Abstract
Hyperventilation-induced hypocapnia is common among asthma patients. This case study illustrates both methodology and results from a patient undergoing training in capnometry-assisted respiratory training (CART). CART is a 4-week training aimed at normalizing basal and acute levels of end-tidal carbon dioxide (PCO2) using a portable capnometer. In the presented case, basal levels of PCO2 increased from hypocapnic to normocapnic range over the course of treatment. Improvements were accompanied by improvements in lung function and reductions in diurnal lung function variability. Improvements remained stable throughout follow-up.
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Notes
The TIDAL WAVE® Sp uses the CAPNOSTAT® CO2 sensor which passes an infrared light beam through the gas sample. The CO2 concentration of the sample is directly related to the specific wavelength of infrared light energy absorbed by the CO2 molecules. A photodetector measures the remaining light energy not absorbed by the sample and compares that to the infrared source thus measuring the CO2 concentration of the sample. End tidal CO2 is calculated continuously on a breath by breath basis.
Name and identifying information were altered or removed for anonymity.
References
Ayala, E. S., Meuret, A. E., & Ritz, T. (2010). Confrontation with blood and disgust stimuli precipitates respiratory dysregulation in blood-injury-injection phobia. Biological Psychology, 84, 87–97.
Bass, C., & Gardner, W. N. (1985). Respiratory and psychiatric abnormalities in chronic symptomatic hyperventilation. British Medical Journal, 290, 1387–1390.
Boezen, H. M., Schouten, J. P., Postma, D. S., & Rijcken, B. (1994). Distribution of peak expiratory flow variability by age, gender and smoking habits in a random population sample aged 20–70 yrs. The European Respiratory Journal, 7, 1814–1820.
Bowler, S. D., Green, A., & Mitchell, C. A. (1998). Buteyko breathing techniques in asthma: A blinded randomised controlled trial. The Medical Journal of Australia, 169, 575–578.
Braman, S. S. (2006). The global burden of asthma. Chest, 130, 4S–12S.
Bruton, A., & Holgate, S. T. (2005). Hypocapnia and asthma: A mechanism for breathing retraining? Chest, 127, 1808–1811.
Butler, J., Caro, C. G., Alcala, R., & Dubois, A. B. (1960). Physiological factors affecting airway resistance in normal subjects and in patients with obstructive respiratory disease. The Journal of Clinical Investigation, 39, 584–591.
Cooper, S., Oborne, J., Newton, S., Harrison, V., Thompson Coon, J., Lewis, S., et al. (2003). Effects of two breathing exercises (buteyko and pranayama) in asthma: A randomized controlled trial. Thorax, 58, 674–679.
Fried, R. (1993). The psychology of physiology of breathing. New York: Plenum Press.
Gardner, W. N. (1996). The pathophysiology of hyperventilation disorders. Chest, 109, 516–534.
Girodo, M., Ekstrand, K. A., & Metivier, G. J. (1992). Deep diaphragmatic breathing: Rehabilitation exercises for the asthmatic patient. Archives of Physical Medicine and Rehabilitation, 73, 717–720.
Jack, S., Rossiter, H. B., Pearson, M. G., Ward, S. A., Warburton, C. J., & Whipp, B. J. (2004). Ventilatory responses to inhaled carbon dioxide, hypoxia, and exercise in idiopathic hyperventilation. American Journal of Respiratory and Critical Care Medicine, 170, 118–125.
Katzman, M. A., Struzik, L., Vijay, N., Coonerty-Femiano, A., Mahamed, S., & Duffin, J. (2002). Central and peripheral chemoreflexes in panic disorder. Psychiatry Research, 113, 181–192.
Kinsman, R. A., Luparello, T., O’Banion, K., & Spector, S. (1973). Multidimensional analysis of the subjective symptomatology of asthma. Psychosomatic Medicine, 35, 250–267.
Lehrer, P. M., Vaschillo, E., Vaschillo, B., Lu, S. E., Scardella, A., Siddique, M., et al. (2004). Biofeedback treatment for asthma. Chest, 126, 352–361.
Meuret, A. E., & Ritz, T. (2010). Hypocapnia in anxiety and respiratory disease: Empirical evidence and clinical strategies. International Journal of Psychophysiology, 78, 68–79.
Meuret, A. E., Ritz, T., Wilhelm, F., & Roth, W. T. (2007). Targeting PCO2 in asthma: Pilot evaluation of a capnometry-assisted breathing training. Applied Psychophysiology and Biofeedback, 32, 99–109.
Meuret, A. E., Rosenfield, D., Hofmann, S. G., Suvak, M. K., & Roth, W. T. (2009). Changes in respiration mediate changes in fear of bodily sensations in panic disorder. Journal of Psychiatric Research, 43, 634–641.
Meuret, A. E., Rosenfield, D., Seidel, A., Bhaskara, L., & Hofmann, S. G. (2010). Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity. Journal of Consulting and Clinical Psychology, 78, 691–704.
Meuret, A. E., Wilhelm, F. H., Ritz, T., & Roth, W. T. (2003). Breathing training for treating panic disorder. Useful intervention or impediment? Behavior Modification, 27, 731–754.
Meuret, A. E., Wilhelm, F. H., Ritz, T., & Roth, W. T. (2008). Feedback of end-tidal PCO2 as a therapeutic approach for panic disorder. Journal of Psychiatric Research, 42, 560–568.
Meuret, A. E., Wilhelm, F. H., & Roth, W. T. (2001). Respiratory biofeedback-assisted therapy in panic disorder. Behavior Modification, 25, 584–605.
Nathan, R. A., Sorkness, C. A., Kosinski, M., Schatz, M., Li, J. T., Marcus, P., et al. (2004). Development of the asthma control test: A survey for assessing asthma control. American Academy of Allergy, Asthma and Immunology, 113, 59–65.
National Heart, Lung, and Blood Institute (NHLBI). (2007). National Asthma Education and Prevention Program. Expert panel report 3: Guidelines for the diagnosis and management of asthma (NIH Publication No. 07-4051). U.S. Department of Health and Human Services, National Institutes of Health (NIH). Retrieved from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf.
National Heart, Lung, and Blood Institute (NHLBI). (2009). Morbidity & mortality: 2009 chart book on cardiovascular, lung and blood diseases. U. S. Department of Health and Human Services, National Institute of Health. Available at: http://www.nhlbi.nih.gov/resources/docs/2009_ChartBook.pdf.
Newhouse, M. T., Becklake, M. R., Macklem, P. T., & McGregor, M. (1964). Effect of alterations in end-tidal CO2 tension on flow resistance. Journal of Applied Physiology, 19, 745–749.
Oakes, D. F. (1996). Clinical practitioner’s pocket guide to respiratory care (4th ed.). Old Town, MN: Health Educator Publications Inc.
O’Cain, C. F., Hensley, M. J., McFadden, E. R., Jr., & Ingram, R. H., Jr. (1979). Pattern and mechanism of airway response to hypocapnia in normal subjects. Journal of Applied Physiology, 47, 8–12.
Osborne, C. A., O’Connor, B. J., Lewis, A., Kanabar, V., & Gardner, W. N. (2000). Hyperventilation and asymptomatic chronic asthma. Thorax, 55, 1016–1022.
Rafferty, G., Saisch, S., & Gardner, W. (1992). Relation of hypocapnic symptoms to rate of fall of end-tidal PCO2 in normal subjects. Respiratory Medicine, 86, 335–340.
Ritz, T., Dahme, B., & Roth, W. T. (2004). Behavioral interventions in asthma biofeedback techniques. Journal of Psychosomatic Research, 56, 711–720.
Ritz, T., Meuret, A. E., Wilhelm, F., & Roth, W. T. (2003). End-tidal PCO2 levels in asthma patients in the laboratory and at home. Biological Psychology, 62, 233–234.
Ritz, T., Meuret, A. E., Wilhelm, F., & Roth, W. T. (2009). Changes in PCO2, symptoms, and lung function of asthma patients during capnometry-assisted breathing training. Applied Psychophysiology and Biofeedback, 34, 1–6.
Ritz, T., Rosenfield, D., Meuret, A. E., Bobb, C., & Steptoe, A. (2008). Hyperventilation symptoms are linked to a lower perceived health in asthma patients. Annals of Behavioral Medicine, 35, 97–104.
Slader, C., Reddel, H., Spencer, L., Belousova, E., Armour, C., Bosnic-Anticevich, S., et al. (2006). Double blind randomised controlled trial of two different breathing techniques in the management of asthma. Thorax, 61, 651–656.
Stalmatski, A. (1997). Freedom from asthma: Buteyko’s revolutionary treatment. London: Kyle Cathie.
Thomas, M., McKinley, R. K., Freeman, E., & Foy, C. (2001). Prevalence of dysfunctional breathing in patients treated for asthma in primary care: Cross sectional survey. British Medical Journal, 322, 1098–1100.
Thomas, M., McKinley, R. K., Freeman, E., Foy, C., & Price, D. (2005). The prevalence of dysfunctional breathing in adults in the community with and without asthma. Primary Care Respiratory Journal, 14, 78–82.
Thomas, M., McKinley, R. K., Freeman, E., Foy, C., Prodger, P., & Price, D. (2003). Breathing retraining for dysfunctional breathing in asthma: A randomised controlled trial. Thorax, 58, 110–115.
Thomas, M., McKinley, R. K., Mellor, S., Watkin, G., Holloway, E., Scullion, J., et al. (2009). Breathing exercises for asthma: A randomized controlled trial. Thorax, 64, 55–61.
van den Elshout, F. J., van Herwaarden, C. L., & Folgering, H. T. (1991). Effects of hypercapnia and hypocapnia on respiratory resistance in normal and asthmatic subjects. Thorax, 46, 28–32.
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This research was supported by grant 5R01HL89761 from the National Heart, Lung, and Blood Institute. There are no conflicts of interest to report.
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Jeter, A.M., Kim, H.C., Simon, E. et al. Hypoventilation Training for Asthma: A Case Illustration. Appl Psychophysiol Biofeedback 37, 63–72 (2012). https://doi.org/10.1007/s10484-011-9178-6
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DOI: https://doi.org/10.1007/s10484-011-9178-6