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Cited by 75Asthma and respiratory diseasesRespiratory and Cough-Related ResearchPsychosomatic Disorders and Their Treatments

Hyperventilation and asymptomatic chronic asthma

Open access
Osborne, C A·2000·Thorax
DOI 10.1136/thorax.55.12.1016PMC PMC1745650
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Abstract

BACKGROUND: We have consistently argued that mild asthma is an important underlying aetiological factor in patients with severe symptomatic hyperventilation. While hyperventilation has been demonstrated in acute asthma, there have been few studies in mild chronic asthma, and mechanisms are uncertain. METHODS: Twenty three currently asymptomatic chronically asthmatic patients (occasional use of bronchodilators, normal lung function, hyperresponsive to methacholine) were studied and 17 matched normal subjects acted as controls. Ventilation, pattern of breathing, arterial carbon dioxide and oxygen tensions (PaCO(2), PaO(2)), end tidal PCO(2) (PETCO(2)), standard lung function, airway responsiveness to methacholine, airway inflammation assessed by eosinophils in induced sputum, and psychiatric morbidity (Spielberger STAI-Y and Beck Depression Inventory) were measured. RESULTS: Despite the absence of current asthmatic symptoms, no clinical evidence of hyperventilation, and normal lung function in the patients with asthma, PaCO(2) and PETCO(2) were significantly (p<0.01) lower in the patients than in the control group (mean (SD) PaCO(2) 4.96 (0.43) kPa for patients versus 5.27 (0.38) kPa for controls (mean difference 0.31 kPa, 95% confidence interval (CI) 0.06 to 0.56, p<0.02)). PETCO(2) was very similar to PaCO(2) in both groups (mean (SD) PETCO(2) 4.89 (0.47) kPa for the patients and 5.28 (0.40) for the controls (mean difference 0.39 kPa, 95% CI 0.12 to 0.66, p<0.01)). There was no significant difference in ventilation or respiratory pattern between the two groups. The reduced PaCO(2) in the asthmatic patients correlated significantly with the concentration of methacholine provoking a fall in FEV(1) of more than 20% (PC(20)) (r = 0.56, p<0.01) but not with any aspect of lung function, eosinophil count, or anxiety/depression. CONCLUSION: Mild asymptomatic asthma is not associated with clinically significant hyperventilation but is associated with a significant reduction in both arterial and end tidal PCO(2) which relates to airway hyperresponsiveness rather than to the degree of airway obstruction or mucosal inflammation. Anxiety and depression appear not to be implicated.

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  • Other suggested methods of diagnosis include the SEBQ, end-tidal carbon dioxide measurement, breath holding time, and MARM.

    “Other suggested methods of diagnosis include other questionnaires such as the Self Evaluation of Breathing Questionnaire (SEBQ), end-tidal carbon dioxide measurement”

    From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [29]

    The Psychiatric assessment section reports measuring end-tidal PCO₂, and the Discussion says those measurements accurately reflected arterial PCO₂ in patients with mild or moderate asthma. The paper does not suggest the SEBQ, breath-holding time, or MARM as diagnostic methods; its questionnaires were the STAI and BDI. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • MARM has been shown to have good inter-examiner reliability and is consistent with older and more complex methods such as RIP, which has limitations when posture is slumped.

    “It has been shown to have good inter-examiner reliability and is consistent with older and more complex methods such as respiratory induction plethysmography (RIP), which has limitations when posture is slumped [29].”

    From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [29]

    The methods passage (Psychiatric assessment; page unavailable) describes measuring breathing with a pneumotachograph and capnograph, while the Discussion addresses agreement between end-tidal and arterial PCO₂. Searches for MARM, inter-examiner reliability, RIP, and slumped posture found no passage addressing the attributed comparison or posture limitation. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Authors
Osborne, C. A.
Affiliations
King's College London (GB)
Corresponding author
Osborne, C A
Venue
Thorax
Publisher
BMJ
Published
2000-12-01
Volume
55
Issue
12
Pages
1016-1022
ISSN
0040-6376 (ISSN-L)
DOI
10.1136/thorax.55.12.1016
PMC
PMC1745650
OpenAlex
W2073669569
Cited by
75
References
1
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 1 · 2021: 3 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 3 · 2015: 1 · 2014: 7 · 2013: 3 · 2012: 7
FWCI
1.43
Type
journal article
Language
en
Open access
Locations
  • Thorax (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
Wellcome Trust
Topics
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
hyperventilation, asymptomatic asthma, arterial carbon dioxide, end-tidal carbon dioxide, methacholine responsiveness, airway hyperresponsiveness, eosinophils, induced sputum, anxiety, depression, breathing pattern
MeSH terms
Adolescent, Adult, Asthma, Carbon Dioxide, Chronic Disease, Female, Humans, Hyperventilation, Male, Partial Pressure, Severity of Illness Index, Respiratory Mechanics, Case-Control Studies

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