Influence of breathing therapy on complaints, anxiety and breathing pattern in patients with hyperventilation syndrome and anxiety disorders

The effect of breathing therapy was evaluated in patients with hyperventilation syndrome (HVS). The diagnosis of HVS was based on the presence of several suggestive complaints occurring in the context of stress, and reproduced by voluntary hyperventilation. Organic diseases as a cause of the symptoms were excluded. Most of these patients met the criteria for an anxiety disorder. The therapy was conducted in the following sequence: (1) brief, voluntary hyperventilation to reproduce the complaints in daily life: (2) reattribution of the cause of the symptoms to hyperventilation: (3) explaining the rationale of therapy-reduction of hyperventilation by acquiring an abdominal breathing pattern, with slowing down of expiration: and (4) breathing retraining for 2 to 3 months by a physiotherapist. After breathing therapy, the sum scores of the Nijmegen Questionnaire were markedly reduced. Improvements were registered in 10 of the 16 complaints of the questionnaire. The level of anxiety evaluated by means of the State-Trait Anxiety Inventory (STAI) decreased slightly. The breathing pattern was modified significantly after breathing retraining. Mean values of inspiration and expiration time and tidal volume increased, but end-tidal CO2 concentration (FETCO2) was not significantly modified except in the group of younger women (< or = 28 years). A canonical correlation analysis relating the changes of the various complaints to the modifications of breathing variables showed that the improvement of the complaints was correlated mainly with the slowing down of breathing frequency. The favorable influence of breathing retraining on complaints thus appeared to be a consequence of its influence primarily on breathing frequency, rather than on FETCO2.

Attenuation of hypercapnic carbon dioxide chemosensitivity after postinfarction exercise training: possible contribution to the improvement in exercise hyperventilation

OBJECTIVE

To elucidate the responsible mechanisms of increased slope of minute ventilation relative to carbon dioxide production (VE/VCO(2)) during exercise after acute myocardial infarction without overt signs of heart failure, patients who had an acute myocardial infarction were examined after participating in a three month supervised exercise training programme.

DESIGN

Exercise testing, hypercapnic CO(2) chemosensitivity measurement (rebreathing method), and pulmonary function test were repeated at entry and after three months in 50 acute myocardial infarction patients with neither symptoms nor signs of heart failure who completed the training programme. Ten patients who performed initial inhospital training served as controls.

RESULTS

Age, peak oxygen uptake, left ventricular ejection fraction, CO(2) chemosensitivity, respiratory parameters (percentage of predicted normal vital capacity (%VC), forced expiratory volume in one second, and carbon monoxide transfer factor (%TLCO)) were all significantly correlated with VE/VCO(2) slope. Multivariate regression analysis showed that age (beta = 0.29, p = 0.01), %TLCO (beta = -0.27, p = 0.01), and CO(2) chemosensitivity (beta = 0.49, p < 0.001) were independent determinants of VE/VCO(2) slope. After three months, there was no significant change in these parameters in the control group. Peak oxygen uptake, %TLCO, and %VC and attenuation in CO(2) chemosensitivity increased significantly in the training group. The VE/VCO(2) slope decreased marginally (p = 0.11). The changes in VE/VCO(2) slope were correlated only with those in CO(2) chemosensitivity (r = 0.50, p < 0.001).

CONCLUSION

After acute myocardial infarction, exercise hyperventilation is seen in association with aging, enhanced hypercapnic CO(2) chemosensitivity, and reduced TLCO, even in the absence of overt heart failure. The correlation of VE/VCO(2) attenuation after training with the reduction in CO(2) chemosensitivity suggests that exercise training may reduce increased VE/VCO(2) slope, at least partially by reducing CO(2) chemosensitivity.

Hyperventilation-induced seizures in mentally impaired children

Two children with profound development delay and medically intractable seizures were found to have hyperventilation-induced seizures. Following detection of this precipitating factor the parents, teachers and caretakers were taught to modify the childrens' breathing when they began to hyperventilate. In both patients this technique resulted in a dramatic decrease in seizure frequency.

[Hyperventilation syndrome: evaluation of voluntary hypoventilation programs in two rehabilitation centers]

PURPOSE

The effectiveness of a voluntary hypoventilation technique was assessed in two rehabilitation centers in patients with hyperventilation syndrome.

METHODS

In the first center, 55 patients participated in an open program determining themselves the frequency and number of their consultations. In the second center 158 patients participated in a 10-week program that imposed five 60-min sessions.

RESULTS

In the first center, the patients participated in 4.8 30-min sessions over a 6.1 week period. Their cardinal complaints had declined by 48% (range 14% to 67% depending on the type of complaint) at the end of the program. In the second center the patients experienced an improvement in their comfort of life (less sleep disorders, fatigability, symptoms of severe hypocapnia), increasingly so with each new session, those having completed the program reaching a 62% improvement.

DISCUSSION

Due to the strong correlation observed between the clinical improvement (with a longer interval between acute episodes) and the quality of patient participation the beneficial effect of these voluntary hypoventilation rehabilitation programs cannot be attributed solely to the psychological effect of patient care.

[Hyperventilation syndrome and dysfunctional breathing : update]

Dysfunctional breathing is a group of respiratory disorders that cause dyspnea, with no organic cause, or that are disproportionate to the organ involvement. Hyperventilation syndrome is the best-known manifestation of dysfunctional breathing. It is very often associated or secondary to anxiety disorders. When the diagnosis of dysfunctional breathing is not considered, it can lead to multiple and unnecessary investigations, further increasing anxiety. The diagnosis is based on various tests, none of which is really specific, and remains based on a bundle of arguments. Management must be adapted for each patient and is based on respiratory rehabilitation techniques.

The grey area of effort syndrome and hyperventilation: from Thomas Lewis to today

Lewis used the diagnosis 'effort syndrome' for subjects whose ability to make and sustain effort had been reduced by homeostatic failure. A major element was depletion of the body's capacity for buffering the acids produced by exercise. In his view this systems disorder was not to be regarded as a specific organ disease, and losing sight of the metabolic element would foster the invention of fanciful, unphysiological diagnoses. His views were dismissed because normal resting plasma bicarbonate levels were considered by others in that era to exclude serious depletion of the body's total capacity for buffering the effects of exertion. Today, effort syndrome is still a useful diagnosis for a condition of exhaustion and failure of performance associated with depletion of the body's buffering systems. Other elements associated with homeostatic failure are now recognised, principally emotional hyperarousal and hyperventilation. Their physiological interrelationships are described. Effort syndrome is amenable to recovery through rehabilitation, and it may be a mistake to treat chronic fatigue syndrome and unspecific illness without including it in the differential diagnosis.