As many as half of all people with COPD also experience anxiety. Feelings of breathlessness can sometimes trigger panic attacks. Anxiety medications may help, but other treatments may be more effective.

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that affects as many as 1 in 9 people globally. Responsible for more than 3 million deaths each year, COPD is mainly known for its physical symptoms, such as difficulty breathing.

But many people with COPD also experience effects on their mental health. Between 7–50% of people with COPD experience anxiety. They’re also up to 10 times more likely to experience regular panic attacks.

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.

According to 2023 research, people with COPD-induced anxiety are more likely to have COPD exacerbations and have a worse outlook.

Here’s what you need to know about the link between COPD and anxiety and what you can do to manage symptoms.

With COPD, you may have anxiety for various 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 COPD medications can also trigger feelings of anxiety.

COPD and mental health

People with COPD are more likely to experience anxiety, depression, and panic disorders than people who don’t have COPD. These mental health conditions can contribute to:

  • reduced ability to manage symptoms and adhere to treatment
  • lower lung function
  • more frequent (and longer) hospital stays
  • poorer quality of life
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A panic attack is a sudden, intense episode of fear or anxiety when no threat exists. It can cause shortness of breath, a rapid heart rate, and other physical symptoms.

People with COPD may experience symptoms of a panic attack in situations that don’t necessarily relate to their mental health, such as after exercising.

But many people with COPD experience true panic attacks, which are often unpredictable and not linked to activities that typically cause those symptoms. A 2017 study found that 43.3% of participants experience such panic attacks.

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 cycle, you may have a hard time distinguishing the symptoms of anxiety from the symptoms of COPD.

Doctors sometimes prescribe anti-anxiety medications diazepam (Valium) or alprazolam (Xanax) to people who do not have COPD. However, these drugs can cause a decreased rate of breathing, which can worsen COPD. They may also interact with other medications you use.

Studies into which medications might help relieve anxiety symptoms in people with COPD have produced mixed results. While there’s no conclusive evidence, some studies have shown that the following medications may help relieve symptoms:

Remember, all medications have the potential for side effects. Increased anxiety, intestinal upset, headaches, or nausea can happen when you first start these medications. SSRIs may also increase the risk of breathing problems in older adults, according to one 2018 study.

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.

Some people with COPD may already take several medications to manage their symptoms. You may be hesitant to take more medications or be concerned about possible drug interactions.

Research suggests that several nondrug options can be effective alternatives or add-on treatments to help reduce anxiety symptoms and the frequency of panic attacks.

Pulmonary rehabilitation

Ask your doctor if they can refer you to a pulmonary rehabilitation program. These programs provide education about COPD and coping strategies for 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.

Relaxation techniques

Research suggests that relaxation techniques may not only improve well-being but also reduce symptoms like shortness of breath in people with COPD. Such techniques include:

Counseling and therapy

Many people with COPD find that individual counseling is effective in reducing anxiety. Cognitive behavioral therapy is a common approach 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 managing the same health issues can help you feel less alone.

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 anxiety symptoms, talk with your doctor about possible treatments before it affects your daily life.