The low specificity of the Hyperventilation Provocation Test
Abstract
The Hyperventilation Provocation Test (HVPT) has become a routine procedure in the diagnosis of hyperventilation syndrome (HVS). During an HVPT the patient voluntarily overbreathes for several minutes to produce hypocapnia. The test is considered positive if the induced symptoms are recognized by the patient as similar to those experienced in daily life. The present study tests the assumption that hypocapnia is the primary trigger for symptoms during an HVPT. In a randomized double-blind crossover design. 115 patients suspected of HVS and 40 healthy controls performed an HVPT and a placebo test (PT, isocapnic overbreathing). The HVPT induced more symptoms than the PT, especially more neuromuscular symptoms, cerebral symptoms, paresthesias, and temperature sensations. However, the absolute difference between the number of symptoms induced by the HVPT and PT was small. In patients, the PT induced 66% of symptoms induced by the HVPT. In the control group this percentage was 60%. The low specificity of the HVPT implies that symptom recognition during the HVPT is invalid as a diagnostic criterion for HVS.
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Associated symptoms in dysfunctional breathing may be attributable to hyperventilation and respiratory alkalosis but are not specific to dysfunctional breathing.
“The key symptom in dysfunctional breathing is breathlessness after organic causes have been ruled out, but associated symptoms may be attributable to hyperventilation (increased minute ventilation) and respiratory alkalosis (e.g. tingling, tetany and numbness), but these are not specific to dysfunctional breathing [7].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [7]
The key symptom in dysfunctional breathing is breathlessness after organic causes have been ruled out.
“The key symptom in dysfunctional breathing is breathlessness after organic causes have been ruled out, but associated symptoms may be attributable to hyperventilation (increased minute ventilation) and respiratory alkalosis (e.g. tingling, tetany and numbness), but these are not specific to dysfunctional breathing [7].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [7]
Cites
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Beyond attentional strategies: a cognitive-perceptual model of somatic interpretation
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Self-citationBreathing retraining: A rational placebo?
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Dysfunctional breathing: a review of the literature and proposal for classification
Boulding, R., Stacey, R., Niven, R., & Fowler, S. J. (2016) · European Respiratory Review · doi:10.1183/16000617.0088-2015 · Cited by 372 · see citing works
Hyperventilation syndrome: A chimera?
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Hyperventilation syndrome: an elegant but scientifically untenable concept
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- Authors
- Hornsveld, H., & Garssen, B.
- Affiliations
- Slotervaartziekenhuis (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Hornsveld, Hellen
- ORCID
- Garssen, Bert
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 1996-11
- Volume
- 41
- Issue
- 5
- Pages
- 435-449
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2136760991
- Cited by
- 34
- References
- 6
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 5 · 2021: 1 · 2020: 1 · 2019: 2 · 2016: 1 · 2015: 1 · 2014: 3 · 2013: 2 · 2012: 1
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
- Keywords
- hyperventilation syndrome, hypocapnia, placebo tests, symptom induction, diagnostic specificity, neuromuscular symptoms, paresthesia, symptom recognition
- MeSH terms
- Adult, Animals, Carbon Dioxide, Double-Blind Method, Humans, Hyperventilation, Male, Maximal Expiratory Flow Rate, Psychophysiologic Disorders, Surveys and Questionnaires, Respiratory Function Tests, Hypocapnia, Cross-Over Studies
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