Asthma

What asthma feels like

We asked people to describe how it feels getting asthma symptoms, when breathing becomes difficult. Lisa explained her ‘minor’ symptoms or low-level feelings of breathlessness were fairly quickly eased by using her inhaler. Although she felt short of breath, it wasn’t a struggle to breathe. Peter describes how low level symptoms might sometimes linger and get worse to the point where breathing became more problematic.

Peter is symptom free for about 9 months of the year, but there are times when his asthma is less well controlled and he finds over a period of time he can begin to feel worried about his breathing.

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Age at interview: 62

Sex: Male

Age at diagnosis: 45

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The symptoms I have I think are the same as what other people have. And they vary in severity from being very mild to being quite debilitating and that seems to be a bit of a characteristic of the condition called asthma. It not only affects different people in different ways, and to different degrees but any one individual can be affected in a different way over the course of a year let’s say.

So I reckon typically I probably have nine months of the year when I’m pretty fine. I can do most of what I want to do. And I probably have two or three months of the year when I’m restricted to a greater or lesser extent. Sometimes quite badly restricted. So it is variable.

The symptoms are yes, tightness in the chest coughing, wheezing. I think probably the, oh and shortness of breath. The shortness of breath and the coughing are the things that trouble me most. It may be mild and I might not notice it until I’m sort of walking up a steep hill for a few minutes or it may affect me just going up a few stairs. And I may not be able to hold a normal conversation because I haven’t got enough breath to keep it going.

If there’s a bad cough alongside that as well then you can’t sleep. As soon as you lie down it starts you off coughing so you have to sit up. And if you’re doing that for several days on end or a couple of weeks, or three weeks, coughing and coughing and coughing and coughing then you pull all your muscles in your upper body and so it hurts like mad whenever you do cough. And you really can’t sleep partly because you’re coughing, partly because you can’t get comfortable anywhere.

People talk about asthma attack which sounds like something sudden and violent. Well I haven’t had that experience. I can detect that the asthma is getting worse but it’ll be, it’ll deteriorate over two or three or four day period before I might reach a point where I’m struggling to breath. And, I wouldn’t describe that as an attack, it’s a steady deterioration. Although I have had the sensation of being afraid that I can’t carry on breathing. Which is frightening. It sounds absurd but I can remember sort of sitting on the bed and concentrating on breathing and thinking, telling myself all you’ve got to do is carry on you know, steadily slowly, breathing in and out. It sounds ridiculous to suggest, to suggest that you don’t know how to do that, but you know, and it’s obviously quite frightening when, when that happens. But I’ve only had that happen once, to the point where I really quite frightened.

In contrast to low level symptoms an asthma ‘attack’ was described as more dramatic. While there are a wide variety of experiences, it is striking that many people described the feelings in similar, often very vivid, ways.

People said they felt that they couldn’t get enough air into – or out of - their lungs – as if they were ‘breathing through a straw’, or even in some cases as if ‘suffocating’, ‘choking’ or ‘drowning’. They described ‘struggling’ or ‘fighting’ for air. Stephen said it felt as though he’d lost half his lungs, as though the air is only going down half way and he’s only getting half the air that he needs. Faisil described it as like having ‘itchy lungs’ and ‘gasping for breath’. Not being able to breathe out felt as if the air had ‘nowhere to go’ or was ‘stuck’ or ‘closed off’.

Mark describes how asthma symptoms can feel to him ‘like drowning in a pool’.

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Age at interview: 49

Sex: Male

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If you had to describe what asthma was to someone who didn’t know, what was, how would you describe it?

Well I think the best way to describe asthma is at its worst, right, it is just like you’re drowning in a pool because you, both ways with drowning and with asthma you’re trying to fight for air. You’re trying to breathe air, you know, either with your nose or with your mouth, you want it then. And you can’t. And what makes it so much more worser is when you’ve got triple the problems like hay fever, right, which again I have, so it makes it more difficult to even to try to even try to breathe through the nose. And also the mouth as well.

When Christine has an asthma attack she says it can feel like very hard work as you struggle with each breath.

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Age at interview: 59

Sex: Female

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It’s extremely hard work.

It’s very hard work because you’re struggling for every breath, and you can breathe in but you can’t breathe out. And because you can’t breathe out, the next breathe has got nowhere to go.

So you’re kind of trying to force air in past air that should be coming out, as it were and this is where you get this characteristic, [makes noise] sort of sound. I was very, very thin. I was very thin. I was quite seriously underweight because I was using all the calories up trying to breathe, but I did have a flat stomach, so it wasn’t all bad.

The feeling of a ‘tight’ chest is a common symptom. In some cases, people said it could feel as though a person was gripping them around the chest or sitting on them and squashing them so hard they could not breathe. Catherine compared it to a heavy weight and said that it could feel very frightening. Alice said that she sometimes fears she might suffocate during an attack

For most people these symptoms can be relieved relatively quickly by using a reliever inhaler during the attack.

Catherine describes the feeling of tightness in the chest as ‘like a huge weight’, as if someone is sitting on her chest.

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Age at interview: 39

Sex: Female

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It’s like somebody’s sitting on your chest and they’ve got their hands round your throat and you can feel it. It’s like that there’s this huge weight sitting and no matter how hard you breathe in your chest wall feels like it’s not moving, at all.

In reality it probably is moving a bit but because everything, all the airway passages have narrowed so much you’re trying to force through air and there isn’t the room for it to go. And it is like you’re suffocating.

Alice feels frightened she may suffocate when she has an asthma attack but knows that the steroid inhalers will usually solve the problem, or she can use a nebuliser if she can’t manage the inhaler.

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Age at interview: 59

Sex: Female

Age at diagnosis: 18

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Can you describe what it feels like having an asthma attack?

Well, obviously, yes, I mean, there's... I would say two or three different things. One is when you suddenly notice that you’re coughing all the time, and I'm coughing because I'm short of breath, but it comes out as needing to cough. Then sometimes I'm needing to cough because mucus has built up and trying to clear that, and that's one of the things that happen, you know, you get the inflammation in the, I suppose it’s the trachea, and also mucus production is increased. And you need to shift that so that you can breathe in or out and the coughing, you know, it’s just uncomfortable and you feel uncomfortable. But I think thanks to the steroid preventers, I don't get the same amount of inflammation, and the absolute worst thing is, when everything is inflamed, your trachea’s closing up, you can’t breathe, and you actually can't breathe. And I think it’s that you can't breathe out but I'm not sure because I've forgotten which, which way, which way it works. But that not being able to breathe is absolutely panic making. And you don't know whether things are going to open up again and you will be able to breathe or whether you will suffocate or your heart will stop. And I always used, also used to worry a bit about brain damage, with the lack of oxygen to my brain, I've given up worrying about that now, but I think it is that sense of, of suffocation that is the worst thing. One could put up with the coughing because, or I could, because I don't feel that's life threatening, but the thing that was so frightening was the suffocation, the inflammation and that's why I think the steroids are such a godsend.

Is it... how easy or difficult is it to use the inhaler when you are in the middle of an attack like that, when you’re not being able to breathe?

Then I would use my nebuliser because and if I was in a very bad state, somebody i.e. my husband could help me set it up but I have a, a nebuliser and have had one for a very long time, but because that's, you just can put the mask over your face and breathe in, that would be easier. If I’m just kind of coughing, I'll just use the inhalers, and it’s quite easy because I think what prevents you from doing things is the panic.

When breathing becomes difficult it can be difficult to move, to think clearly or to talk, even to tell other people how you are feeling or what they could do to help. Jane Z said that when you can’t breathe you can easily begin to feel confused because you are not getting enough oxygen to the brain. Christine pointed out how this can also have repercussions for friends, relatives or work colleagues if they are with you when you are going through a bad attack - "All you can think about is drawing breath, literally. It’s much more terrifying for people around you because they can’t do anything, they’ve just got to sit and watch you".

Susan describes how her symptoms start with coughing and tightness. It can be difficult to think straight when she is trying to concentrate on her breathing. [AUDIO ONLY]

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Age at interview: 31

Sex: Female

Age at diagnosis: 18

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A lot of the time with me it starts, either I just start coughing or it’s like a bit of a tightness in my throat, like your throat is getting smaller. So I don’t tend to start wheezing until quite a lot later on until it’s quite bad. And then if I take my inhaler then it’ll just clear up quite easily, usually. But then if it gets worse it’s, it’s kind of like you’re trying to breathe through something really small, like through a straw or something. And it feels like there’s something that’s stopping you kind of breathing properly, like opening and closing your lungs.

So it’s kind of like you can’t, you just can’t get enough air out.

Like you can breathe in some, like mostly OK but then you just can’t breathe out properly. And it’s just, it’s really exhausting.

And I tend to find that I kind of, I stop thinking completely straight. I think as I’m thinking so much and I’m worried so much about my breathing that I can’t cope with other things so I can’t, I can’t always explain what’s going on and I can’t always work out what words I need to use. So I can kind of get half way through a sentence, if I’m trying to explain what’s happening to someone, I might get half way through and I just can’t remember the word that I’m after or I can’t remember where in the sentence I am because I’m concentrating so much on breathing that the rest of the things are just too complicated.

The advice for people experiencing asthma symptoms is to try not to panic, because this can make things worse. Although most people know this is a sensible and obvious strategy, in practice it can be difficult not to panic. Asthma can be a life-threatening condition in some cases, and the fear of not being able to get your breath is very powerful. In addition, as Catherine points out, in order to make the situation better you need to be able to take a deep breath in order to inhale the medication, and ‘what’s the one thing you can’t do….take a big breath in…’. Jane Y says ‘my husband is a rock’ as he helps her to stay calm by reminding her to stay calm, sit down, concentrate on breathing and not to try to talk. Some people say that using a spacer with the inhaler can make things easier when you are having an asthma attack.

Dee explains how she can feel both physical and psychological symptoms during an asthma episode. The aim of medication is to try to avoid getting to that point. [AUDIO ONLY]

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Age at interview: 52

Sex: Female

Age at diagnosis: 23

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It’s like as if, the sensation is of constriction in your windpipe and in your lungs. It’s like you’ve got a balloon that is, you know, won’t blow up, which I guess is your lungs. The hardest thing to control, when you have an asthma attack, that you feel is getting out of your control because I suppose the thing to remember is that you might have an asthma attack, which just means you’re feeling a little bit wheezy, where I don’t know, you’ve, you know, a bit of exertion or bit of tiredness or whatever, and you know that if you then go and get the reliever you’ll be fine. But you can also get to a point where you maybe ignore that for a while and then you start to panic, so the physical feeling of being short of breath then becomes a psychological feeling of fear and panic because your body becomes really aware very quickly that you’re in danger and your, just your normal fright flight responses kick in and you you’re looking for action. You want something to happen. But your ability to take that action is diminishing by the moment because, of course, you’re not actually processing any oxygen and you need people around you to know what this looks and feels like so that people around you, family, friends, work colleagues, would be able to work out that they need to go and run and get your inhaler or they need to phone for help for you. So I suppose first it’s a physical feeling and then next it’s a psychological panic.

And of course, the whole aim of the medication is to ensure that you never get to that point.

Val explains how it feels as if her breath is 'stuck' when she is asthmatic and how she tries to keep calm.

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Age at interview: 62

Sex: Female

Age at diagnosis: 57

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Sometimes it feels like…your, my breath is stuck so I can’t breathe out . Sometimes it’s wheezing, like I explained in the winter, I can walk down the road and I just can’t stop wheezing. Often it’s coughing, so I just cough and cough and cough for no reason sometimes, and anything can kind of trigger the coughing. So it’s mainly those breathlessness, coughing and wheezing…are the main symptoms.

I notice you said that you try not to panic too much…

I try not to panic. So for instance the other day I had two coughing attacks and I just kind of think ‘I mustn’t panic’, I’ve got to try and stop the coughing with the inhaler and normally I can do that. I can take the blue inhaler and stop the coughing.

So does it help to kind of remember back to know that it will subside?

Yes, absolutely, yes. Or, if I can’t, if I feel tight-chest - tight-chestedness is the other thing - if I feel tight-chested I’ll kind of think it will sort itself out. I know it will sort itself out. If I haven’t, my feeling is if I haven’t had an emergency attack by now, I’m hopefully not going to get one if I do not panic and just take the inhaler and just wait until it sorts itself out.

And sometimes that requires a fair amount of blue inhaler, but most times it will just require maybe two or three doses and it sorts itself out.

It sounds like that’s quite an important part of it. I’ve heard people say that if you get into a panic attack then it can actually exacerbate…

Yes, yes, no I think that is really important and I kind of decided I would do that from the beginning kind of reading about it and realising that panicking made it worse and anxiety made it worse. I decided very early on that the thing I mustn’t do is panic when I have an attack.

A doctor explains how anxiety can exacerbate the onset of an asthma attack.

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Sex: Male

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There is absolutely no doubt that anxiety acts as a potent trigger for asthma. Managing it is very difficult. Because it lies as much in the management of the anxiety as in the management of the asthma.

Some people of course get very frightened when they have an asthma attack, and that’s not surprising. It’s a very frightening thing to happen. And of course, therefore, when they feel they’re on the verge of another attack, panic may set in, and that may in fact exacerbate the likelihood of getting an attack. There are a number of different options to do it, people have tried yoga and things like that. As far as I’m concerned I’m all for people trying these things if they feel it works for them. The scientific evidence to support that is virtually absent, but it’s, any way in which anxiety can be managed better is likely in those individuals to improve their asthma control. There are a number of different options to do it, people have tried yoga and things like that. As far as I’m concerned I’m all for people trying these things if they feel it works for them. The scientific evidence to support that is virtually absent, but it’s, any way in which anxiety can be managed better is likely in those individuals to improve their asthma control.

As well as the physical symptoms of breathlessness, wheezing and coughing, some people spoke about asthma making them feel exhausted. This could be during symptoms, because of the effort of breathing, and people often mentioned feeling unable to move or even stand while it was happening. Or it could be more general tiredness and exhaustion.

Jenny has brittle asthma and can feel a sense of fatigue and exhaustion when she is experiencing an asthma attack.

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Age at interview: 34

Sex: Female

Age at diagnosis: 18

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I can do things, but I get puffed and short of breath and then I go blue and, you know, and I have to be very careful that I don’t get over-tired; it’s getting over-tired makes me, can make me wheeze and also because I’ve been so ill for what, seven years now, I’m actually [coughs] at great risk of ME chronic fatigue because I get sort of over one virus and something else hits me, so and then I get too tired, my body just goes into shut down mode.

And I do have days where I am completely useless, where I just sit on the sofa and I sleep and I’ll wake up, eat something and I sleep again, you know, that’s basically all I, all I can do because my body is either fighting something or it has been fighting something.

I mean, the other week the dog wasn’t well, it was like Saturday night, half-ten, eleven o’clock at night and she needed to go to the emergency vets and I could just not – I’d had a busy day and I just couldn’t do it, I couldn’t get up off my bed to take her so my mum and dad had to take her, eleven o’clock at night and sit there for an hour at the, you know, until midnight at the vets…because I was just so physically tired and then my breathing goes off when I’m tired as well, but that, it’s not asthma breathing then that goes off, it’s fatigue breathing. But anything that upsets your breathing pattern when you are an asthmatic like me, anything that upsets the breathing pattern can trigger the asthma off.

Other people talked about a persistent cough or wheeze interrupting sleep, and creating a vicious circle where they became more and more tired. Coughing has only been recognised as a symptom of asthma in the last 20-30 years; being woken by coughing at night suggests the asthma is not well controlled. Jane Y said that she finds it helps if you have several pillows so that you are in a more elevated position for sleeping. The severity and frequency of asthma symptoms varies enormously – not everyone gets all of the symptoms and some people only experience them from time to time.

Andreane explains that not everyone experiences asthma in the same way so it’s important for health professionals to treat each person’s asthma individually.

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Age at interview: 48

Sex: Female

Age at diagnosis: 33

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Some of my attacks I don’t get breathless, I just have difficulty breathing out. How can I put it? Because some people you can [imitates someone gasping with an asthma attack] but sometimes I don’t get that, I just have a very, very, tight, tight chest. And that’s all the symptom I can get. So I’m not always, for the medical profession they have a sort of a check list, if you do this, if you do this, you do that, you do that, but not everyone meets that check list criteria every time. So I try to say to people, to the medical profession, don’t categorise a person with asthma, having standard symptoms, because each individual is separate. And their symptoms can be one or two of the same things or can be totally different.

(Also see ‘Emotions and coping’, ‘Relationships, family and friends’, ‘Support and support groups’ and ‘Managing asthma – reviews and action plans’).

Last reviewed August 2017.