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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Child Having Asthmatic Symptoms. Worse During Early Fall. Diagnosed As Non-allergic Rhinitis. Taking Flonase. Is It Panic/anxiety Reaction?

Hi , My 10 year old has been having asthma like symptoms - nasal congestion, shortness of breath, chest tightness, tingling of feet and fingers. His symptoms get worse during weather change from Summer to Fall. He is ok going from Winter to Spring and to Summer. He thought it was a panic attack and went to the ER and they gave him asthma treatment but it did not help. What helps is him relaxing and calming his mind down when we gets the breathlessness. Dr says it is not asthma. Allergist thinks it is non-allergic rhinitis so he is taking flonase. Otherwise he is is just inhaling steam w vicks. It is hard to figure out if it is a panic/anxiety reaction or he has a real physiological issue. Pls advise.
Mon, 18 Nov 2013
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  User's Response
HI
Thank for asking to HCM
I really appreciate your concern, looking to age of kid panic attack is less likely even if it there then this kind of panic attack induces asthmatic attack which very typical, but the nasal congestion and other upper respiratory elements is impossible, it may be a kind of allergic constitution and need to be treated accordingly, encourage the kid for drinking water give him pure honey before going to bed, it will come around, more aggressive medicine some time flare up the symptoms have nice day.
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Pediatrician Dr. Sumeet Arora's  Response
Hello there,

Thank you for choosing HCM for your query.

Your son's symptoms as you described are nasal congestion, shortness of breath, chest tightness, tingling of feet and fingers.
These symptoms typically occur in asthma as you rightly said but can also occur in hyperventilation (overbreathing) and since he has already been treated like an asthma patient and didnot show any improvement and the fact that what helps him is calming and relaxing him definitely go in the direction of hyperventilation caused by anxiety.

I would recommend you to find out the reason for his anxiety attacks especially since you said his symptoms are typically worse during early fall.

Are there any triggers that cause him to have anxiety during early fall like if there are tests coming up or performing better in a sports or athletics or if he has vacation during that time and seeks someone's attention.
It is also possible that early fall is the season when he gets nasal congestion and which may trigger his anxiety of being unable to breath effectively which may trigger him to hyperventilate, this may happen if he has a past association or memory of having trouble breathing or has seen someone who got very sick with asthma.

You can teach him breathing exercises and effective breathing during nasal congestion and give him medications to relieve his nasal congestion.
If he continues to have frequent panic attacks, then he may need some counseling by a psychologist to be able to manage his attacks better.

At the same time, I would recommend you to follow his symptoms closely and watch for any warning signs so as not to miss anything organic causing his symptoms. Watch for:
1. Any dizziness or episode of syncope (passing out) especially while exercise.
2. Chest pain or breathlessness while exercising or exertional activity.
3. Unable to keep up with his peers while running or exercising.
4. If he complaints of his heart beating fast or feeling funny in his chest.

If any of the above symptoms are present or develop later, he should see his pediatrician or physician at the earliest to rule out any underlying pathology like a cardiac problem causing his symptoms.

Hope this helps.

Regards,
Dr. Sumeet.



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Child Having Asthmatic Symptoms. Worse During Early Fall. Diagnosed As Non-allergic Rhinitis. Taking Flonase. Is It Panic/anxiety Reaction?

HI Thank for asking to HCM I really appreciate your concern, looking to age of kid panic attack is less likely even if it there then this kind of panic attack induces asthmatic attack which very typical, but the nasal congestion and other upper respiratory elements is impossible, it may be a kind of allergic constitution and need to be treated accordingly, encourage the kid for drinking water give him pure honey before going to bed, it will come around, more aggressive medicine some time flare up the symptoms have nice day.