BREATHING TECHNIQUES for HYPERVENTILATION SYNDROME, PANIC ATTACKS and ASTHMA
Anderson B, Ley R (2001) Dyspnea during panic attacks. Behav Modification, 25, 546-54
• a large majority of people with panic attacks suffer dyspnoea

Anon (2012) Device diagnosis and combined treatment of hyperventilation syndrome. Ter Arkh; 84(3):28-31
• people with HVS may describe a need for concentration to breathe, while those for asthma may describe a sense of effort
Add:

Barker N, Everard ML (2015) Getting to grips with ‘dysfunctional breathing’. Paed Respir Rev; 16(1):53-61. doi:10.1016/j.prrv.2014.10.001
• high levels of undiagnosed asthma have been found in people presenting to A & E with HVS, while HVS appears to be relatively common in asymptomatic asthmatics
• misdiagnosis of asthma may lead to increasing medication without relief of symptoms
• chest pain can be caused by musculoskeletal imbalance
• people with HVS tend to be high-achieving and perfectionist
• stress can cause the diaphragm to become flattened, hypertonic and relatively immobile
• voluntary control can be exerted over the pattern and rate of respiration, breathing retraining is recognised as the first line treatment for adults
• breathing retraining is recognised as the first line treatment for adults
• breathing retraining can reduce respiratory symptoms, anxiety and depression, and increase quality of life; these improvements are sustained

Barker NJ, Jones M, O'Connell NE et al (2013) Breathing exercises for dysfunctional breathing/hyperventilation syndrome in children. Cochrane Database Syst Rev. Dec 18;12:CD010376

Bastow V (1999) Buteyko method or modulation of breathing pattern: just how different are they in managing hyperventilation? J Association of Chartered Physiotherapists in Respiratory Care, 32, 29-30
• discussion of similarities

Bastow V (2000) Hyperventilation syndrome and physiotherapy – a retrospective audit. J Association of Chartered Physiotherapists in Respiratory Care, 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

Boulding R, Stacey R, Niven R et al (2016) Dysfunctional breathing: a review of the literature and proposal for classification. Eur Respir Rev; 25(141):287-94. doi: 10.1183/16000617.0088-2015
err.ersjournals.com/content/25/141/287.long

Bradley D (2012) Hyperventilation Syndrome. Kyle Cathie, London
• excellent book for patients

Buchholz I (1994) Breathing, voice and movement therapy. Biofeedback & Self Regulation, 19, 2, 141-53

Burton CD (1993) Hyperventilation in patients with recurrent functional symptoms. Br J Gen Pract, 43, 422-5.

Chaitow L, Bradley D, Gilbert C (2014) Recognizing and Treating Breathing Disorders. Churchill-Livingstone.

Chenivesse C, Similowski T, Bautin N et al (2014) Severely impaired health-related quality of life in chronic hyperventilation patients: exploratory data. Respir Med; 108(3):517-23. doi: 10.1016/j.rmed.2013.10.024
www.sciencedirect.com/science/article/pii/S0954611113004393

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
• long-term reduction in panic attacks achieved by learning to control breathing

Courtney R (2009) The functions of breathing and its dysfunctions and their relationship to breathing therapy. Internat J Osteopath Med;12(3):78–85. doi:10.1016/j.ijosm.2009.04.002

Courtney R, Cohen M, van Dixhoorn J (2011) Relationship between dysfunctional breathing patterns and ability to achieve target heart rate variability with features of "coherence" during biofeedback. Altern Ther Health Med; 17(3):38-44.

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

Critchley HD, Nicotra A, Chiesa PA et al (2016) Slow breathing and hypoxic challenge: cardiorespiratory consequences and their central neural substrates.
PLoS One; 10(5): e0127082. doi: 10.1371/journal.pone.0127082
www.ncbi.nlm.nih.gov/pmc/articles/PMC4431729/

D'Alba I, Carloni I, Ferrante AL et al (2015) Hyperventilation syndrome in adolescents with and without asthma. Pediatr Pulmonol; 50(12):1184-90. doi: 10.1002/ppul.23145

Decuyper M, De Bolle M, Boone E et al (2012) The relevance of personality assessment in patients with hyperventilation symptoms. Health Psychol; 31(3):316-22

de Groot EP (2011) Breathing abnormalities in children with breathlessness. Paed Respir Rev; 12(1):83–87. doi:10.1016/j.prrv.2010.09.003

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 identified in 80% of patients with HVS

Denipah N, Dominguez CM, Kraai EP et al (2017) Acute management of paradoxical vocal fold motion (vocal cord dysfunction). Ann Emerg Med; 69(1):18-23

Doumit M, Krishnan U, Jaffι A, Belessis Y (2012) Acid and non-acid reflux during physiotherapy in young children with cystic fibrosis. Pediatr Pulmonol, 47, 2, 119–124
• head-down postural drainage has not been proven to exacerbate reflux.

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

Freire R, Perna G, Nardi AE (2010) Panic disorder respiratory subtype: psychopathology, laboratory challenge tests, and response to treatment. Harv Rev Psychiatry, 18, 220–229

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: 826–830.
• 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.

Grammatopoulou EP, Skordilis EK, Georgoudis G et al (2014) Hyperventilation in asthma: A validation study of the Nijmegen Questionnaire. J Asthma;51(8):839-46. doi: 10.3109/02770903.2014.922190.
www.ncbi.nlm.nih.gov/pubmed/24823322
• the Nijmegen Questionnaire is a valid and reliable questionnaire for screening hyperventilation syndrome in patients with stable mild-to-moderate asthma

Gridina I, Bidat E, Chevallier B et al (2013) Prevalence of chronic hyperventilation syndrome in children and teenagers. Arch Pediatr; 20(3):265-8. doi: 10.1016/j.arcped.2012.12.016

Grossman P (1985) A controlled study of a breathing therapy treatment of hyperventilation syndrome. 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
• 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): 5–8
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

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

Jones M, Harvey A, Marston L, O'Connell NE. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009041. DOI: 10.1002/14651858.CD009041.pub2

Kang BS (2015) A case of hyperventilation syndrome mimicking complex partial seizure: usefulness of EEG monitoring in emergency department. J Epilepsy Res; 5(1):20-22. doi: 10.14581/jer.15005.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4494991/

Kraft AR (1984) The hyperventilation syndrome. Br J Psych, 145, 538-42.
• relaxation and breathing re-training are the most effective treatments

Lung FW, Lee TH, Huang MF (2012) Parental bonding in males with adjustment disorder and hyperventilation syndrome. BMC Psychiatry;12:56.

Matrka L (2014) Paradoxic vocal fold movement disorder. Otolaryngol Clin North Am; 47(1):135-46. doi: 10.1016/j.otc.2013.08.014

McGarvey LPA, Ing AJ (2004) Idiopathic cough, prevalence and underlying mechanisms. Pulm Pharmacol Ther, 17, 435-9
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WPM-4DS6TVN-2&_coverDate=12%2F01%2F2004&_alid=350471042&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=6994&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5a528a631f39b35263f5eb6f917e6dd2

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/

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
www.ingenta.com/isis/searching/ExpandTOC/ingenta;jsessionid=35i4mm2q7qnw2.crescent?issue=pubinfobike://sage/j246/2001/00000025/00000004&index=6
• panic symptoms reduced by increasing self-monitored ETCO2 using handheld capnometry

Morice AH (1998) Asthma Update, 56, 44-8.
• includes identifying hyperventilation syndrome

Munemoto T, Masuda A, Nagai N et al (2013) Prolonged post-hyperventilation apnea in two young adults with hyperventilation syndrome. BioPsychoSocial Med;7:9

Nishino T, Ishikawa T, Nozaki-Taguchi N et al (2012) Lung/chest expansion contributes to generation of pleasantness associated with dyspnoea relief. Resp Physiol Neurobiol, 184, 1, 27–34

Osborne CA, O’Connor BJ, Lewis A (2000) Hyperventilation and asymptomatic chronic asthma. Thorax, 55:1016–22
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

Parasa M, Saheb SM, Vemuri NN (2014) Cramps and tingling: a diagnostic conundrum. Anesthesia, Essays Researches; 8(2):247-249. doi: 10.4103/0259-1162.134524
www.ncbi.nlm.nih.gov/pmc/articles/PMC4173627/

Perri M (2006) Rehabilitation of breathing pattern disorders, in: Rehabilitation of the spine: a practitioner's manual. Lippincott, Williams and Wilkins.

Pitman A (2004) Hyperventilation syndrome. Pulse, 64, 43, 52-8

Pearson MG (2007) Breathing exercises for asthma: panacea or placebo? Thorax, 62, 1033-4.
thorax.bmj.com/cgi/content/extract/62/12/1033?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Pearson&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=62&firstpage=1033&resourcetype=HWCIT
• 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.

Ramirez J-M (2014). The integrative role of the sigh in psychology, physiology, pathology, and neurobiology. Progress in Brain Research; 209:91–129. doi.org/10.1016/B978-0-444-63274-6.00006-0
www.ncbi.nlm.nih.gov/pmc/articles/PMC4427060/

Ristiniemi H, Perski A, Lyskov E et al (2014) Hyperventilation and exhaustion syndrome. Scandinavian J Caring Sciences; 28(4):657-664. doi:10.1111/scs.12090.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4282474/

Sakellari V (1997) Hyperventilation effect on postural sway. Arch Phys Med Rehab, 78, 730-6

Singh J (2001) Management of hyperventilation. ACPRC Journal, 34, 50-5
• symptoms, mechanism, evidence for physiotherapy, Buteyko

Sardinha A, Freire RC, Zin WA et al (2009) Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications. J Bras Pneumol, 35(7):698-708

Schleifer LM, Ley R, Spalding TW (2002) A hyperventilation theory of job stress and musculoskeletal disorders. Am J Ind Med; 41: 420-432. doi: 10.1002/ajim.10061

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.
jap.physiology.org/cgi/content/abstract/51/6/1625
• yoga reduces the ventilatory response to CO2

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

Tomioka S, Enomoto N, Momota Y (2015) Hyperventilation syndrome after general anesthesia. J Anaesthesiol Clin Pharmacol; 31(2):284-5. doi: 10.4103/0970-9185.155219
www.ncbi.nlm.nih.gov/pmc/articles/PMC4411866/

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

Warburton CJ, Jack S (2006) Can you diagnose hyperventilation? Chronic Respir Dis, 3, 3, 113-115
crd.sagepub.com/cgi/reprint/3/3/113


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