When your breathing gets hard, fear often follows. Then the fear makes your chest feel tighter, and breathing feels even harder. Many people with asthma or COPD describe this loop. This guide explains why anxiety and breathlessness show up together, what the research does and does not show, and how a virtual pulmonary rehab program can help you handle those moments with a plan.
Why do anxiety and shortness of breath go together?
Breathlessness is frightening, and worry can make a breathless moment feel worse. The National Heart, Lung, and Blood Institute says living with COPD may cause fear, anxiety, depression and stress (NHLBI). MedlinePlus also lists emotional distress such as anxiety, and panic attacks, among the causes of breathing difficulty (MedlinePlus).
That does not mean your breathlessness is “just anxiety.” Lung disease can cause breathlessness on its own, and anxiety can pile on top of it. Only your care team can sort out which is which for you.
A caution before you assume it is anxiety
MedlinePlus says to contact your health care provider for any breathing difficulty. It also says to go to the emergency room or call your local emergency number, such as 911, if breathing difficulty comes on suddenly or seriously interferes with your breathing and even talking (MedlinePlus).
What can you do in the moment?
The American Lung Association says pursed-lip breathing reduces the number of breaths you take and keeps your airways open longer, and that it helps get more oxygen into your lungs and calms you down when you feel short of breath (American Lung Association). Its steps are:
- Sit in a chair and loosen your neck and shoulder muscles.
- Breathe in slowly through your nose with your mouth closed.
- Purse your lips as if you were about to whistle or blow out a candle.
- Breathe out slowly through pursed lips, making the exhale longer than the inhale.
- Keep repeating until your breathing feels normal.
If you continue to be short of breath, the American Lung Association says to call 911 and seek immediate medical attention (American Lung Association). For a fuller walk through, see our guide on what to do when you feel short of breath.
Practice when you feel calm
The American Lung Association also notes that you do not want to first try these exercises when you are short of breath (American Lung Association). Practicing on calm days, so the steps feel familiar, is a simple way to prepare. Belly breathing is another option; read our guide to belly breathing.
What does the research say about rehab and emotional well-being?
A Cochrane review of pulmonary rehabilitation for COPD included 65 randomised controlled trials with 3,822 participants. The authors concluded that pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances people’s sense of control over their condition (Cochrane, McCarthy et al. 2015).
Research on talk therapy is more limited. A Cochrane review of psychological therapies for anxiety in COPD found only low quality evidence, from three trials and 319 participants with anxiety data. The authors said it is difficult to draw reliable conclusions (Cochrane, anxiety in COPD). If anxiety or low mood is a big part of your life, tell your doctor. NHLBI notes that talking with your healthcare provider or a professional counselor may help, and that support from family, friends and patient support groups can too (NHLBI).
How does rehab address the panic cycle?
Rehab is not a treatment for panic or an anxiety disorder. What it can do is give you skills, practice and confidence for breathless moments. In Bloom’s program that includes:
- Breathing skills such as pursed-lip breathing, taught and checked live by a licensed clinician so you know you are doing them well.
- Exercise built around your own limits, so breathless moments become familiar and planned for, not a surprise.
- Education about your condition and your action plan, so you know what is expected and when to call your doctor.
- A plan you can follow at home, matched to your day.
Every rehab session is one on one, live by video, and each patient gets an individualized treatment plan. Sessions are run by licensed respiratory therapists and clinical exercise physiologists. Education sessions about your condition may include other patients. We meet every patient where they are.
Who might benefit?
Bloom serves adults with commercial insurance who have moderate to severe asthma, COPD, ILD or long COVID. If you want to see how coverage works, read does insurance cover pulmonary rehab. You can also see how rehab helps with asthma in our guide to asthma rehab with a respiratory therapist, or read more on our breathing anxiety page.
Frequently asked questions
MedlinePlus lists emotional distress such as anxiety, and panic attacks, among the causes of breathing difficulty. Because lung and heart problems can cause the same symptom, ask your provider to check any breathing difficulty.
No. COPD can cause breathlessness by itself, and anxiety can add to it. NHLBI says living with COPD may cause fear, anxiety, depression and stress, so the two often overlap.
The American Lung Association describes pursed-lip breathing: breathe in slowly through your nose, then out slowly through pursed lips with a longer exhale. Practice it on calm days first.
A Cochrane review of 65 trials found that pulmonary rehabilitation improves emotional function and sense of control in COPD. It is not a treatment for anxiety disorders, so talk with your doctor if anxiety is severe.
MedlinePlus says to go to the emergency room or call your local emergency number, such as 911, if breathing difficulty comes on suddenly or seriously interferes with your breathing and even talking. The American Lung Association says to call 911 if you continue to be short of breath.
Yes. Every rehab session is one on one, live by video, with an individualized treatment plan. Education sessions about your condition may include other patients.
Ready to talk with a rehab specialist?
Not sure whether rehab fits you? Take our free 2 minute lung health assessment.
Ready to take the next step? Call 1-866-972-8228 or use the see if you qualify form.
This article is for education only and is not medical advice. Talk with your doctor about what is right for you.
