eMedicine Specialties > Emergency Medicine > Pulmonary

Hyperventilation Syndrome: Follow-up

Author: Brian Kern, MD, Staff Physician, Department of Emergency Medicine, Wayne State University, Detroit Medical Center
Coauthor(s): Adam J Rosh, MD, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Contributor Information and Disclosures

Updated: Nov 16, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is not indicated, but many patients with chronic hyperventilation syndrome (HVS) are admitted because their symptomatology resembles many serious organic problems and because no simple way to confirm the diagnosis in the ED is available.

Further Outpatient Care

  • Patients should be referred to a consultant psychiatrist, psychologist, or family physician with expertise and interest in managing HVS. Some physiotherapists and respiratory therapists have extensive experience in retraining patients in proper breathing techniques and should be consulted.
  • Patients may also be referred for treatment with acupuncture. This modality is useful in reducing anxiety levels, thereby reducing the severity of symptoms associated with HVS. By reducing anxiety, the frequency of symptomatic periods may also be reduced.7

Inpatient & Outpatient Medications

  • Several medications, including benzodiazepines and SSRIs, are effective in reducing the frequency and the severity of hyperventilation. These agents require prolonged use and are best managed by a consultant on an ongoing outpatient basis rather than through sporadic prescriptions following an ED visit.

Complications

  • Complications are related mainly to invasive procedures and investigations (eg, angiography) that are used in the workup of hyperventilation syndrome. Complications are also a result of symptoms produced indirectly by hyperventilation (eg, injuries sustained in a fall during a syncopal episode due to hyperventilation).

Prognosis

  • Patients with chronic HVS experience multiple exacerbations throughout their lives.
  • Children who experience acute hyperventilation often continue this pattern into adulthood.
  • Many patients have associated disorders (eg, agoraphobia) that may dominate the clinical picture.
  • Management of these underlying disorders affects the course of hyperventilation.
  • Patients who are treated with breathing retraining, stress reduction therapy, and various medications (eg, benzodiazepines, SSRIs) experience significant reductions in the frequency and the severity of exacerbations.

Patient Education

  • Patients should have the underlying pathophysiology explained and should be instructed in the technique of deflating the upper chest followed by controlled diaphragmatic breathing.
  • For excellent patient education resources, visit eMedicine's Anxiety Center. Also, see eMedicine's patient education articles, Anxiety, Panic Attacks, and Hyperventilation.

Miscellaneous

Medicolegal Pitfalls

  • Hyperventilation can be a symptom of serious underlying pathology, including pulmonary embolism, asthma, and other respiratory disorders. The diagnosis of HVS should not be made in patients with a prior history of organic causes for respiratory insufficiency.
  • Particular care must be exercised when considering a diagnosis of HVS in an elderly person or in those with comorbid disease.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Edward J Newton, MD, to the development and writing of this article.



More on Hyperventilation Syndrome

Overview: Hyperventilation Syndrome
Differential Diagnoses & Workup: Hyperventilation Syndrome
Treatment & Medication: Hyperventilation Syndrome
Follow-up: Hyperventilation Syndrome
References
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References

  1. Shu BC, Chang YY, Lee FY, et al. Parental attachment, premorbid personality, and mental health in young males with hyperventilation syndrome. Psychiatry Res. Oct 31 2007;153(2):163-70. [Medline].

  2. Martinez JM, Kent JM, Coplan JD, et al. Respiratory variability in panic disorder. Depress Anxiety. 2001;14(4):232-7. [Medline].

  3. Bartley J. Nasal congestion and hyperventilation syndrome. Am J Rhinol. Nov-Dec 2005;19(6):607-11. [Medline].

  4. Castro PF, Larrain G, Perez O, et al. Chronic hyperventilation syndrome associated with syncope and coronary vasospasm. Am J Med. Jul 2000;109(1):78-80. [Medline].

  5. Ong JR, Hou SW, Shu HT, et al. Diagnostic pitfall: carbon monoxide poisoning mimicking hyperventilation syndrome. Am J Emerg Med. Nov 2005;23(7):903-4. [Medline].

  6. Malmberg LP, Tamminen K, Sovijarvi AR. Orthostatic increase of respiratory gas exchange in hyperventilation syndrome. Thorax. Apr 2000;55(4):295-301. [Medline].

  7. Gibson D, Bruton A, Lewith GT, et al. Effects of acupuncture as a treatment for hyperventilation syndrome: a pilot, randomized crossover trial. J Altern Complement Med. Jan-Feb 2007;13(1):39-46. [Medline].

  8. Blau JN, Wiles CM, Solomon FS. Unilateral somatic symptoms due to hyperventilation. Br Med J (Clin Res Ed). Apr 2 1983;286(6371):1108. [Medline].

  9. Callaham M. Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Ann Emerg Med. Jun 1989;18(6):622-8. [Medline].

  10. DeGuire S, Gevirtz R, Hawkinson D, et al. Breathing retraining: a three-year follow-up study of treatment for hyperventilation syndrome and associated functional cardiac symptoms. Biofeedback Self Regul. Jun 1996;21(2):191-8. [Medline].

  11. Evans RW. Neurologic aspects of hyperventilation syndrome. Semin Neurol. Jun 1995;15(2):115-25. [Medline].

  12. Folgering H. The pathophysiology of hyperventilation syndrome. Monaldi Arch Chest Dis. Aug 1999;54(4):365-72. [Medline].

  13. Gardner WN. The pathophysiology of hyperventilation disorders. Chest. Feb 1996;109(2):516-34. [Medline].

  14. Han JN, Stegen K, Schepers R, et al. Subjective symptoms and breathing pattern at rest and following hyperventilation in anxiety and somatoform disorders. J Psychosom Res. Dec 1998;45(6):519-32. [Medline].

  15. Hornsveld H, Garssen B. The low specificity of the Hyperventilation Provocation Test. J Psychosom Res. Nov 1996;41(5):435-49. [Medline].

  16. Innocente DM. Hyperventilation syndrome. Thorax. Sep 2001;56(9):740. [Medline].

  17. Lum LC. Hyperventilation syndromes in medicine and psychiatry: a review. J R Soc Med. Apr 1987;80(4):229-31. [Medline].

  18. Papp LA, Klein DF, Gorman JM. Carbon dioxide hypersensitivity, hyperventilation, and panic disorder. Am J Psychiatry. Aug 1993;150(8):1149-57. [Medline].

  19. Sullivan GM, Kent JM, Kleber M, et al. Effects of hyperventilation on heart rate and QT variability in panic disorder pre- and post-treatment. Psychiatry Res. Jan 30 2004;125(1):29-39. [Medline].

  20. Tavel ME. Hyperventilation syndrome--hiding behind pseudonyms?. Chest. Jun 1990;97(6):1285-8. [Medline].

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Further Reading

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Contributor Information and Disclosures

Author

Brian Kern, MD, Staff Physician, Department of Emergency Medicine, Wayne State University, Detroit Medical Center
Brian Kern, MD is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robin R Hemphill, MD, MPH, Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University
Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Paul Blackburn, DO, FACOEP, FACEP, Program Director, Department of Emergency Medicine, Maricopa Medical Center; Assistant Professor, Department of Surgery, University of Arizona
Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

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