Overview

A panic attack and an asthma attack can be confused with each other because they can generate similar symptoms, such as a feeling of shortness of breath or a chest pressure.^1,2 However, to identify the key differences between them is helpful for being able to inform the symptoms in a clear way, and then, getting adequate medical help.³ In this article, we will analyse both conditions and their differences, as well as when to look for medical assistance. 

What is a panic attack?

Panic attack is defined as the presence of periods of intensive fear or discomfort that reaches its peak in approximately 10 minutes.^2,4 These attacks can last between 5 to 20 minutes, although the person can feel that the duration of the fear is longer. In addition, panic attacks might happen multiple times a day or just on some occasions during the year.⁴ 

This condition can be associated with panic disorder, anxiety, psychosis, substance use disorder (SUD), but everybody can have at least one panic attack during their lifetime. Additionally, the attacks do not have a specific trigger, hence, persons can feel a stimulus of internal threat that they cannot control.^4,5

Symptoms of a panic attack

The Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) establishes that a person must present an intense fear in addition to at least 4 of the 13 symptoms detailed below to be diagnosed with a panic attack:^2,4

• Heart palpitations
• Sweating
• Tremor
• Feeling of shortness of breath
• Feeling of choking
• Chest pressure or chest pain
• Nausea
• Dizziness
• Depersonalization and/or derealization
• Fear of losing control
• Fear of dying
• Numbness  and tingling
• Hot flashes or chills  

Panic attacks can be part of the manifestations of many conditions; therefore, they are used during the analysis of the diagnosis, and the evaluation of the severity of different diseases or disorders. ²

What is an asthma attack? 

Asthma is a condition characterised by an overreaction of different structures in the airways, leading to their long-term inflammation. It is usual for persons with asthma to have immediate relatives with this condition as well, with/or a story of allergies, hay fever or atopic eczema.⁸ There are diverse factors that can cause the inflammation, they are divided into allergic and non-allergic.^6,7 

Allergic factors:

• Pollens
• Mould
• House dust mites
• Animal dander
• Cockroach residue 

Non-allergic factors:

• Exposure to tobacco smoke
• Pollution
• Cold air
• Viral infections
• Pain relievers
• Exercise
• Emotional factors, such as anxiety

The combination of these factors can trigger an asthma attack, which is the exacerbation of asthma. An asthma attack is caused because triggers generate an increased reaction of the airways, as well as their inflammation, and their narrowness, also known as bronchospasm. The resulting consequence is a reduction of the air flow.^6,7,8 

Symptoms of an asthma attack

The limitation of air flow might generate one or more of the next symptoms:^6,8,9

• Wheezing
• Shortness of breath
• Chest pressure
• Cough

There are other symptoms that can be presented, such as:^6,8,9

• Production of mucus and phlegm
• Difficulty to speak due to the shortness of breath
• Sweating
• Gasping for air
• Weakness

Key differences between panic attack and asthma attack

A person can have anxiety and asthma at the same time. In the specific case of panic attacks, they have been documented as more present in people with asthma, than in people without asthma.^1,3,10,11 In this section, we will analyse key differences between both conditions.

Triggers

In panic attacks, there is not always a specific trigger; however, the triggers tend to be an emotional component, such as sadness, anxiety or stress. Meanwhile, in asthma attacks, emotional components could be triggers, but it is more common that allergic factors act like likely triggers.^2,4,6,7

Mental, emotional and physical components

The mental and emotional factors unchain the physical reactions, for example, heart palpitations or nausea, in panic attacks. In asthma attacks, the low air flow causes physical reactions like wheezing and chest pressure. In addition, in asthma attacks, the presence of mucus and phlegm is common, while in panic attacks they are not present. In contrast, panic attacks present the fear of losing control, depersonalization or derealization and asthma attacks do not have these symptoms.^2,4,6,7

Breathing characteristics

The person has the feeling of not breathing properly, so they start to breath rapidly, it is known as hyperventilation, and usually happens in panic attacks. On the other hand, in asthma attacks, the person has shortness of breath provoked by the narrowness and inflammation of the airways, known as a  bronchospasm.^2,4,6,7,8

Chest pressure

In panic attacks, the chest pressure can be referred to as a sharp chest pain that results after a stressful situation or concern, it is accompanied by the feeling of an imminent death. In asthma attacks, the chest pressure is caused by the changes in the airways, such as the inflammation and their narrowness. However, in asthma attacks, the person does not have the feeling of imminent death.^2,4,6,7,8

Response to treatment

The use of relaxation techniques, and to remember that the symptoms cannot cause physical damage are helpful to deal with panic attacks. In the case of asthma attacks, medications like bronchodilators and corticosteroids are helpful to reduce the inflammation of airways in a short time, while the person can get medical attention. As the source of the symptoms are different, the treatments between both conditions are also completely different.^1,3,9,12 It is important to mention that if the person has asthma and panic attacks, it is important to look for medical help with the aim of receiving accurate treatment. 

What to do during a panic attack?

Firstly, it is crucial to highlight that everybody can have a panic attack during their lifetime. Additionally, if the panic attacks are happening very frequently, it is important to look for medical help because it might be a panic disorder.^4,5 

Actions to take during a panic attack:^4,5

• Try to breathe in deeply and slowly 
• Try relaxation techniques
• Try to be aware about the physical space where you are
• Remember that what you are feeling is uncomfortable, but nothing is causing you a physical damage
• Try to focus your mind in relaxing and positive images
• Remember that these stressful thoughts will pass

What to do during an asthma attack?

It is important that the person with asthma, as well as family and close friends, are aware about what to do in an asthma attack. There are some measures that can help:^8,9

• First of all, try to be calm
• Take one puff of your salbutamol inhaler every 30 to 60 seconds, until 10 puffs  
• If you detect some trigger that might be causing the symptoms, avoid it as soon as possible
• If after that, you continue feeling bad, remember that you can ask for emergency medical help

When to seek emergency medical help?

In both conditions, shortness of breath and chest pressure can be presented, and both symptoms might require emergency medical help in some cases. In the UK remember to call 999/112.

These are warning symptoms that alongside shortness of breath, require emergency medical help:^6,8,9

• When speaking becomes difficult due to shortness of breath
• If the person is gasping for air
• If the person has pale, grey or blue lips or skin
• Weakness
• Sweating
• sudden confusion (delirium)

These characteristics are important because due to the low air flow, the person might require the administration of oxygen through different devices in the hospital.^6,8,9

Next, we will see warning symptoms that require emergency medical help, if they are associated with chest pressure:¹³

• When the chest pressure is continuous and lasts for more than 5 minutes
• If chest pressure is referred to as a chest pain that spreads to the jaw, neck, back, or arms
• When the pain is accompanied with shortness of breath, sudden confusion, sweating, nausea or weakness

These different symptoms together might be the clinical manifestations of a heart attack.¹³

Summary

Panic attacks are common in persons with asthma, to know key differences between panic attacks and asthma attacks, can guide the patient, family and close friends about what to do when symptoms appear, mainly because the treatment of both conditions are completely different. In addition, it is important to recognize warning symptoms that can indicate conditions, such as a heart attack, that require emergency medical help.