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Cited by 0Psychosomatic Disorders and Their TreatmentsRespiratory and Cough-Related ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Physiotherapy Education and Breathing Retraining for Patients With Hyperventilation Syndrome: An Observational Study

Open access
Beaumont, Marc, Selleron, Bertrand, Passard, Gregoire, Karsandi, Kamber, Proffit, Mathilde, Valentin, Rémi, Poncin, William·2026·Physiotherapy Canada
DOI 10.3138/ptc-2024-0066PMC PMC13641797
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Abstract

Purpose: The hyperventilation syndrome (HVS) is a dysfunctional breathing disorder with significant consequences on quality of life. HVS treatment involves an educational approach and breathing exercises. Although better understanding of HVS is needed, it is also relevant to provide evidence of HVS physiotherapy treatment efficiency. This study aimed to assess the effects of respiratory physiotherapy in HVS patients. Method: Patients referred by a physician to a physiotherapist for HVS-related symptoms were included in this prospective observational study. They received six respiratory physiotherapy sessions (1/wk) composed of therapeutic education and breathing exercises. The primary objective was to assess the pre-post change on HVS symptoms, using the Nijmegen Questionnaire, between baseline and 5 weeks. Secondary objectives assessed anxiety, depression, dyspnoea, quality of life, and respiratory rate at 5 weeks. Results: Of 46 patients, 42 were analyzed. Compared to baseline, after 5 weeks, anxiety, dyspnoea, respiratory rate, and most quality of life subscores significantly improved. The Nijmegen score decreased by 11.6 points ( p < 0.001) and this decrease was maintained after 3 months. Conclusions: HVS symptoms have significantly decreased while anxiety, depression, dyspnoea, and quality of life substantially improved after six respiratory physiotherapy sessions.

AI snapshot

Written from the paper’s full text.

TL;DR

In this prospective observational pre–post study, six weekly respiratory physiotherapy sessions combining therapeutic education and breathing exercises significantly reduced hyperventilation syndrome symptoms in adults referred for HVS. The Nijmegen score fell by 11.6 points at 5 weeks and the improvement was maintained at 3 months.

Key findings

  • The primary outcome, Nijmegen Questionnaire score, decreased by 11.6 points (95% CI 9.5, 13.7; p < 0.001) from baseline to 5 weeks; 29 of 42 participants remaining at day 35 had a score ≤22.
  • After the education-only first session, Nijmegen score improved by −5.1 points (95% CI −8.1, −2.0; p < 0.001); between the first session and day 35 it improved by −6.6 points (95% CI −9.2, −3.9; p < 0.001), and there was no significant change between end of programme and 3 months (−0.3 points; 95% CI −3.4, 2.9; p > 0.99).
  • Secondary outcomes improved: HADS anxiety decreased by 1.9 points (95% CI 1.0, 3.0; p < 0.001), D-12 total dyspnoea decreased by 8.8 points (95% CI 6.8, 10.8; p < 0.001), and median respiratory rate decreased from 16.5 to 12.5 breaths/min (p < 0.001). HADS depression did not significantly improve (median 6.0 to 5.0; p = 0.08).
  • Most SF-36 quality-of-life subscores improved, including mental component score (40.4 to 47.1; p < 0.001), but physical component score (p = 0.46), bodily pain (p = 0.18), and general health perceptions (p = 0.25) did not.

Methods

  • Prospective observational pre–post intervention study in two private physiotherapy clinics in France (Nice and Saint-Jean-de-la-Ruelle), October 2021–September 2022; adults >18 years consecutively referred by a physician for HVS were included after nonopposition, excluding chronic respiratory diseases, inability to complete questionnaires, guardianship/trusteeship, or refusal.
  • Participants received six 30-minute respiratory physiotherapy sessions once weekly over 5 weeks: session 1 was education-only; sessions 2–6 included therapeutic education and breathing exercises targeting reduced respiratory rate/tidal volume, nasal breathing, abdominal breathing, and integration into daily life.
  • Outcomes included Nijmegen Questionnaire (primary at 5 weeks; also day 7 and day 90), HADS, D-12, SF-36, and respiratory rate. Analysis used SPSS 27 with paired t-test or Wilcoxon signed-rank test, repeated-measures ANOVA with Bonferroni correction, and intention-to-treat with last observation carried forward; 46 patients were included and 42 remained at day 35.

Limitations

  • The authors state the study was not randomized, so it could not compare the intervention with natural symptom evolution; HVS diagnosis was not formally ascertained using recommended procedures such as provocation testing; the assessor was not blinded, though the primary outcome was self-reported; breathing depth/tidal volume was not measured; follow-up was limited to 3 months; and no minimal clinically important difference for the Nijmegen score has been established.
  • The text also makes evident that this was a small, predominantly female sample (85% female) from two private clinics, with no control group, so regression to the mean, placebo/attention effects, and limited generalizability cannot be excluded.
  • Quality-of-life findings may be limited by use of the generic SF-36, which the authors note is less responsive than specific tools and has a 4-week recall period within a 5-week study.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3138/ptc-2024-0066

Cites

63 of 63 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

20 of 46 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured

  • Premisecitation
    § Abstract

    In France, the treatment regimen led by a trained physiotherapist is the only therapeutic intervention prescribed to HVS patients.

    “In France, the treatment regimen proposed above and led by a trained physiotherapist is the only therapeutic intervention prescribed to HVS patients.39,40”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [39] Bautin N, 2021, Rev Prat

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [40] Bott J, 2009, Thorax source

      The Level of evidence 1+ Recommendation section recommends breathing retraining as a first-line treatment for hyperventilation syndrome, and the Breathing techniques section describes retraining by a physiotherapist. Neither section says that physiotherapy is the only intervention prescribed or describes prescribing practice in France. Page numbers are unavailable in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Interpretationcitation
    § Discussion

    The coexistence of asthma in the study of Thomas et al. may have reduced the benefits of their educational and breathing programme.

    “However, the coexistence of asthma in the study of Thomas and colleagues may have reduced the benefits of their educational and breathing programme.12”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Dubreuil C, 2012, Rev Mal Respir Actual source

      The References (page unavailable) identify Thomas et al. (2003) as a breathing-retraining study in asthma, supporting the claim that its participants had asthma. The asthma and treatment sections (pages unavailable) do not say that asthma reduced the benefits of Thomas et al.’s programme. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Interpretationreasoning
    § Discussion

    The dysfunctional breathing present in HVS could be modified by respiratory physiotherapy.

    “This result is very interesting because it suggests that the dysfunctional breathing present in HVS11 could be modified by respiratory physiotherapy.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [11] Dubois M, 2016, J Neurosci source

      The Physiological significance section (page unavailable) suggests that dysregulated respiratory-related cortical activity could be involved in idiopathic chronic hyperventilation. It does not say that respiratory physiotherapy could modify the breathing dysfunction. The study’s participants were healthy and unlikely to have chronic hyperventilation syndrome. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
  • Premisecitation
    § Discussion

    Holloway and West did not report a significant difference between groups for quality of life improvement at 6 months.

    “Similarly, Holloway and West62 did not report a significant difference between the groups for quality of life improvement at 6 months.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [62] Holloway EA, 2007, Thorax source
  • Findingown data
    § Discussion

    Dyspnoea was significantly reduced with a mean decrease of −10 points in the D-12 total score.

    “Dyspnoea is significantly reduced with a mean decrease of −10 points in the D-12 total score.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 19
  • May combine two claims. 26
  • The quote only partly states this claim. 1

  • Classified as probably not a substantial claim.

    Premisereasoning
    § Abstract

    There is no recommendation for medical treatment of HVS.

    “Consequently, there is no recommendation for medical treatment of HVS.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [39] Bautin N, 2021, Rev Prat

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [40] Bott J, 2009, Thorax source

      The Level of evidence 1+ Recommendation section recommends breathing retraining as first-line treatment for hyperventilation syndrome. The Breathing techniques section likewise discusses breathing-based treatment, but our copy does not establish that there are no recommendations for medical treatment of HVS. A search for medical and pharmacological treatment found no passage resolving that broader claim. (LLM, conf=0.73)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Abstract

    The treatment of HVS involves an educational approach, exercises for ventilatory control through voluntary hypoventilation, and specific therapeutic elements according to the patient's symptoms, such as exercise training or relaxation.

    “The treatment of HVS involves an educational approach, exercises for ventilatory control through voluntary hypoventilation, as well as specific therapeutic elements, according to the patient's symptoms, such as exercise training or relaxation.9,12,13,27,36,37”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [9] Boulding R, 2016, Eur Respir Rev source

      The Treatment section describes reassurance after diagnosis and breathing retraining, including controlled pauses intended to reduce hyperventilation. It does not describe exercise training or relaxation as symptom-specific HVS treatments; it says no literature exists on pulmonary rehabilitation for dysfunctional breathing. Page numbers are unavailable in our copy. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [12] Dubreuil C, 2012, Rev Mal Respir Actual source
    • cites [13] Gardner WN, 1996, Chest source

  • Classified as probably not a substantial claim.

    Premisecitation
    § Abstract

    In the Cochrane review on breathing exercise training for dysfunctional breathing, the authors conclude that their results are unable to inform clinical practice because there is no evidence regarding the effectiveness of breathing exercises due to lack of studies.

    “In the Cochrane review on breathing exercise training for dysfunctional breathing, the authors conclude that their results are unable to inform clinical practice as, owing to the lack of the studies, there is no evidence regarding the effectiveness of breathing exercises.6”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [6] Jones M, 2013, Cochrane Database Syst Rev source

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisecitation
    § Abstract

    The clinical community acknowledges physiotherapy as an effective treatment for HVS and, more broadly, for chronic dysfunctional breathing.

    “However, the clinical community acknowledge physiotherapy as an effective treatment for HVS and, more broadly, for chronic dysfunctional breathing.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [40] Bott J, 2009, Thorax source

      In the Breathing techniques section, the guideline reports benefits of physiotherapy and breathing retraining for hyperventilation syndrome (HVS); its recommendation section says breathing retraining should be offered as first-line treatment for HVS. It also reports improvement in dysfunctional breathing symptoms in a cohort with asthma, but does not establish physiotherapy as effective for chronic dysfunctional breathing more broadly. Page numbers were not available in our copy. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [9] Boulding R, 2016, Eur Respir Rev source

      The Treatment section says physiotherapy-directed breathing techniques may relieve symptoms and describes follow-up with a respiratory specialist physiotherapist. But the Discussion says most published treatments target HVS, may not work for other breathing patterns, and have not been rigorously tested. The source therefore does not establish physiotherapy as an effective treatment for chronic dysfunctional breathing broadly. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [27] Hornsveld H, 1997, Neth J Med source

  • May combine two claims.

    Premisecitation
    § Methods

    The Nijmegen Questionnaire has a documented cut-off score of 23/64 suggesting a positive diagnosis of HVS, which is widely applied.

    “The cut-off score of 23/64 for the Nijmegen Questionnaire that suggests a positive diagnosis of HVS is documented48,49 and widely applied.50,51”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [48] Vansteenkiste J, 1991, Eur Respir J source
    • cites [49] Van Doorn P, 1983, De Psycholoog

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [50] Ogilvie VL, 2015, N Z J Physiother source

      The Criterion validity section (p. 4) says the 23/64 cut-off is documented and applied in multidisciplinary health settings. However, the Introduction (p. 1) calls a score above 23/64 a positive *screening* result, and the Conclusion (p. 6) recommends interpreting it alongside other clinical assessments when diagnosing HVS. The source therefore supports the documented and applied cut-off, but not treating it alone as a positive diagnosis. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [51] Gilbert C, Chaitow L, Bradley L. Recognizing and treating breathing disorders – a multidisciplinary approach. 2nd ed. London: Churchill Livingstone-Elsevier; 2013. 320 p.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation
    § Discussion

    The D-12 allows assessment of the sensory and emotional components of dyspnoea, which is recommended by international scientific societies for dyspnoea evaluation.

    “D-12,46,58 used in our study, allows the assessment of the sensory and emotional components of dyspnoea, which is recommended by international scientific societies for dyspnea evaluation.59”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [46] Yorke J, 2011, J Asthma Off J Assoc Care Asthma source
    • cites [58] Yorke J, 2010, Thorax source
    • cites [59] Parshall MB, 2012, Am J Respir Crit Care Med source

  • May combine two claims.

    Premisecitation
    § Discussion

    The last Cochrane review conducted in 2013 meta-analyzed the effects of breathing exercises in patients with HVS and refrained from issuing recommendations.

    “Thus, the last Cochrane review conducted in 2013, which meta-analyzed the effects of breathing exercises in patients with HVS6 refrained from issuing recommendations.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [6] Jones M, 2013, Cochrane Database Syst Rev source

      The 2013 Cochrane review evaluated breathing exercises for DB/HVS, and its Implications for practice section explicitly says no clinical recommendations can be made. But it did not meta-analyze effects: the Data synthesis section describes pooling as a plan, while Key results reports only one eligible study with no numerical data. (LLM, conf=0.91)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Around 29% to 64% of asthma patients exhibit HVS.

    “Indeed, around 29% to 64% of asthma patients exhibit HVS,31,54–56”
    Quote in the paperNot a substantial claim2 of 4 sources checked
    • cites [31] Stanton AE, 2008, J Asthma source
    • cites [54] Thomas M, 2001, BMJ source

      The Results report that 29% of respondents with treated asthma scored above the Nijmegen questionnaire threshold, supporting the lower end of the range. The paper does not report 64%, and its Limitations of study section cautions that a positive questionnaire score cannot establish a diagnosis of hyperventilation syndrome (HVS). (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [55] Thomas M, 2005, Prim Care Respir J source

      The Results report positive Nijmegen screening scores in 29% of people diagnosed and treated for asthma, supporting the lower end of the range. The Discussion says the questionnaire was not validated for diagnosing symptomatic hyperventilation in asthmatic populations. Our copy does not report 64% or establish that all patients with positive scores had HVS. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
    • cites [56] Martínez-Moragón E, 2005, Arch Bronconeumol source

  • May combine two claims.

    Study design and conductreasoning
    § Methods

    The study's sample size was justified: assuming an expected average Nijmegen score of 34, aiming to reduce to 23, expected difference 11 points, with SD 21.5, alpha 5%, beta 10%, required 41 patients; to account for 10% missing/withdrawals, 46 patients needed to be included.

    “Assuming an expected average Nijmegen score of 34 among patients with HVS,43 and aiming to reduce the score of these same patients to the normal range (i.e., score of 23), the expected difference was set at 11 points.”
    • Also stated in: § Methods · plain
      “Using a mean difference in pre-intervention and post-intervention scores of 11 points with a standard deviation of 21.5,38,43 for α-error of 5% and a β-error of 10%, the number of patients required was 41. To consider missing data or withdrawals of consent of 10%, a total of 46 patients needed to be included.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [43] Van Dixhoorn J, 2015, ERJ Open Res source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [38] Bruton A, 2018, Lancet Respir Med source

      The citation is attached to the expected average Nijmegen score of 34 among patients with HVS. The Results report a baseline Nijmegen score of 19.2 for this asthma-trial sample, and the Methods > Statistical analysis justify sample size using AQLQ scores, not a Nijmegen score of 34. A search of our copy found no passage establishing the cited estimate for patients with HVS. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Discussion

    In those studies, quality of life improved between the beginning and the end of treatment; quality of life was assessed using specific questionnaires.

    “However, in the latter studies, quality of life improved between the beginning and the end of treatment; quality of life was assessed using specific questionnaires (Saint George questionnaire or asthma quality of life questionnaire).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [61] Bowler SD, 1998, Med J Aust source
    • cites [62] Holloway EA, 2007, Thorax source

  • May combine two claims.

    Findingown data
    § Discussion

    Physical functioning, role limitations due to physical problems, role limitations due to emotional problems, and health transition significantly improved.

    “The other components that significantly improved were physical functioning (PF), role limitations due to physical problems (RP), role limitations due to emotional problems (RE), and health transition (HT).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    After 5 weeks, most SF-36 subscores significantly improved, except the physical component score, bodily pain, and general health perceptions.

    “Regarding the quality of life, most of SF-36 subscores significantly improved, except the physical component score, bodily pain, and general health perceptions.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The physiotherapy programme was delivered consistently across therapists and sessions as instructed.

  • May combine two claims.

    Findingown data
    § Discussion

    The most significant improvement in quality of life concerned the Mental Composite Score (MCS) (+7 points), followed by general mental health (MH) (+3 points), vitality (VT) (+2 points), and social functioning (SF) (+1.3 points).

    “the most significant improvement concerned the psychological component – Mental Composite Score (MCS) (+7 points) followed by general mental health (MH) (+3 points), vitality (VT) (+2 points), and social functioning (SF) (+1.3 points).”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data
    § Results

    After 5 weeks, the respiratory rate, the D-12 total score, and its subscores significantly improved.

    “In brief, the respiratory rate, the D-12 total score, and its subscores significantly improved”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The physiotherapy programme was delivered consistently across therapists and sessions as instructed.

  • May combine two claims.

    Findingown data
    § Conclusion

    In this observational study, HVS symptoms significantly decreased; anxiety-depression, dyspnea, and quality of life significantly improved after 6 respiratory physiotherapy sessions, and clinical improvement was maintained after 3 months.

    “In this observational study, we found that HVS symptoms significantly decreased; anxiety-depression, dyspnea, and quality of life significantly improved after 6 respiratory physiotherapy sessions, and clinical improvement was maintained after 3 months.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Abstract

    Hyperventilation syndrome (HVS) is a dysfunctional breathing disorder characterized by an abnormally rapid and/or deep breathing pattern.

    “Hyperventilation syndrome (HVS) is a dysfunctional breathing disorder characterized by an abnormally rapid and/or deep breathing pattern.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Missri J, 1978, JAMA source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § Methods

    Data were analyzed using an intention-to-treat (ITT) approach, with the last observation carried forward to handle missing data.

    “Data were analyzed using an intention-to-treat (ITT) approach, with the last observation carried forward to handle missing data.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The last observation carried forward adequately handles missing data without biasing the results.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § Methods

    The study was approved by the ethics board on September 10, 2021 (CEPRO 2021-028) and registered on ClinicalTrials.gov (NCT05488301).

    “The study was approved by the ethics board on September 10, 2021 (Institutional Review Board of the French learned society for respiratory medicine – Société de Pneumologie de Langue Française – CEPRO 2021-028) and registered on ClinicalTrials.gov (NCT05488301).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Discussion

    Grossman et al. evaluated the impact of respiratory physiotherapy on anxiety in HVS and found that respiratory physiotherapy significantly decreased the anxiety score.

    “Grossman and colleagues evaluated the impact of respiratory physiotherapy on anxiety in the context of HVS.52 As in our study, the patients included in the study by Grossman and colleagues had initially a high anxiety score, and respiratory physiotherapy significantly decreased this anxiety score.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Grossman P, 1985, J Psychosom Res source

  • May combine two claims.

    Premisecitation
    § Discussion

    The diagnosis of HVS is often based solely on the Nijmegen Questionnaire, which may overestimate its prevalence.

    “even though the diagnosis of HVS is often based solely on the Nijmegen Questionnaire, which may overestimate its prevalence.31”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Stanton AE, 2008, J Asthma source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given
    § Methods

    The research is reported according to the STROBE statement for observational studies.

    “The research is reported according to the STROBE statement for observational studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Results

    Four patients were lost to follow-up.

    “Four patients were lost to follow-up (Figure 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § Discussion

    It is very likely that most patients in the asthma meta-analysis did not present HVS, which may explain the small decrease in the Nijmegen score compared to our study.

    “Therefore, it is very likely that most of their patients did not present HVS, which may explain this small decrease in the Nijmegen score compared to the average decrease obtained in our study.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Results

    46 patients were prospectively included in the study.

    “Between October 2021 and September 2022, 48 patients were referred to the physiotherapy centres, and 46 were prospectively included for this study (2 refusals to participate).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The included patients had HVS despite not all elements of the recommended diagnostic triad being confirmed.

  • May combine two claims.

    Interpretationown data
    § Abstract

    HVS symptoms have significantly decreased while anxiety, depression, dyspnoea, and quality of life substantially improved after six respiratory physiotherapy sessions.

    “HVS symptoms have significantly decreased while anxiety, depression, dyspnoea, and quality of life substantially improved after six respiratory physiotherapy sessions.”
    • Also stated in: § Abstract · plain
      “Hyperventilation symptoms significantly decreased, while anxiety, depression, dyspnoea, and quality of life significantly improved after six respiratory physiotherapy sessions.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed improvements in symptoms and quality of life are attributable to the physiotherapy programme rather than to confounding, natural history, or regression to the mean.
    • Rests on an assumption: The physiotherapy programme was delivered consistently across therapists and sessions as instructed.

  • May combine two claims.

    Premisecitation
    § Discussion

    Grossman et al. (1985) compared breathing exercises to a control group and reported a significant improvement in the intervention group for symptoms and anxiety.

    “the authors reported a significant improvement in the intervention group for symptoms and anxiety compared to the control group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Grossman P, 1985, J Psychosom Res source

  • May combine two claims.

    Premisecitation
    § Discussion

    Thomas et al. conducted an RCT in asthmatic patients with probable HVS; after 1 month there was no significant difference for HVS symptoms, but at 6 months the difference became significant; the decrease in the Nijmegen score in the treated group was −2.5 points.

    “After 1 month, the authors did not find a significant difference for HVS symptoms, but this difference became significant at 6 months. The decrease in the Nijmegen score in the treated group was relatively small (−2.5 points) compared to our results (−11.6 points).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Thomas M, 2003, Thorax source

  • May combine two claims.

    Interpretationreasoning
    § Discussion

    The treatment duration in Thomas et al. was shorter than in our study, which may explain the difference in results between both studies.

    “Besides, the treatment duration in their study was shorter than what was proposed in our study. This may perhaps explain the difference in results obtained between both studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation
    § Discussion

    In our study, we used the generic SF-36, which is considered less responsive in comparison to specific tools.

    “In our study, we used the generic SF-36, which is considered less responsive in comparison to specific tools.63”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [63] Wiebe S, 2003, J Clin Epidemiol source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation
    § Discussion

    These considerations are in line with current knowledge of the impact of rehabilitation on cerebral plasticity and the modification of cortical motor control.

    “These considerations are in line with current knowledge of the impact of rehabilitation on cerebral plasticity and the modification of cortical motor control.65,66”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [65] Levin MF, 2021, Disabil Rehabil source
    • cites [66] Nahum M, 2013 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Discussion

    The assessor was not blinded.

    “Thirdly, the assessor was not blinded”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § Discussion

    The results of this treatment are promising for HVS symptoms, dyspnoea, and quality of life.

    “Therefore, it is relevant to propose breathing exercises and therapeutic education for these patients, as the results of this treatment are promising for HVS symptoms, dyspnoea, and quality of life.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning
    § Discussion

    Education and reassurance included in the intervention could be involved in the modulation of the somatosensory afferences of ventilatory mechanics and the psychophysiological processing of the conscious sensation of ventilation.

    “Moreover, education and reassurance included in the intervention could be involved in this modulation of the somatosensory afferences of ventilatory mechanics and the psychophysiological processing of the conscious sensation of ventilation.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning
    § Discussion

    This study may have clinical implications, even though the results must be viewed with caution due to the observational design.

    “Further on, this study may have clinical implications, even though the results must be viewed with caution due to the observational design.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Discussion

    The study did not measure the depth of breathing.

    “Finally, we did not measure the depth of breathing”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning
    § Discussion

    The questions in the SF-36 refer to sensations over the last 4 weeks, while our study lasted 5 weeks, which may explain the limited evolution of quality of life in our study.

    “Furthermore, the questions in the SF-36 refer to sensations over the last 4 weeks, while our study lasted 5 weeks, which may explain the limited evolution of quality of life in our study.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning
    § Discussion

    The primary outcome (the Nijmegen Questionnaire) was a self-reported questionnaire, which minimizes the limitation of non-blinded assessor.

    “however, our primary outcome (the Nijmegen Questionnaire) was a self-reported questionnaire, which minimizes this limitation.”
    Quote in the paperSubstantial claim
37 of 37

  • The paper relies on this without support.

    The observed improvements in symptoms and quality of life are attributable to the physiotherapy programme rather than to confounding, natural history, or regression to the mean.

    “HVS symptoms have significantly decreased while anxiety, depression, dyspnoea, and quality of life substantially improved after six respiratory physiotherapy sessions.”

  • The paper relies on this without support.

    The included patients had HVS despite not all elements of the recommended diagnostic triad being confirmed.

    “Therefore, in routine practice, patients are sometimes referred to physiotherapy without having all of the elements of the recommended diagnostic triad.”

  • The paper relies on this without support.

    The Nijmegen Questionnaire is responsive to change in HVS symptoms.

    “The primary endpoint was the change in HVS symptoms 5 weeks (day 35) after the first physiotherapy session, as assessed by the Nijmegen Questionnaire.49”

  • The paper relies on this without support.

    The last observation carried forward adequately handles missing data without biasing the results.

    “Data were analyzed using an intention-to-treat (ITT) approach, with the last observation carried forward to handle missing data.”

  • The paper relies on this without support.

    The physiotherapy programme was delivered consistently across therapists and sessions as instructed.

    “physiotherapists were instructed to rely on several operational objectives to guide the adaptation of breathing.”

  • The paper relies on this without support.

    Physiotherapy is recommended as a first-line treatment for HVS.

    “Even though physiotherapy is recommended as a first-line treatment, its modalities are not clearly established.”

  • The paper relies on this without support.

    The modalities of physiotherapy for HVS are not clearly established.

    “Even though physiotherapy is recommended as a first-line treatment, its modalities are not clearly established.”

  • The paper relies on this without support.

    The minimal clinically important difference for the Nijmegen score has not yet been established.

    “Nevertheless, it should be noted that the minimal clinically important difference for the Nijmegen score has not yet been established.”

  • The paper relies on this without support.

    This is the first study evaluating the impact of respiratory physiotherapy on dyspnoea in HVS patients.

    “To our knowledge, this is the first study evaluating the impact of respiratory physiotherapy on dyspnoea in this population.”

  • The paper relies on this without support.

    Breathing exercise is a conscious way of regaining voluntary control of breathing overpassing automatic drive.

    “since breathing exercise is a conscious way of regaining voluntary control of breathing overpassing automatic drive.”

  • The paper relies on this without support.

    This is the only nonpharmacological intervention that can be proposed for HVS patients.

    “However, this is to the best of our knowledge the only nonpharmacological intervention that can be proposed for HVS patients.”

  • The authors state this as an assumption.

    Respiratory exercise modifies the cortical network implied in breathing when awake to restore physiological ventilatory control.

    “to prove our mechanistic assumption that respiratory exercise modifies the cortical network implied in breathing when awake to restore physiological ventilatory control.”
12 of 12

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Three-month follow-up is dated from two different starting points

    Minor

    The study design places the follow-up visit three months after the last session, which occurred on day 35. The outcome-measures section instead places day 90-about three months after baseline-as the follow-up.

  • Depression is described as significantly improved despite a nonsignificant result

    Minor

    The lay summary says depression significantly improved, but Table 1 reports p = 0.08 for the depression subscale. The Results section also states that only the anxiety subscale significantly improved.

  • The number analyzed differs between the abstract and Table 1

    Minor

    The abstract says 42 of 46 patients were analyzed, whereas Table 1 explicitly says its analysis includes all 46 enrolled patients. The paper does not distinguish these counts in the abstract.

  • Day 35 is called the end of five sessions rather than six

    Minor

    The discussion calls day 35 the end of five sessions, but the study schedule identifies day 35 as the sixth session.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 13

  1. Jones M, 2013, Cochrane Database Syst Rev, 2013, CD009041
  2. Dubreuil C, 2012, Rev Mal Respir Actual, 4, 243
  3. Cristina S, 1996, Funct Neurol, 11, 53
  4. Monday J, 1995, Rev Mal Respir, 12, 291
  5. Freeman J, 1987, J R Coll Physicians Lond, 21, 46
  6. Bautin N, 2021, Rev Prat, 35, 166
  7. Van Dixhoorn J, 2015, ERJ Open Res, 1, 00001
  8. Yorke J, 2011, J Asthma Off J Assoc Care Asthma, 48, 602
  9. Van Doorn P, 1983, De Psycholoog, 18, 573
  10. Ogilvie VL, 2015, N Z J Physiother, 43, 3
  11. Gilbert C, Chaitow L, Bradley L. Recognizing and treating breathing disorders – a multidisciplinary approach. 2nd ed. London: Churchill Livingstone-Elsevier; 2013. 320 p.
  12. Santino TA, 2020, Cochrane Database Syst Rev, 3, CD001277
  13. Richard J, 2000, Lausanne : Institut universitaire de médecine sociale et préventive, 28

Related

Authors
Beaumont, M., Selleron, B., Passard, G., Karsandi, K., Proffit, M., Valentin, R., & Poncin, W.
Affiliations
  • Centre Hospitalier Régional Universitaire de Brest (FR)
  • Private Respiratory Physiotherapy Clinic, Saint Jean de la ruelle, France;
  • Private Respiratory Physiotherapy Clinic, Nice, France;
  • Sorbonne Université (FR)
  • UCLouvain (BE)
ORCID
Venue
Physiotherapy Canada
Publisher
University of Toronto Press Inc. (UTPress)
Published
2026-05-31
Volume
78
Issue
2
Pages
190-200
ISSN
  • 0300-0508 (ISSN-L)
  • 1708-8313
DOI
10.3138/ptc-2024-0066
PMC
PMC13641797
OpenAlex
W4411254769
Semantic Scholar
40efd2b28195ab86ddc42151f952309701557a95
Cited by
0
References
52
FWCI
0.00
Type
journal article
Language
en
Open access
Locations
  • Physiotherapy Canada (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
hyperventilation syndrome, respiratory physiotherapy, breathing retraining, dysfunctional breathing, patient education, Nijmegen questionnaire, anxiety, depression, dyspnea, quality of life, respiratory rate

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-23.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-23.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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