We used to go to the emergency room in the middle of the night. I’d wake up to hear the shower running, and I’d know it meant my baby brother couldn’t breathe. At first, when he was a baby, we didn’t know why. It only really happened when he was sick, so my mom sort of figured he just reacted badly to colds. He’d wake up wheezing, and my mom would hold him in a steamy shower. When that didn’t work, we’d jump into the car and drive half an hour to the nearest ER. My mom and dad would keep all the windows open to let in the cold air. At the hospital, the triage nurse would rush my tiny baby brother into a tent filled with steam. Then they’d give him some medicine, and then he’d breathe normally again. Bizarrely, no one at the hospital ever said asthma. They said he was “croupy.” My mom finally read an article about childhood asthma in the paper and asked her pediatrician if that was what caused her son’s breathing troubles. The pediatrician was so shocked he began to laugh. “They didn’t tell you that at the hospital?” he asked. He couldn’t believe the ER doctors would fail to offer that kind of basic information. “Of course it’s asthma! I thought you knew!” (This was, by the way, the kind of pediatrician who happily woke up at midnight to meet us at the ER and tell us all jokes until we calmed down. He took calls at home at any hour and could make my brother laugh while getting a shot, so I’m not surprised he went on to become an expert in child happiness.)
Asthma is scary. It’s genuinely dangerous, and it triggers primal fear in its victims. There are few things as scary as not being able to breathe. My brother, an active, adventurous, and otherwise healthy kid, spent his childhood cursed with severe asthma that necessitated years of ER trips and a variety of unpleasant drugs. I recently asked him if the attacks terrified him, and his answer surprised me: “The fear I felt from having asthma attacks as a young kid was totally manageable, because mom would take care of me and we had all the equipment and stuff.” Wow, check out mister No-Anxiety-Disorder.
However, even my brother has experienced some mild asthma-related anxiety. “I think I subconsciously associate [anxiety] with asthma, probably because asthma attacks are the most consistently stressful/traumatic thing I’ve gone through in my life,” he told me.
For a child with an anxiety disorder, asthma can be absolutely terrifying. Feeling unable to breathe can easily trigger a panic attack, and the panic may make breathing feel even harder. Anxiety medications can speed your heart and cause shaking, so an anxious child who is having an asthma attack is very likely to experience some degree of panic even after using her inhaler, especially if panicked breathlessness prevents her from realizing that the medicine is working. A student shared her experience:
Twice I has asthma attacks while I was hiking with other families. Both times, I ended up having a panic attack. It felt like my inhaler wasn’t working, so I got more panicked. It was like a snowball.
An anxious child who suffers from asthma may also sometimes mistake a panic attack for an asthma attack. My student also described a panic attack that was caused by a stressful life event:
I felt a lot like I couldn’t breathe, and I was really really scared. My inhaler didn’t help at all, and I thought I was going to die. My dad told me to use my relaxation techniques. Once I stopped being scared, my breathing felt totally normal. This makes me think that the feeling of breathlessness was “in my head,” not in my throat.
If your anxious child or student has asthma, talk to him before his next attack. Explain that, unlike asthma, anxiety doesn’t really affect breathing ability, and help him practice distinguishing between panic and asthma. Teach him to take complete, slow breaths. Finally, consider using a peak flow meter to help your child determine whether his anxiety is skewing his perception of his breathing ability.
Of course, it’s extremely important for children and adults to follow their doctors’ orders exactly, especially regarding serious illnesses like asthma. Ask your doctor, but I assume you should instruct your child to use his inhaler or other asthma medication even if he’s not sure whether his breathlessness is caused by asthma or anxiety. Cognitive-Behavioral Therapy and relaxation techniques can be used after medication is administered.
As always, the best thing you can do for your anxious student or child is remain calm. It’s very upsetting to watch someone you care about struggle to breathe, especially when that someone is a young child. However, children look to their caregivers for clues about danger, so it’s important to behave as though you are in control of the situation.
Asthma is a serious and life-threatening disease. Children with asthma need to be in the care of a qualified pediatrician or specialist.
My brother’s asthma has gotten much better, and he’s now able to backpack through forests and float wild rivers and play with his band in front of huge crowds. He’s the coolest person I’ve ever met, and tomorrow is his 21st birthday!