A Personal Reflection on Coping

As a kid, I received counseling for my anxiety. I now understand that this fear is irrational. Through therapy, I learned strategies to help me live a normal life despite my anxiety. For example, I learned that the feelings I experience in these situations are not typical, and no one else in the room is feeling what I feel. I’ve learned to simply go about my business and manage these feelings as best as I can.

I'm The Best At Drawing ABGs

I went into Room 2 to do an ABG. The guy was an end-stage COPDer, but he wasn’t in any respiratory distress. So, I sat next to him, chatted a bit while prepping my ABG kit, and then felt for his pulse.

"I'm not going to poke you right away," I told him. "I'll let you know when I'm ready." I like to take my time so that when I do poke, I find the best spot.

When I finally inserted the needle, the blood flowed smoothly and quickly into the syringe. The patient was impressed.

"Wow," he said. "You're good. That didn’t even hurt."

I grinned. "I know. I don’t waste time missing anymore. Back when I was younger, I’d miss every now and then. But now, I just get it right away and be done with it—so I can spend more time in the RT Cave."

He laughed. "You’re really funny. I like that."

"Well, thanks," I said.

The next day, I had to draw his blood gas again. As soon as I told him, he said, "Oh, good! You’re the guy who’s really good at it."

I shook my head. "Wait a minute. You’re not supposed to be overconfident, arrogant, and condescending about my work until after I draw. Now you may have just jinxed me."

He laughed again.

I prepped, gave my usual warning about letting him know before I poked, and took my time finding the perfect spot. Then I inserted the needle—slowly—and… nothing.

"See what I mean?" I said.

I readjusted, and this time, I got it.

"There. Now you know why you don’t say anything until after."

"But you still got it," he said. "Man, you’re good. Better than anyone else who’s poked me."

Hypertonic Saline --- Blue Light Special

Doctors are ordering hypertonic saline for nearly every patient in the hospital these days, regardless of whether it’s actually needed. Most of the time, it feels like we’re just wasting our time.

“Step right up, folks! Come one, come all! If you’re admitted to our hospital today, you’ll be eligible for our blue light special: hypertonic saline!”

Don’t listen to those grumbling RTs complaining that it’s a pointless therapy. What do they know?

You might overhear a conversation like this:

"Are you having trouble coughing stuff up?" the RT asks the patient.

"No, I’ve been coughing stuff up all day," the patient replies confidently.

The RT raises an eyebrow, thinking, If that’s true, then why on earth did the doctor order hypertonic saline?

Ah, but the doctors know best. Hypertonic saline, our blue light special, is practically a miracle treatment. It works almost as well as Albuterol to scrub every bit of mucus—or anything else—right out of your lungs! COPD? Fixed. Asthma? Gone. Pneumonia? Cured. Even a microscopic virus doesn’t stand a chance. A little salt water solves it all!

"But," the RT protests, "this patient isn’t even short of breath."

No matter! Hypertonic saline for everyone!

Links Between Asthma and Anxiety

I have both asthma and a diagnosis of anxiety, which has always left me wondering: Is there a link between the two, or is it just a coincidence that I have both? As I began researching this a few years ago, I was surprised to learn that 6-24% of people with asthma also have anxiety (1, 2). This means I'm not alone, and it's likely not a coincidence that I have both conditions. So, what exactly is anxiety, and why are people with asthma more likely to experience it than the general population? Here’s some of what I’ve learned.

What is Anxiety?

Imagine walking into a room and seeing someone you've always wanted to meet standing there. You’ve anticipated this moment and prepared things to say. But suddenly, you feel a wave of discomfort: your heart races, your breathing rate increases, and you struggle to focus. You start to fear unlikely outcomes, like the person not liking what you have to say, or worse, forgetting what to say or saying something foolish. Your mind might even convince you that you’re going to say something irrational. Prolonged exposure to these situations can cause physical symptoms like stomach discomfort, nausea, and headaches.

Can Anxiety Impact Your Life?

This irrational fear can make you avoid these situations altogether, or if you do attend, you might go out of your way to avoid the person. While it may feel safer, it has certainly impacted my life, probably even leading me to quit journalism and become a respiratory therapist instead.

Can Anxiety Trigger Asthma?

When certain people or groups make me feel uncomfortable, I tend to keep to myself and avoid engaging. If you're wondering why I didn’t come up to talk to you at that meeting last night, now you know: it’s easier if you approach me. Fortunately, I received counseling for my anxiety in the past and have educated myself on the subject. I know it’s irrational. These people aren't dangerous, and they're not thinking, “Look, there's John. What an idiot!” Those are the types of irrational thoughts anxiety creates. I’ve learned that action cures fear—just go about your business, sit with people you feel comfortable with, and calm yourself. Eventually, people realize I have something intelligent to say, and they begin to like me. This is how I manage those irrational anxiety moments. It’s not easy, but it’s part of what I have to deal with.

Why Are Asthmatics More Likely to Have Anxiety?

I’m not an expert on anxiety—I'm a respiratory therapist, writer, and researcher, not a psychotherapist. However, I’ve come across some interesting theories about why people with asthma might be more likely to develop anxiety.

1. Dyspnea-Fear of Suffocation Theory
   You may have heard of Pavlov’s dogs. Ivan Pavlov, a Russian physiologist, discovered that dogs salivated not only when they were fed but also when they anticipated food. Similarly, during a severe asthma attack, when you can barely catch your breath, panic and anxiety may set in due to the perceived fear of suffocating and dying. This is a rational fear, but it can cause anxiety or panic attacks in response to a wide range of stimuli (such as certain people or situations) later in life. Ronald Ley proposed this theory in 1989 (3, Ley).

2. Biomarkers Theory
   Although this theory doesn’t have a formal name yet, it suggests that the chemicals released during asthma and allergy attacks (such as histamine, leukotrienes, cytokines, and chemokines) might also cross the blood-brain barrier. These chemicals could potentially cause changes in the brain, making someone more predisposed to anxiety or panic disorders. Further research into this theory could either support or challenge the dyspnea-fear theory.

3. Medication-Induced Anxiety
   Certain medications, like bronchodilators and theophylline, can cross the blood-brain barrier and have been linked to anxiety (2). This connection should be considered when evaluating the relationship between asthma and anxiety disorders.

Conclusion

There is still much to learn about the brain, and it will take time before researchers fully understand the link between asthma and anxiety. That said, it seems clear that there is a connection, and future asthma guidelines should consider anxiety as a potential comorbidity. Physicians should be aware of this link and either rule it out through testing or properly diagnose and treat it so that all people with asthma can live normal, healthy lives.

References:

1. Katon, W.J., et al. “The relationship of asthma and anxiety disorders.” Psychosomatic Medicine, 2004 May-Jun;66(3):349-355.
2. Deshmukh, V., et al. “Anxiety, panic, and adult asthma: a cognitive behavioral perspective.” Respiratory Medicine, 2007 February, 101(2):194-202.
3. Ley, R. “Respiration and Emotion.” Springer, 2001, pages 65-74.

Can anxiety result in worse asthma control?

When I was a patient at National Jewish in 1985, it became clear that my anxiety was contributing to worse asthma control. While my asthma was never questioned, the experts there suggested that my anxiety might have led me to neglect self-care, even though I knew exactly what I needed to do to manage my condition.

I knew I should take my medicine every day as prescribed, yet I didn’t always comply. I also knew that I should use my rescue medicine no more than every 4-6 hours, but I often used it as a crutch. Instead of seeking help when I needed it, I relied on my inhaler until it was empty, sometimes waiting until I could barely breathe to reach out for help.

Looking back, I understand that this was a bad idea, but I did it anyway. The experts at the hospital suggested that my anxiety played a role in my actions. At the time, I couldn’t fully grasp the idea that my asthma could be influenced by my nerves. I thought it was a crazy notion, and many of the other patients at the hospital felt the same way.

However, in retrospect, I now see the merit in their argument. The counselors and psychologists I worked with at the hospital helped me develop coping strategies for managing my anxiety. Their support in addressing my anxiety played a significant role in helping me gain better asthma control.

By learning to manage my anxiety, I was able to take my medicine consistently, regardless of how I felt, and seek help when I needed it. This connection between anxiety and asthma control is well-established in research, and I believe it made a real difference in my asthma management.

Theodore Roosevelt’s Childhood Battle with Asthma: A Fight for Breath

Theodore Roosevelt is remembered as a symbol of strength, resilience, and the "strenuous life." But before he became a war hero, a cowboy, and the 26th president of the United States, he was a frail, sickly child tormented by severe asthma. His early struggles with the condition shaped his determination to overcome obstacles, though the treatments he endured were often as painful as the disease itself.

What Was Roosevelt’s Asthma Like?

Young Roosevelt’s asthma attacks were terrifying. He often woke in the middle of the night, gasping for breath, feeling as though he was suffocating. Medical science in the mid-19th century had little understanding of asthma, and the available treatments ranged from useless to outright torture—a word Roosevelt himself might have used to describe them.

The Treatments: A Mix of Folk Remedies and Pseudo-Science

Roosevelt’s family, desperate for relief, turned to Dr. Henry Hyde Salter, a British physician whose book, On Asthma: Its Pathology and Treatment (1860), was one of the leading texts on the condition at the time. Salter believed that asthma had a nervous component and could be treated through exposure therapy, stimulants, and inducing extreme bodily reactions. Some of the treatments Roosevelt endured included:

• Cigar Smoking – Salter believed that smoking could relax the airways, particularly if it induced nausea, faintness, or vomiting. Roosevelt, just a child, was made to smoke cigars in an attempt to stop attacks—an experience he surely found miserable.

• Stramonium Smoke – This treatment involved inhaling the smoke of dried Datura stramonium leaves (a plant in the nightshade family) to relieve airway constriction. Some patients found temporary relief, but it was hardly a cure.

• Strong Coffee – Caffeine, a mild bronchodilator, was one of the more effective treatments Roosevelt’s family used. Salter advocated for strong doses of coffee during attacks, and Roosevelt reportedly relied on it.

• Mustard Plasters – Applied to the chest, mustard plasters were meant to stimulate circulation and “draw out” illness. In reality, they often just caused burning pain.

• Late-Night Carriage Rides – Theodore Roosevelt Sr., deeply concerned for his son, would take him on fast carriage rides through New York City at night, hoping the rush of air would help him breathe.

The Psychological Toll

For young Theodore, asthma wasn’t just physically debilitating—it was socially isolating. He often had to stay indoors while other boys played. His suffering was compounded by the belief (common at the time) that asthma was partly caused by weakness or nervous temperament.

How Roosevelt Overcame His Condition

Theodore Roosevelt Sr. refused to let his son accept frailty as his fate. He encouraged vigorous exercise, eventually building a home gym and pushing young Theodore to box, hike, row, and lift weights. As Roosevelt grew older, he adopted what he called the “strenuous life”, strengthening his body to the point where his asthma attacks became less frequent. By his teenage years, he had largely outgrown the worst of his condition, though he remained prone to respiratory issues throughout his life.

Legacy of His Struggle

Roosevelt’s battle with asthma shaped his entire outlook. He learned to push through adversity, which later translated into his fearless leadership, both in politics and on the battlefield. His early health struggles might have made him seem an unlikely future president, but they instead forged the resilience that made him one of the most dynamic leaders in American history.

His story remains an inspiration—not just for those with asthma, but for anyone facing seemingly insurmountable challenges. If a frail, asthmatic child could grow up to charge up San Juan Hill, break up monopolies, and establish the National Parks, who’s to say what the rest of us are capable of?

Asthma Experts vs. Reality: The Truth About Rescue Inhaler Refills

It can be frustrating when asthma specialists without asthma lecture us on how to manage our condition.

Take this comment from an asthma specialist, for example: "At some point, beta agonist overuse (let’s say more than 3–5 annual refills) is a risk factor for expensive urgent care visits, hospitalizations, or fatal outcomes, especially if the overuse approaches 12 or more units per year."

But where is the evidence to support this? While I agree that 3–5 annual refills might indicate poor asthma control for some, it’s not a universal rule. Many asthmatics, myself included, get an albuterol refill every month—not because of poor control, but because insurance limits us to one inhaler per month.

During severe asthma attacks, I might go through 1–3 inhalers in a single month. This makes it crucial to have more than one rescue inhaler on hand. If you wait until you need a refill, you might not have enough inhalers to get through a flare-up.

Additionally, some asthmatics—despite having well-controlled asthma—still require more than 3–5 albuterol inhalers per year, even if they’re not intentionally stocking up. For instance, I use Trelegy every day along with Singulair, and most days, my asthma is well controlled. However, I still experience mild shortness of breath on some days, requiring an extra puff or two (or three or four) of my rescue inhaler.

So, for asthma experts to assert that frequent rescue inhaler use automatically indicates poor control or increased risk of urgent care visits, hospitalizations, or fatal outcomes is misleading. While this might apply to some, it’s certainly not true for everyone—something I can personally attest to.