“Do you feel anxious?”

This was the question that my doctor would regularly ask me years ago, when my asthma was uncontrolled. Despite everything we did, we still weren’t treating my asthma the right way, and every so often, she’d ask me if I felt anxious.

“No. I don’t feel anxious.” I replied, time after time. She even offered to prescribe me anxiety meds, which I didn’t need.

Finally I told her, “You’d be anxious too if you couldn’t breathe.” That seemed to sink in for my doctor. I wasn’t experiencing symptoms of generalized anxiety disorder, which most of us just refer to in shorthand as “anxiety,” but my uncontrolled asthma was instead creating symptoms similar to those seen in anxiety — and certainly made me feel mildly uneasy.

Anxiety and asthma can be hard to tell apart because there’s significant overlap between each condition in terms of symptoms, physiological changes inside your body, and comorbidity. Here’s a closer look at the connections between them.

Symptom overlap

Anxiety or panic attacks and asthma share three symptoms involving breathing: shortness of breath, chest tightness, and rapid breathing rate. Without pulmonary function testing during symptoms, it can be very difficult to tell some symptoms of anxiety and asthma apart.

Some side effects of asthma medications, particularly beta₂-agonists or bronchodilators, can also cause symptoms that are similar to anxiety. These include shaking or trembling, heart palpitations or a feeling of increased heart rate, dizziness, or light-headedness. Anxiety can also be a side effect of these medications, making things even more tricky.

Anxiety can also lead to asthma symptoms. This is partly due to chemical changes in the body that are similar between the two conditions.

Physiological overlap

Asthma can certainly induce symptoms of anxiety. Conversely, in a particular subtype of asthma which my friend John refers to as psychologically-induced asthma, anxiety can also induce asthma in some people.

Stress responses cause physiological changes that affect our airways, releasing histamines and leukotrienes — two biological compounds that we try to block or reduce in asthma treatment. Anti-histamines and leukotriene inhibitors are both medications that work on specific aspects of the body’s response to allergic triggers. Both histamines and leukotrienes play a role in the body’s stress response. They increase under physiological stress.

Comorbidity: Asthma as a mental health risk factor

Finally, co-occurrence of asthma and anxiety is common. It appears anxiety can be a precursor to asthma development, and asthma can be a precursor to developing an anxiety disorder. A 2007 study notes that adults with asthma have a 1.5 greater prevalence of anxiety disorders than the general population.

Adults with asthma, especially severe or uncontrolled asthma, are more likely to experience anxiety or other mental health conditions than adults without asthma.

Tackling anxiousness and asthma

Discovering strategies to keep both symptoms of anxiety and asthma in check is important to manage these two conditions.

Identify sources of stress

Whether related to asthma or everyday life, identify sources of stress. Find ways to minimize stress, and talk to others for advice if needed. Your doctor can be a good resource for providing assistance with asthma-related problems, as well as helping you access a mental health provider who can address anxiety and stress.

Implement self-care strategies

What makes you feel better when you’re stressed? Identify self-care strategies that you can use to prevent stress and wind down.

Common strategies include:

• writing in a journal
• organizing your day in a planner
• grabbing coffee or lunch with a friend
• listening to music
• taking a bath
• making an appointment with a therapist or other mental health provider

Exercise

Exercise can also be a healthy coping mechanism for both anxiety and stress. Research from 2004 suggests that both high- and low-intensity cardiorespiratory exercise reduces anxiety symptoms, though high-intensity activities may reduce anxiety symptoms more quickly.

Exercise actually strengthens cells through the recovery process from the “micro-damage” caused by exercise. This makes them more resilient to stress. Exercise effectively helps with anxiety by increasing feel-good hormones, including serotonin.

It also relieves muscle tension through movement and “rewires” parts of the brain to replace pathways that previously provoked a fear response to instead respond with positive memories. The brain becomes more resilient toward the flight aspect of the flight or fight response.

The takeaway: Controlling asthma is key

Not everyone living with asthma will experience anxiety, and vice versa. I’m fortunate to not regularly experience asthma-induced anxiety or anxiety-induced asthma. But it’s important to remember that uncontrolled asthma can make symptoms of anxiety worse. Work with your doctor to control your asthma -- make an asthma action plan, so you know how to respond if your asthma starts getting worse. Simply having a plan to follow can be helpful in keeping anxiousness at bay.