How is hyperventilation treated?

From the Guidelines

Hyperventilation should be treated by addressing the underlying cause and monitoring oxygen saturation, while avoiding dangerous practices like rebreathing from a paper bag. The treatment approach involves slowing down breathing to increase carbon dioxide levels, which can be achieved through techniques like breathing into cupped hands. According to the BTS guideline for oxygen use in adults in healthcare and emergency settings 1, patients with a definite diagnosis of hyperventilation should have their oxygen saturation monitored, and those with normal or high SpO2 do not require oxygen therapy.

Key considerations in treating hyperventilation include:

• Identifying and treating underlying conditions like anxiety disorders, asthma, or pulmonary diseases
• Using relaxation techniques such as progressive muscle relaxation, guided imagery, or mindfulness meditation to reduce anxiety
• Considering cognitive behavioral therapy (CBT) for recurring episodes to address psychological factors
• Prescribing medications like benzodiazepines or SSRIs for anxiety management, and beta-blockers for physical symptoms, as needed. However, the most recent and highest quality study on hyperventilation treatment, which is the BTS guideline 1, does not recommend specific medications but emphasizes the importance of monitoring and addressing underlying causes.

It's essential to prioritize the patient's safety and well-being, and the BTS guideline's recommendation to avoid rebreathing from a paper bag as a treatment for hyperventilation should be strictly followed 1. The study on CSA-HCSB 1 provides insight into the mechanisms of hyperventilation in certain conditions but does not directly inform the treatment approach for hyperventilation in general. Therefore, the treatment should focus on the principles outlined in the BTS guideline 1.

From the Research

Definition of Hyperventilation

• Hyperventilation is defined as breathing in excess of the metabolic needs of the body, eliminating more carbon dioxide than is produced, and, consequently, resulting in respiratory alkalosis and an elevated blood pH 2.
• The traditional definition of hyperventilation syndrome describes "a syndrome, characterized by a variety of somatic symptoms induced by physiologically inappropriate hyperventilation and usually reproduced by voluntary hyperventilation" 2.

Treatment of Hyperventilation

• The therapeutic approach to hyperventilation syndrome has several stages and/or degrees of intervention: psychological counselling, physiotherapy and relaxation, and finally drug therapy 2.
• Breathing exercises, such as breathing control, diaphragmatic breathing, yoga breathing, Buteyko breathing, biofeedback-guided breathing modification, and yawn/sigh suppression, may be used to treat hyperventilation syndrome 3.
• Relaxation techniques, such as relaxation therapy, may also be used in conjunction with breathing exercises to treat hyperventilation syndrome 3.

Effectiveness of Breathing Exercises

• There is limited evidence on the effectiveness of breathing exercises for treating hyperventilation syndrome, with only one small, poorly reported randomized controlled trial (RCT) available 3.
• The RCT found a significant reduction in the frequency and severity of hyperventilation attacks in the breathing exercise group compared with the control group, but the results are unable to inform clinical practice due to the poor quality of the study 3.
• Further well-designed clinical trials are needed to determine the effectiveness of breathing exercises for treating hyperventilation syndrome 3.

Diagnosis of Hyperventilation

• The diagnosis of hyperventilation syndrome should be based on three elements: 1) the patient should hyperventilate and have low Pa,CO2, 2) somatic diseases causing hyperventilation should have been excluded, and 3) the patient should have a number of complaints which are, or have been, related to the hypocapnia 2.
• The detection of signs of (possible) dysregulation of breathing leading to hypocapnia is the main approach to diagnosis 2.

Relationship between Hyperventilation and Anxiety

• Hyperventilation has numerous theoretical and empirical links to anxiety and panic 4.
• Voluntary hyperventilation (VH) tests have been applied experimentally to understand psychological and physiological mechanisms that produce and maintain anxiety, and therapeutically in the treatment of anxiety disorders 4.