Many people with COPD have anxiety, for a variety of reasons. When you have trouble breathing, your brain sets off an alarm to warn you that something is wrong. This can cause anxiety or panic to set in.

Anxious feelings may also arise when you think about having a progressive lung disease. You may worry about experiencing an episode of difficult breathing. Certain medications used to treat COPD can also trigger feelings of anxiety.

The breathlessness-anxiety cycle

Anxiety and COPD often create a cycle of breathlessness. Feelings of breathlessness can provoke panic, which can make you feel more anxious and can make it even harder to breathe. If you get caught up in this breathlessness-anxiety-breathlessness cycle, you may have a hard time distinguishing the symptoms of anxiety from the symptoms of COPD.

Having some anxiety when you have a chronic disease can be a good thing. It can prompt you to follow your treatment plan, pay attention to your symptoms, and know when to seek medical attention. But too much anxiety can severely impact the quality of your life.

You may end up going to the doctor or the hospital more often than you need to. You may also avoid enjoyable social and leisure activities that can cause breathlessness, such as walking the dog or gardening.

Coping with anxiety

People who don’t have COPD are sometimes prescribed anti-anxiety medications such as diazepam (Valium) or alprazolam (Xanax). However, these drugs can cause a decreased rate of breathing, which can make COPD worse, and can interact with other medications you use. Over time, these medications may cause dependence and addiction problems as well.

You may find relief with a nonaddictive anti-anxiety medication that doesn’t interfere with breathing, such as buspirone (BuSpar). Certain antidepressants, such as sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa), also reduce anxiety. Your doctor can help determine what medication will work best for you. Remember, all medications have the potential for side effects. Increased anxiety, intestinal upset, headaches, or nausea can happen when you first start these medications. Ask your doctor about starting with a low dose and working your way up. This will give your body time to adjust to the new medication.

You can increase the effectiveness of medication by combining it with other methods for reducing anxiety. Ask your doctor if he or she can refer you to a pulmonary rehabilitation program. These programs provide education about COPD and coping strategies to deal with your anxiety. One of the most important things you learn in pulmonary rehabilitation is how to breathe more effectively.

Breathing retraining

Breathing techniques, such as pursed-lip breathing, can help you:

  • take the work out of breathing
  • slow your breathing down
  • keep air moving for longer
  • learn how to relax

To do pursed lip breathing, relax your upper body and breathe in slowly through your nose to the count of two. Then purse your lips as if you are going to whistle and breathe out slowly through your mouth to the count of four.

Counseling and therapy

Many people with COPD find that individual counseling is effective in reducing anxiety. Cognitive behavioral therapy is a common therapy that helps decrease anxiety symptoms through relaxation techniques and breathing exercises.

Group counseling and support groups can also help you learn how to cope with COPD and anxiety. Being with others who are dealing with the same health issues can help you to feel less alone.

The takeaway

COPD can be stressful enough on its own. Dealing with anxiety on top of it can complicate things, but you have treatment options. If you start noticing symptoms of anxiety, talk to your doctor and find a treatment before it begins to affect your daily life.

Panic attacks: Q&A


What’s the relationship between panic attacks and COPD?


When you have COPD, a panic attack can feel very similar to a flare-up of your breathing problems. You might suddenly feel your heart racing and your breathing becoming harder. You may notice numbness and tingling, or that your chest feels tight. However, a panic attack can stop on its own. By having a plan on how to cope with your panic attack, you may be able to control your symptoms and avoid an unnecessary trip to the emergency room.

• Use distraction by focusing on a task. For example: opening and closing your fists, counting to 50, or reciting the alphabet will force your mind to focus on something other than how you are feeling.
• Pursed lip breathing or other breathing exercises can control your symptoms. Meditation or singing may be useful as well.
• Positive imagery: Picture a place you would rather be like a beach, an open meadow, or a mountain stream. Try imagining yourself being there, peaceful and breathing easier.
• Do not drink alcohol or caffeine, or smoke during a panic attack. These can aggravate your symptoms. Inhalers are not recommended.
• Get professional help—a counselor can teach you other tools for managing your anxiety and panic

Judith Marcin, MD Family MedicineAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.