primary symptoms( panic attacks, insomnia, tachycardia). Third, anxiety can trigger and worsen asthma symptoms. Emotions definitely play a role in asthma control. We teach caregivers that they must remain calm while attending to an asthmatic during an attack, and try to calm the patient also. Anxiety and fear will worsen an attack. A patient who stays calm will recover sooner. Oh, laughter and crying can also trigger an attack.
 If, hopefully, this is all related to anxiety, I'd suggest finding an asthma educator locally to fully cover all aspects of this disorder. Our goal is to near normal life in your daytime hours, and also have uninterrupted sleep. We work together with you and your physician to help create an action plan to take control of your lung health. Follow this link to find the board certified educators in your state: http://www.naecb.org/cbr/find_cert.aspx

I hope this helped you!