Differentiating Breathlessness due to COVID/Flu from that due to Anxiety

Breathlessness is a feeling of being short of breath, wanting more air, or an inability to breathe comfortably or freely.

Breathlessness is a symptom experienced intermittently or in advanced cases constantly, over many months or years, by people who have known chronic health conditions like chronic obstructive pulmonary disease (COPD includes chronic bronchitis and emphysema), asthma, interstitial lung disease (ILD), and congestive heart failure (CHF).

However, breathlessness is also one of the important symptoms of infections of the respiratory system caused by viruses like Influenza (Flu) and Coronavirus (COVID: Flu-like illness), seen when the virus spreads to the lower respiratory tract and lungs. When a pandemic of Flu or COVID is present, there is a lot of news and information all around on how the infection is spreading and impacting people. It is but natural to sometimes feel anxiety, fear, and even panic in such situations.

Anxiety often manifests as a feeling of breathlessness. However, since this is one of the known and more serious symptoms of Flu and COVID, it can lead to unnecessary panic and significant stress, with adverse impact on health and wellness, and avoidable burdening of health facilities.

Here are 5 important points that can help a person or his family member differentiate between feeling breathless due to anxiety, or possibly due to COVID/Flu.

1. Fever is the prominent symptom of COVID/Flu and it rises over 2-3 days to usually >100 deg C. Anxiety does not cause fever, even though sometimes the body may feel a bit warm or flushed. If in doubt one can take or monitor the temperature with a home thermometer over 24-48 hours.
2. Characteristic symptoms of COVID or Flu along with breathlessness are cough, sore throat (or throat pain), nose or throat congestion, and body pain. There may be physical weakness causing difficulty in doing routine tasks, and sometimes headache, and inability to smell or taste. These symptoms are absent in anxiety-induced breathlessness.
3. Symptoms suggestive of anxiety-related breathlessness typically include associated nervousness, panic, fear, feeling stressed, nausea, sweating, palpitations, obsessive or disturbing thoughts, light-headedness or dizziness, and feeling a sense of weakness without any actual physical weakness.
4. Onset and Duration: COVID or Flu symptoms set in gradually and increase in severity over 2-3 days after which breathlessness may be experienced over the next few days. In anxiety, the shortness of breath can come and go for a day or two lasting from 5-10 minutes to 30-45 minutes at a time.
5. Relief of anxiety and associated breathlessness is usually achieved when the person is calmed, reassured, and takes slow deep breaths. Other activities giving relief from anxiety include going for a walk, doing stretching exercises, listening to relaxing music, reading or watching something interesting or amusing, good sleep or rest, and eating a nutritious tasty meal. Breathlessness due to COVID or Flu is continuous, increasing in severity, and requires medical care and treatment.

Pulse oximetry is a simple test that can be performed at home to determine a person’s oxygen saturation in the blood, and pulse rate. It can help in identifying people who need oxygen or medical care immediately.

Advisory and guidance for India: https://www.mohfw.gov.in/index.html

Further reading –

10-point approach to stress management

Coronavirus and COVID-19: Awareness and Readiness

Common Cold and Flu- Know the difference, effective care and 10 alert signs