It is important to tell the difference

General practice p 1098

General practitioners and emergency departments from time to time see patients with asthma who appear very breathless, with fast deep breathing and wheeziness, who complain of tingling lips and hands and who recover quite rapidly after breathing in and out of a paper bag and then using a few puffs of salbutamol. Asthma and anxiety with dysfunctional breathing are both common conditions and they often coexist. Indeed, a paper in this week's issue suggests a very high prevalence of dysfunctional breathing among patients with asthma.1 There are reasons to doubt the prevalence suggested by this paper, but the overlap between anxiety and asthma nevertheless creates a problem for patients and their doctors since we seem not to be very good at telling the difference.

Several studies have shown that patients with asthma have significantly higher anxiety scores than normal and are more likely to have clinically diagnosed panic disorder. 2 3 Conversely, patients with panic disorders, hyperventilation, or “overbreathing” may have unidentified airways reversibility.4 Demeter investigated 47 patients referred for hyperventilation syndrome using methacholine challenge and reversibility testing and judged …