Teaching with a Twist: Anxiety and COPD

This article was written by Stephanie Williams, BS, RRT. Stephanie is the Director of Community Programs and Volunteer Management for the COPD Foundation.

I love riddles. I love to figure them out, I love to create them. But there is one riddle that I encounter often as a respiratory therapist that I wish we could solve for everyone with COPD: which came first, trouble breathing or anxiety?

We see people asking about anxiety on COPD360social a lot. People ask if anxiety is ‘normal’ or if anxiety can make breathing worse. Some people ask if anxiety can cause breathing problems or if breathing problems cause anxiety. I think those are really good questions. You may be wondering these same things yourself. For any number of reasons, you may not have talked with your doctor about these questions, but I would encourage you to mention them to your healthcare team. Anxiety and breathing problems are so common, it would be more surprising to find someone with COPD who doesn’t experience some anxiety.

I remember a personal situation from a few years ago, when I was at work as an RT in a hospital. I was having a medical issue that made it hard for me to get my breath. My boss instructed me to go to the ER where I was treated for the issue, but I will never forget how my anxiety was dismissed and minimized. The nurses told me that I should “calm down” because I was making the situation worse. I was irritated because they obviously didn’t understand how it felt to struggle for air. I told them that they would be anxious, too, if they couldn’t get their breath. I will never forget that incident. It changed the way I interacted with anxious patients after that.

Dealing with anxiety is no joke. Anxiety and stress can absolutely have an impact on your breathing. They can make you feel as though you can’t get your breath. They can make you feel like someone has turned the oxygen off in the room where you are. Feeling anxious can make your heart rate go up and can make you have trouble sleeping, among other things. The key is recognizing it as anxiety and being able to break the vicious cycle it can cause.

In the same way that anxiety can cause difficulty breathing, you need to know that the difficulty breathing can cause anxiety, too. Sometimes, you may notice a cycle of shortness of breath, anxiousness, leading to increased shortness of breath, more anxiousness, and so on. That anxiety is your body’s way of letting you know something is going on, an alert response to a stressful situation

If you are feeling short of breath due to your lung condition, then this is the time to take your rescue inhaler. This medicine will help you to open your airways and begin to take deeper, more fulfilling breaths. One thing to remember: if you notice that you are needing your rescue inhaler more frequently than usual, you need to call your doctor and let them know that your maintenance medication routine is not keeping you in the “Green Zone” on your My COPD Action Plan. Taking your rescue medication more frequently can be a sign of a developing exacerbation.

So, what are some things you can do to help when you are feeling anxious?

1. Do some pursed lip breathing (PLB). Take a breath in through your nose while counting to two, and then pucker your lips and blow out while counting to four. Repeat this process again and again until your breath becomes more normal.
2. Practice mindfulness or grounding techniques. There are lots of different techniques that are described on YouTube or other places on the Internet, but here are two of my favorites:
   • a. Crazy counting – When I find myself feeling anxious, I like to refocus my energy on something else and will count to 100 by fours or to 101 by using only odd numbers. By doing this routine activity in an unusual way, it encourages my brain to think about the math task instead of the situation that is causing my anxiety. If I can redirect my mind, I find that I usually feel better and can regain some control over the anxious feeling.
   • What did I eat for dinner? To mix things up a little bit, I sometimes ask myself to recall what I had for dinner last night, the night before, etc. This one really helps me focus on something else. There are lots of other topics you might use that will challenge your recall in an anxious moment.
3. Talk it out. Talking about the anxiety can take some of its power away. Find someone you can call when you start to experience anxiousness. Talking it out can help you identify patterns or triggers for the anxiety that might help you avoid future situations. And if you talk with someone else who experiences anxiety like you do, it can help you to know there are others who understand what you are going through.

The bottom line is that you are not alone in dealing with anxiety and COPD. Your doctor can help you find a treatment plan for anxiety that happens frequently or is severe in that it impacts your functioning. Let your healthcare team know that you are experiencing anxiety so they can help set you in the right direction.

Now the Twist – The MOVIE STAR NAME GAME

Here’s how it works:

I will give the name of a movie, and the next person will name an actor/actress in that movie. The next person will give another movie that actor/actress was in, and the next will list another actor or actress in that movie.

For instance, if I gave you the movie “Planes, Trains, and Automobiles”

• Person 2 – “Steve Martin”
• Person 3 – “Father of the Bride”
• Person 4 – “Diane Keaton”
• Person 5 – would list another of Diane Keaton’s movies, etc.

So here you go – The movie is “Field of Dreams”

Who can name an actor from that movie?