Panic, Anxiety, and Chronic Dyspnea

Abstract

M F WAS A 77-year-old man with idiopathic pulmonary fibrosis who received hospice care at home. He and his family reported new anxiety symptoms related to fear of suffocating after hospice care began. He was admitted to an inpatient hospice unit when breathlessness became progressively worse and functional ability declined significantly. The patient’s anxiety increased. He reported frequent (up to three times per week) panic attacks prompted by difficulty breathing. During the panic attacks, he had thoughts about dying by suffocation and visions of a terrifying death fighting to breathe. He experienced shaking, sweating, and increased heart rate only during these attacks. He said his fear of suffocation and sense of loss of control were so great that he sometimes wished that he could “get it over with.” The Acute Panic Inventory1–3 (API) score was 25. The Sheehan’s Patient Rated Anxiety Scale4 was 61 indicating significant anxiety, specifically related to panic symptoms, and distress.