BREATHING TECHNIQUES for HYPERVENTILATION SYNDROME, PANIC ATTACKS and ASTHMA
Anderson B, Ley R (2001) Dyspnea during panic attacks. Behav Modification, 25, 546-54
www.ingenta.com/isis/searching/ExpandTOC/ingenta;jsessionid=62u9ros1m3iss.circus?issue=pubinfobike://sage/j246/2001/00000025/00000004&index=4
a large majority of people with panic attacks suffer dyspnoea
Bastow V (1999) Buteyko method or modulation of breathing pattern: just how different are they in managing hyperventilation? J ACPRC, 32, 29-30
discussion of similarities
Bastow V (2000) Hyperventilation syndrome and physiotherapy a retrospective audit. J ACPRC, 33, 19
audit on the subjective and objective benefits of physiotherapy
Bonn (1984) Enhanced adaptive behavioural response in agoraphobic patients pretreated with breathing retraining. Lancet, 2, 665-9
Bradley D (2007) Hyperventilation Syndrome, Kyle Cathie, London
excellent book for patients
Burton CD (1993) Hyperventilation in patients with recurrent functional symptoms. Br J Gen Pract, 43, 422-5.
Chaitow L, Bradley D (2002) Multidisciplinary Approaches To Breathing Pattern Disorders. Churchill-Livingstone.
osteopathic approach
Chevalier B, Schwartzstein RM (2000) Hyperventilation syndrome: Insights into a puzzling disorder. J Respir Dis, 21(9) 569-574
overview of symptoms and diagnosis, with recommended treatment of breathing retraining and psychological therapy.
Chin K (1997) Hypoxaemia in patients with hyperventilation syndrome. Q J Med, 90, 477-85
qjmed.oupjournals.org/cgi/content/abstract/90/7/477?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1098269428607_81&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=90&firstpage=477&journalcode=qjmed
hypoxaemia of unknown origin may indicate HVS
Clark DM (1985) Respiratory control as a treatment for panic attacks. J Behav Ther & Exp Psychiat, 16, 23-30.
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V5V-45X008K-43&_user=10&_handle=B-WA-A-A-WW-MsSAYWW-UUW-AUECZZCAVW-AUEBWVCEVW-CYAUAADAE-WW-U&_fmt=summary&_coverDate=03%2F31%2F1985&_rdoc=6&_orig=browse&_srch=%23toc%235796%231985%23999839998%23318160!&_cdi=5796&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2eeb02ae0aac84d82f642fbebdad5c32
re-attribution and respiratory control showed substantial reduction in panic attacks within 2 weeks
Cowley (1987) Hyperventilation and panic disorder. Am J Med, 83, 929-37
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TDC-4CMYV65-9N&_user=10&_coverDate=11%2F30%2F1987&_rdoc=1&_fmt=summary&_orig=browse&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=4f91ed3a88e3a20f45360d2143acb51b
50% of patients have both disorders
10% of visits to physicians are related to HVS
David M (1985) Respiratory control as a treatment for panic attacks. J Behavior Ther Exp Psych, 16, 23-30
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V5V-45X008K-43&_user=10&_handle=B-WA-A-A-WW-MsSAYWW-UUW-AUECZZCAVW-AUEBWVCEVW-CYAUAADAE-WW-U&_fmt=summary&_coverDate=03%2F31%2F1985&_rdoc=6&_orig=browse&_srch=%23toc%235796%231985%23999839998%23318160!&_cdi=5796&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2eeb02ae0aac84d82f642fbebdad5c32
long-term reduction in panic attacks achieved by learning to control breathing
DeGuire S et al (1992) Hyperventilation syndrome and the assessment of treatment for functional cardiac symptoms. Am J Cardiol, 70, 673-77.
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T10-4CMB3VT-6H&_user=10&_handle=B-WA-A-A-BU-MsSAYVA-UUA-AUECDCAUDD-AUEBBBAYDD-CYACBDWDC-BU-U&_fmt=summary&_coverDate=09%2F01%2F1992&_rdoc=20&_orig=browse&_srch=%23toc%234876%231992%23999299993%23505549!&_cdi=4876&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=63e4e6cb1484d2d8c3371e49ee77bae1
up to 90% of noncardiac chest pain is thought to be associated with HVS
Demeter SL (1986) Hyperventilation syndrome and asthma. Am J Med, 81, 989-94
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TDC-4CHHHCR-9&_user=10&_handle=B-WA-A-A-CE-MsSAYZW-UUW-AUECZZDEVV-AUEBWVYDVV-CYAUWECEA-CE-U&_fmt=summary&_coverDate=12%2F31%2F1986&_rdoc=9&_orig=browse&_srch=%23toc%235195%231986%23999189993%23503936!&_cdi=5195&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=6eb4e3257610d22f6f50f7676cd415c0
asthma has been identified in 80% of patients with HVS
Duncan SR (1987) Hyperventilation syndrome. Hosp Med, 23, 6, 86-98
ECG changes - non-specific ST-segment and T-wave changes
Enzer (1967) Hyperventilation syndrome in childhood. J Peds, 70, 521-32
Folgering H (1999) The pathophysiology of hyperventilation syndrome. Monaldi Arch Chest Dis, 54(4) 365-72
mechanism and diagnosis, with recommended treatment of counselling and physiotherapy.
Fontana GA (2010) Downregulation of cough by exercise and voluntary hyperpnea. Lung, 188, 95 (suppl.)
Gardner BN (2004) Hyperventilation. Am J Respir Crit Care Med, 170, 2, 105 - 106.
ajrccm.atsjournals.org/cgi/content/full/170/2/105
overview of possible mechanisms of HVS
Gardner WN (1996) The pathophysiology of HVS. Chest, 109, 516-30
www.chestjournal.org/cgi/reprint/109/2/516.pdf
Gardner WN, Meah MS, Bass C (1986) Controlled study of respiratory responses during prolonged measurement in patients with chronic hyperventilation. Lancet; ii: 826830.
end-tidal CO2 can be halved with only a 10% increase in ventilation
Garssen B (1983) Agoraphobia and the hyperventilation syndrome. Behav Res Ther, 21, 643-9
60% agoraphobic patients have HVS, and 60% HVS of patients are agoraphobic
Gibson D, Bruton A, Lewith GT, Mullee M (2007) Effects of acupuncture as a treatment for hyperventilation syndrome: a pilot, randomized crossover trial. J Alt Complem Med, 13(1) 39-46
acupuncture can reduce anxiety and symptoms.
Gilbert C (1999) Hyperventilation and the body. Acc Emerg Nurs, 7, 130-40
Gilbert C (1999) Breathing and the cardiovascular system. J Body Movement Ther, 3, 215-24
Grossman P (1985) A controlled study of a breathing therapy treatment of HVS. J Psychosom Res, 29, 49-58
breathing retraining improves ventilatory and psychological symptoms
Hammo A-H (1999) Exercise-induced hyperventilation: a pseudoasthma syndrome. Ann Allergy Asthma Immunol, 82, 574-8
chest discomfort during exercise may be HVS, but may be misdiagnosed as exercise-induced asthma
Han JN (1996) Influence of breathing therapy on complaints, anxiety and breathing pattern in HVS. J Psychosom Res, 41, 481-93
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8V-3W31839-R&_coverDate=11%2F30%2F1996&_alid=194937701&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=5096&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=3f8b8055ba943372a2c6891ece654578
outcome of breathing retraining - improved Nijmegen questionnaire
Han J, Zhu Y, Li S (2008) The language of medically unexplained dyspnea. Chest, 133, 4, 961-8
Hira HS, Singh A (2009) Significance of upper airway influence among patients of vocal cord dysfunction for its diagnosis: Role of impulse oscillometry. Lung India, 26(1): 58
ukpmc.ac.uk/articlerender.cgi?artid=1973255
Holloway EA, West RJ (2007) Integrated breathing and relaxation training for adults with asthma in primary care: a randomised controlled trial. Thorax, 62, 1039-1042
thorax.bmj.com/cgi/content/abstract/62/12/1039?ijkey=f93f44ad0a05ebac7aa027b4f3882932c2aa9d73&keytype2=tf_ipsecsha
breathing retraining and relaxation ameliorates respiratory symptoms, dysfunctional breathing and adverse mood
Humphriss RL, Baguley DM, Andersson G, Wagstaff S (2004) Hyperventilation in the vestibular clinic: use of the Nijmegen Questionnaire. Clin Otolaryng Allied Sciences, 29(3) 232-7
23% of patients seen for vestibular assessment are diagnosed with HVS
the Nijmegen Questionnaire is quick and easy to administer
Jack S, Rossiter, HB, Pearson MG (2004) Ventilatory responses to inhaled carbon dioxide, hypoxia, and exercise in idiopathic hyperventilation. Am J Respir Crit Care Med, 170, 11-125.
ajrccm.atsjournals.org/cgi/content/abstract/170/2/118?ijkey=94fb809a4f5fcfaa0992e30d7d0d6d694e189eb6&keytype2=tf_ipsecsha
people with HVS show a sustained hyperventilatory drive
HV is maintained during exercise, at the resting CO2 "setpoint."
breath-hold tolerance is attenuated
dyspnoea during exercise is greater than normal and not ascribable to high ventilation.
Kraft AR (1984) The hyperventilation syndrome. Br J Psych, 145, 538-42.
relaxation and breathing re-training are the most effective treatments
Malmberg LP, Tamminen K (2000) Orthostatic increase of respiratory gas exchange in hyperventilation syndrome. Thorax, 55, 295-301
thorax.bmjjournals.com/cgi/content/full/55/4/295?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1093112215522_1622&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=55&firstpage=295&resourcetype=1,2,3,4,10&journalcode=thoraxjnl
when changing from supine to standing, people with HVS have an accentuated increase in ventilation
Maskell N (1999) The value of an intensive physiotherapy course in patients with hyperventilation. ALA/ATS conference, California p.832.
physiotherapy leads to a near-doubling of breath-holding times
McGarvey LPA, Ing AJ (2004) Idiopathic cough, prevalence and underlying mechanisms. Pulm Pharmacol Ther, 17, 435-9
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McHugh P, Aitcheson F, Duncan B (2003) Buteyko breathing technique for asthma. NZ Med J, 116, 1187, 1-7
www.nzma.org.nz/journal/116-1187/710/
active group had exercises promoting hypoventilation steroids by 50% & β2-agonists by 85%.
control group had relaxation and education - β2-agonist by 37%
Meuret AE (2003) Breathing training for treating panic disorder: useful intervention or impediment? Behavior Modification, 27, 5, 731-54
literature review
Meuret AE, Wilhelm FH, Roth WT (2001) Respiratory biofeedback-assisted therapy in panic disorder. Behav Mod, 25, 584-605
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panic symptoms reduced by increasing self-monitored ETCO2 using handheld capnometry
Morice AH (1998) Asthma Update, 56, 44-8.
includes identifying hyperventilation syndrome
Oh TH, Stueve MH, Hoskin TL (2010) Brief interdisciplinary treatment program for fibromyalgia: six to twelve months outcome. Am J Phys Med Rehabil, 89, 2, 115-124.
Osborne CA, OConnor BJ, Lewis A (2000) Hyperventilation and asymptomatic chronic asthma. Thorax, 55:101622
thorax.bmj.com/cgi/content/abstract/55/12/1016
mild asthma is associated with reduced arterial and end tidal PCO2.
Pappa LA (1993) Carbon dioxide hypersensitivity, hyperventilation, and panic disorder. Am J Psychiatry, 150, 49-57
breathing retraining may block a full-blown panic attack
Paulley JW (1990) Hyperventilation. Recenti Progressi Medicina, 82, 9, 594-10
Pitman A (2004) Hyperventilation syndrome. Pulse, 64, 43, 52-8
Pearson MG (2007) Breathing exercises for asthma: panacea or placebo? Thorax, 62, 1033-4.
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explanation of the mechanism of hyperventilation and symptoms - hypocapnia, alkalosis, altered levels of ionised calcium, nerve conduction speeds and smooth muscle control, especially of the vessels supplying the brain and heart; reduction in cerebral blood flow by 40%, leads to symptoms such as faintness, dizziness, chest tightness/discomfort and paraesthesia, especially of the hands.
Powell P, Bentall RP, Nye FJ (2001) Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome. BMJ, 322, 387-8.
education and graded exercise leads to substantial improvement
Ringsberg MC (1999) Presence of hyperventilation in patients with asthma-like symptoms but negative asthma test responses. J Allergy Clin Immunol, 103, 601-8
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Sakakibara M (1996) Effect of slowed respiration on cardiac parasympathetic response to threat. Psychosom Med, 58, 32-7
www.psychosomaticmedicine.org/cgi/content/abstract/58/1/32
slowing the breath reduces anxiety and panic attacks
Settergren G Angdin M, Astudillo R (1998) Decreased pulmonary vascular resistance during nasal breathing: modulation by endogenous nitric oxide from the paranasal sinuses. Acta Physiolog Scand, 163, 3, S1-S29
cat.inist.fr/?aModele=afficheN&cpsidt=2379639
nose-breathing releases NO which reduces pulmonary vascular resistance
Singh J (2001) Management of hyperventilation. ACPRC Journal, 34, 50-5
symptoms, mechanism, evidence for physiotherapy, Buteyko
Stanescu, DC, Nemery B, Veriter C, Marechal C (1981) Pattern of breathing and ventilatory response to CO2 in subjects practicing hatha-yoga. J Appl Physiol, 51, 1625-1629.
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yoga reduces the ventilatory response to CO2
Strohl KP, Thomas AJ (1998) Breathlessness, anxiety, and respiratory physiology
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www.psychosomaticmedicine.org/cgi/reprint/60/6/680.pdf
early childhood experiences may modulate respiratory drive
there is a 2- or 3 or 4-fold variation in respiratory drive in otherwise healthy people
panic attacks can partly be explained by the suffocation false alarm theory.
Thomas S (2004) Buteyko: a useful tool in the management of asthma? Internat J Ther Rehab, 11, 10, 476-9
evidence to support strategies aimed at reducing total ventilation
Thomas M, McKinley RK, Freeman E (2003) Breathing retraining for dysfunctional breathing in asthma. Thorax, 58,110-15
thorax.bmjjournals.com/cgi/content/full/58/2/110#R19
asthmatics with HVS symptoms show improved quality of life following physiotherapy
Thomas M (2001) Prevalence of dysfunctional breathing in patients treated for asthma in primary care. BMJ, 322, 1098-1100
bmj.bmjjournals.com/cgi/content/abstract/322/7294/1098?ijkey=3fba1671edb4e808321c7f7a567d72e0d71e031e&keytype2=tf_ipsecsha
a third of women and a fifth of men with asthma score over 23 on Nijmegen Questionnaire
Timmons BH, Ley R (1994) Behavioral and Psychological Approaches to Breathing Disorders. Plenum Press, London
Trooster T (1997) Peripheral muscle weakness and deconditioning commonly occur in patients with HVS. Eur Resp J, 10, 72s
Tweeddale PM, Rowbottom I, McHardy GJR (1994) Breathing retraining. J Psychosom Res, 38, 11-21
Tweeddale PM, Rowbottom I, McHardy GJR (1994) Breathing retraining: effect on anxiety and depression scores in behavioural breathlessness. J Psychosom Res, 38, 11-21
3-14 weeks of treatment improves symptoms, capnography, anxiety and depression
Vertigan AE (2007) Chronic cough: Behaviour modification therapies for chronic cough Chr Respir Dis, 4, 89-97
Van den Berg AE (2010) Green space as a buffer between stressful life events and health. Soc Sci Med, 70, 8, 1203-1210
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evidence of the benefits of green space being available locally
Warburton CJ, Jack S (2006) Can you diagnose hyperventilation? Chronic Respir Dis, 3, 3, 113-115
Walusinski O (2010) The Mystery of Yawning in Physiology and Disease. Karger. ISBN: 978-3-8055-9404-2
Watkin G (2008) Improvement in health status following outpatient chest physiotherapy for patients with refractory chronic cough (poster) Thorax.
Williams (2000) Audit of hyperventilation syndrome. ACPRC Conference poster
reduced Nijmegen scores and HAD scores in all patients after two sessions and a phone call
ACPRC = Association of Chartered Physiotherapists in Respiratory Care
ALA = American Lung Association
ATS = American Thoracic Society
ETCO2 = end-tidal CO2 (related to PaCO2)
HAD = Hospital anxiety and depression
HVS = hyperventilation syndrome
MI = myocardial infarct
Nijmegen Questionnaire = diagnostic for HVS
NO = nitric oxide