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Cited by 118Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychosomatic Disorders and Their TreatmentsNeuroscience of respiration and sleep

Hyperventilation in panic disorder and asthma: Empirical evidence and clinical strategies

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Meuret, Alicia E., Ritz, Thomas·2010·International Journal of Psychophysiology
DOI 10.1016/j.ijpsycho.2010.05.006PMC PMC2937087
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Abstract

Sustained or spontaneous hyperventilation has been associated with a variety of physical symptoms and has been linked to a number of organic illnesses and mental disorders. Theories of panic disorder hold that hyperventilation either produces feared symptoms of hypocapnia or protects against feared suffocation symptoms of hypercapnia. Although the evidence for both theories is inconclusive, findings from observational, experimental, and therapeutic studies suggest an important role of low carbon dioxide (CO2) levels in this disorder. Similarly, hypocapnia and associated hyperpnia are linked to bronchoconstriction, symptom exacerbation, and lower quality of life in patients with asthma. Raising CO2 levels by means of therapeutic capnometry has proven beneficial effects in both disorders, and the reversing of hyperventilation has emerged as a potent mediator for reductions in panic symptom severity and treatment success.

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  • Respiratory abnormalities have been proposed as a key factor in how PD/A develops or persists.

    “Respiratory abnormalities have been postulated as an important factor in the development or maintenance of PD/A (Gorman et al., 1988; Klein, 1993; see Meuret & Ritz, 2010, for a review)”

    From Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions (2012) · cites this paper as Meuret & Ritz, 2010

  • There is an extensive body of research that implicates respiratory processes and particularly hyperventilation in panic disorder.

    “There is an extensive body of research that implicates respiratory processes and particularly hyperventilation in panic disorder [21, 22].”

    From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [21]

  • Hyperventilation syndrome is often difficult to distinguish from asthma and anxiety disorders.

    “The diagnosis is based on the Nijmegen questionnaire only after organic disease has been ruled out or optimally controlled, and is often difficult to distinguish from asthma and anxiety disorders [5, 16, 21].”

    From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [21]

  • The diagnosis of hyperventilation syndrome is based on the Nijmegen questionnaire only after organic disease has been ruled out or optimally controlled.

    “The diagnosis is based on the Nijmegen questionnaire only after organic disease has been ruled out or optimally controlled, and is often difficult to distinguish from asthma and anxiety disorders [5, 16, 21].”

    From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [21]

    Section 1 says that criteria for hyperventilation syndrome were never agreed upon; it does not describe diagnosis using the Nijmegen questionnaire. Searches for the questionnaire and for a requirement to rule out or optimally control organic disease found no passage establishing the claimed diagnostic procedure. The copy has no page numbers for these passages. (LLM, conf=0.72)

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5 of the 192 references couldn’t be matched to a known paper.

Research works printed but not linked: 12

  1. Alexander JK West JR Wood JA Richards DW 1955 Journal of Clinical Investigation 34 511 32 14367506 PMC438656
  2. Alpers HW Wilhelm FH Roth WT 2005 Psychophysiological measures during exposure in driving phobics Journal of Abnormal Psychology 114 126 139 15709819
  3. Jain N Puranik M Lodha R Kabra SK 2001 Long-term management of asthma Indian Journal of Pediatrics 68 Suppl 4 S31 41 11980467
  4. Laffey JG Kavanagh BP 2002 Hypocapnia New England Journal of Medicine 347 43 53 12097540
  5. Magarian GJ 1982 Hyperventilation syndrome: infrequently recognized common expression of anxiety and stress Medicine (Baltimore) 61 219 236 7045570
  6. Meuret AE Gravenstein J Jaffe M Paulus D (in press) Therapeutic use of ambulatory capnography Capnography, Clinical Aspects 2 Cambridge Cambridge University Press
  7. Meuret AE Weiner I Craighead E 2010 Hyperventilation Corsini’s Encyclopedia of Psychology 2 4 John Wiley and Sons
  8. Meuret AE Rosenfield D Zhou E Conrad A Wilhelm FH Roth WT 2010 Cardio- respiratory instabilities precede the onset of naturally-occurring panic attacks Poster presented at the 30th Annual Conference of the Anxiety Disorders Association of America Baltimore, MA March 4-7-15
  9. Roth WT 2008 Translational research for panic disorder Am J Psychiatry 165 796 798 18593782
  10. Roth WT 2010 Diversity of effective treatments of panic attacks: what do they have in common? Depression and Anxiety 27 5 11 20049938
  11. Solway J Barnes PJ Grunstein MM Leff AR Woolcock AJ 1997 Hyperpnea-induced bronchoconstriction Asthma 1121 1134 Lippincott-Raven Philadelphia, PA
  12. Veltman DJ van Zijderveld GA van Dyck R Bakker A 1998 Predictability, controllability, and fear of symptoms of anxiety in epinephrine-induced panic Biological Psychiatry 44 1017 1026 9821566

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Authors
Meuret, A. E., & Ritz, T.
Affiliations
Southern Methodist University (US)
Corresponding author
Meuret, Alicia E.
ORCID
Venue
International Journal of Psychophysiology
Publisher
Elsevier BV
Published
2010-10
Volume
78
Issue
1
Pages
68-79
ISSN
0167-8760 (ISSN-L)
DOI
10.1016/j.ijpsycho.2010.05.006
PMC
PMC2937087
OpenAlex
W2078549137
Cited by
118
References
192
Citations by year
2026: 5 · 2025: 7 · 2024: 9 · 2023: 10 · 2022: 13 · 2021: 9 · 2020: 8 · 2019: 4 · 2018: 6 · 2017: 9 · 2016: 5 · 2015: 2 · 2014: 8 · 2013: 9 · 2012: 8
FWCI
9.21
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • International Journal of Psychophysiology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health/National Heart, Lung and Blood Institute (R01 HL-089761)
  • Beth and Russell Siegelman Foundation (Meuret)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Keywords
hyperventilation, panic disorder, asthma, hypocapnia, hypercapnia, carbon dioxide levels, bronchoconstriction, capnometry, panic symptoms, quality of life
MeSH terms
Asthma, Carbon Dioxide, Humans, Hyperventilation, Panic Disorder, Hypocapnia, Evidence-Based Medicine, Empirical Research

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