It is frightening and anxiety-producing to be unable to breathe
comfortably. For some, anxiety interferes with treatment of acute
asthmatic symptoms. If you (or your child) fail to respond to an
inhaled bronchodilator but then rapidly respond to similar medication
given by inhalation or injection at a doctor's office or emergency
room, a likely explanation is anxiety interfering with the proper
technique needed for delivery of the aerosol to the airways. This
occurs because anxiety causes more rapid and often shallower
breathing that can both aggravate the asthma further and decrease
delivery of an inhaled medication. It is therefore medically
essential that anxiety be controlled at least sufficiently to permit
effective use of the inhaled bronchodilator.
How do I control anxiety?
Just saying "Relax" will not do the job. For children, it is
essential that parents (or baby- sitters) keep their cool. It is
difficult for visibly panicky parents to deal effectively with
anxiety in a child. For children or adults, anxiety is often
controlled by focusing on some specific behavior such as rate of
breathing.
Two techniques are used to slow respiration increased by
anxiety:
- slow drinking of any liquid
- breathing exercises.
Sitting down with a glass of liquid ranging from water to any
flavored beverage imposes a degree of relaxation by distracting
patients from their discomfort. Additionally, breathing must slow
down in order to drink. Once breathing is slowed, use of the inhaled
bronchodilator is likely to be more effective.
Breathing exercises are a method of gaining control of
respirations by "overriding" the anxiety-producing ventilatory drive.
The technique is as follows:
- Sit down
- Take a long slow deep breath while pushing on your upper
abdomen with folded hands.
- Let the air out slowly through "pursed" lips, i.e. the lips
should be kept almost completely closed, sufficient to cause
considerable resistance.
- Repeat the slow inhalation with abdominal compression and
"pursed" lip expiration at least 2 more times.
- Try the prescribed inhaled bronchodilator again concentrating
on the proper technique.
- Repeat procedures 1 through 5 if needed.
If difficulty breathing is so severe and sudden in onset that the
above relaxation technique does not permit effective delivery of
inhaled medication, a self-injecting adrenalin syringe (EpiPen or
Twinject) provides a useful though rarely needed emergency measure
for temporary relief. This can then permit the above procedure to be
used. Discuss this with your doctor ifyou feel that your situation
justifies this measure.
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