Hyperventilation Syndrome Follow-up

  • Author: Brian Kern, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Dec 7, 2010
 

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.

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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]

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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.

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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).

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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.

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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.

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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, Detroit Receiving Hospital, Wayne State University School of Medicine

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.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Paul Blackburn, DO, FACOEP, FACEP  Attending Physician, Department of Emergency Medicine, Maricopa Medical Center

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.

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, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

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.

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.

References

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