The pathophysiology of hyperventilation disorders

Chest

Volumn 109, Issue 2, 1996, Pages 516-534

  Gardner, William N ^a  

^a KING'S COLLEGE LONDON   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ACID BASE BALANCE; ARTERIAL CARBON DIOXIDE TENSION; CEREBROSPINAL FLUID; HUMAN; HYPERVENTILATION; LUNG ALVEOLUS CARBON DIOXIDE TENSION; PATHOPHYSIOLOGY; PRIORITY JOURNAL; RESPIRATION CONTROL; REVIEW;

EID: 0030045349     PISSN: 00123692     EISSN: None     Source Type: Journal    
DOI: 10.1378/chest.109.2.516     Document Type: Review

References (221)

1. Lewis T, Cotton C, Barcroft J, et al. Breathlessness in soldiers suffering from irritable heart. BMJ 1916; 2:517-19
2. Soley MH, Shock NW. The etiology of effort syndrome. Am J Med Sci 1938; 196:840-51
3. Guttmann E, Jones M. Hyperventilation and the effort syndrome. BMJ 1940; 2:736-39
4. Wood P. Da Costa's syndrome. BMJ 1941; 1:767-72
5. White PD. The soldier's irritable heart. JAMA 1942; 118:270-71
6. Friedman M. Studies concerning the etiology and pathogenesis of neurocirculatory asthenia. Am Heart J 1945; 30:557-66
7. Kerr WJ, Gliebe PA, Dalton JW. Physical phenomomena associated with anxiety states: the hyperventilation syndrome. Cal West Med 1938; 48:12-6
8. Rice RL. Symptom patterns of the hyperventilation syndrome. Am J Med 1950; 8:691-700
9. Lewis BI. Chronic hyperventilation syndrome. JAMA 1954; 155:1204-08
10. Ames F. The hyperventilation syndrome. J Ment Sci 1955; 101:466-525
11. Lewis BI. Hyperventilation syndrome: a clinical and physiological evaluation. Cal Med 1959; 91:121-26
12. Hardonk HJ, Beumer HM. Hyperventilation syndrome. In: Vinken PJ, Bruyn GW, eds. Handbook of neurology (vol 38). Amsterdam: North Holland Biomedical Press, 1979; 309-60
13. Magarian GJ. Hyperventilation syndromes: infrequently recognized common expressions of anxiety and stress. Medicine 1982; 61:219-36
14. Brashear RE. Hyperventilation syndrome. Lung 1983; 161: 257-73
15. Lum LC. Hyperventilation syndromes in medicine and psychiatry: a review. J Soc Med 1987; 80:229-31
16. Gardner WN, Bass C. Invited review: hyperventilation in clinical practice. Br J Hosp Med 1989; 41:73-81
17. Tavel ME. Hyperventilation syndrome - hiding behind pseudonyms? Chest 1990; 97:1285-88
18. Fried R. The psychology and physiology of breathing in behavioural medicine, clinical psychology, and psychiatry. New York: Plenum Publishers, 1993
19. Lewis RA, Howell JBL. Definition of the hyperventilation syndrome. Bull Eur Physiopathol Respir 1986; 22:201-05
20. Gardner WN. Hyperventilation disorders. J R Sot Med 1990; 83:755-57
21. Lewis BI. The hyperventilation syndrome. Ann Intern Med 1953; 38:918-27
22. Bass C, Gardner WN. Respiratory and psychiatric abnormalities in chronic symptomatic hyperventilation. BMJ 1985; 290: 1387-90
23. Lum LC. The syndrome of habitual chronic hyperventilation. Rec Adv Psychosom Med 1976; 3:196-229
24. Stoop A, de Boo T, Lemmens W, et al. Hyperventilation syndrome: measurement of objective symptoms and subjective complaints. Respiration 1986; 49:37-44
25. 2 in patients with hyperventilation syndrome. Bull Eur Physiopathol Respir 1978; 14:503-12
26. Dent R, Yates D, Higenbottam T. Does the hyperventilation syndrome exist [abstract]. Thorax 1983; 38:223
27. 2 and in arterial pH. In: Cherniack NS, Widdicombe JG, Fishman AP, eds. Handbook of physiology: section 3: the respiratory system (volume 2-control of breathing, pt 2). Bethesda, Md: American Physiological Society, 1986: 475-528
28. Howell JBL. Behavioural breathlessness. Thorax 1990; 45:287-92
29. 2-drucks und anpassung der lungenventilation an den Stoffwechsel als leistungen eines regelsystems. Klin Wochenschr 1960; 38:366-76
30. Saltzman HA, Heyman A, Sieker HO. Correlation of clinical and physiologic manifestations of sustained hyperventilation. N Engl J Med 1963; 268:1431-36
31. Gardner WN, Meah MS, Bass C. Controlled study of respiratory responses during prolonged measurement in patients with chronic hyperventilation. Lancet 1986; 2:826-30
32. Fahri LE. Gas stores of the body. In: Fenn WO, Rahn H, eds. Handbook of physiology: section 3: respiration (vol 1). Washington, DC: American Physiological Society, 1964; 873-85
33. 2 during forced breathing. Biochem J 1927; 21:823-30
34. Brassfield CR, Behrmann VG. A correlation of the pH of arterial blood and urine as affected by changes in pulmonary ventilation. Am J Physiol 1941; 132:272-80
35. Brown EBJ. Physiological effects of hyperventilation. Physiol Rev 1953; 33:445-70
36. Arbus GS, Hebert LA, Levesque PR, et al. Characterization and clinical application of the 'significance band' for acute respiratory alkalosis. N Engl J Med 1969; 280:117-23
37. Siesjo BK, Kjallquist A. Invited review: a new theory for the regulation of the extracellular pH in the brain. Scand J Clin Lab Invest 1969; 24:1-9
38. Krapf R, Beeler I, Hertner D, et al. Chronic respiratory alkalosis: the effect of sustained hyperventilation on renal regulation of acid-base equilibrium. N Engl J Med 1991; 324:1394-1401
39. Gennari FJ, Goldstein MB, Schwartz WB. The nature of the renal adaptation to chronic hypocapnia. J Clin Invest 1972; 51:1722-30
40. Severinghaus JW, Mitchell RA, Richardson BW, et al. Respiratory control at high altitude suggesting active transport regulation of CSF pH. J Appl Physiol 1963; 18:1155-66
41. Forwand SA, Landowne M, Follansbee JN, et al. Effect of acetazolamide on acute mountain sickness. N Engl J Med 1968; 279:839-45
42. Houston CS, Riley RL. Respiratory and circulatory changes during acclimatization to high altitude. Am J Physiol 1947; 149:565-88
43. Dempsey JA, Forster HV, Gledhill N, et al. Effects of moderate hypoxemia and hypocapnia on CSF [H+] and ventilation in man. J Appl Physiol 1975; 38:665-74
44. Chiodi H. Respiratory adaptations to chronic high altitude hypoxia. J Appl Physiol 1957; 10:81-7
45. Asmussen E, Nielsen M. Physiological dead space and alveolar gas pressures at rest and during muscular exercise. Acta Physiol Scand 1956; 38:1-21
46. Phillips JR, Eldridge FL. Respiratory myoclonus (Leeuwenhoek's disease). N Engl J Med 1973; 289:1390-95
47. 2 of conscious man. Respir Physiol 1966; 1:206-10
48. 2 response: usefulness and uncertainties. Eur Respir J 1993; 6:611-13
49. Nielson M, Smith H. Studies on the regulation of respiration in acute hypoxia. Acta Physiol Scand 1952; 24:293-313
50. 2 in chronically hyperventilating man. Am Rev Respir Dis 1988; 137(suppl 4):A409
51. 2. J Appl Physiol 1982; 52:287-94
52. Duffin J, McAvoy GV. The peripheral-chemoreceptor threshold to carbon dioxide in man. J Physiol 1988; 406:15-26
53. 2 stimulus threshold for carotid chemoreceptors and breathing. Respir Physiol 1978; 34:359-75
54. Eldridge FL. Post hyperventilation breathing and different effect of active and passive hyperventilation. J Appl Physiol 1973; 34:422-30
55. Datta AK, Shea SA, Horner RL, et al. The influence of induced hypocapnia and sleep on the endogenous respiratory rhythm in humans. J Physiol 1991; 440:17-33
56. Skatrud JB, Henke KG, Dempsey J. A sleep-induced apneic threshold. In: Progress in clinical and biological research: sleep and respiration (vol 345). Chichester, NY: Wiley-Liss, 1990; 191-200
57. Douglas CG, Haldane JS. The causes of periodic or Cheyne-Stokes breathing. J Physiol 1909; 38:401-19
58. Bainton CR, Mitchell RA. Posthyperventilation apnea in awake man. J Appl Physiol 1966; 21:411-15
59. de Backer WA, Heyrman RM, Wittesaele WM, et al. Ventilation and breathing patterns during hemodialysis-induced carbon dioxide unloading. Am Rev Respir Dis 1987; 136:406-10
60. Tawadrous FD, Eldridge FL. Posthyperventilation breathing patterns after active hyperventilation in man. J Appl Physiol 1974; 37:353-56
61. 2 tension. J Appl Physiol 1983; 54:809-13
62. Cummin ARC, Sidhu VS, Telford RJ, et al. Ventilatory responsiveness to carbon dioxide below the normal control point in concious normoxic humans. Eur Respir J 1992; 5:512-16
63. Jennet S, Russel T, Warnock KA. The duration of inspiration during changing states of ventilation in man. J Physiol 1974: 238:54P-5P
64. Skatrud JB, Dempsey JA. Interaction of sleep state and chemical stimuli in sustaining rhythmic ventilation. J Appl Physiol 1983; 55:813-22
65. Meah MS, Gardner WN. Post-hyperventilation apnea in conscious humans. J Physiol 1994; 477:527-38
66. Wagner PC, Eldridge FL. Development of short term potentiation of respiration. Respir Physiol 1991; 83:129-40
67. Haldane JS, Poulton EP. The effects of want of oxygen on respiration. J Physiol 1908; 37:390-407
68. Goldman A. Clinical tetany by forced respiration. JAMA 1922; 78:1193-95
69. Tucker WI. Hyperventilation in differential diagnosis. Med Clin North Am 1963; 47:491-97
70. van Dixhoorn J, Duivenvoorden HJ. Efficacy of Nijmegen questionnaire in recognition of the hyperventilation syndrome. J Psychosom Res 1985; 29:199-206
71. Grossman P, de Swart JCG. Diagnosis of hyperventilation syndrome on the basis of reported complaints. J Psychosom Res 1984; 28:97-104
72. Lindsay S, Saqi S, Bass C. The test-retest reliability of the hyperventilation provocation test. J Psychosom Res 1991; 35:155-62
73. Hornsveld H, Garssen B, Dop MF, et al. Symptom reporting during voluntary hyperventilation and mental load: implications for diagnosing hyperventilation syndrome. J Psychosom Res 1990; 34:687-97
74. Roll M, Zetterquist S. Acute chest pain without obvious organic cause before the age of 40 years: response to forced hyperventilation. J Intern Med 1990; 228:223-27
75. 2 in normal subjects. Respir Med 1992; 86:335-40
76. Macefield G, Burke D. Paraesthesiae and tetany induced by voluntary hyperventilation: increased excitability of human cutaneous and motor axons. Brain 1991; 114:527-40
77. Kugelberg E. Activation of human nerves by hyperventilation and hypocalcemia: neurologic mechanism of symptoms of irritation in tetany. Arch Neurol Psych 1948; 60:153-64
78. Mostellar ME, Turtle EP. Effects of alkalosis on plasma concentration and urinary excretion of inorganic phosphate in man. J Clin Invest 1964; 43:138-49
79. Kreisberg RA. Phosphorus deficiency and hypophosphatemia. Hosp Pract 1977; 12:121-28
80. Brautbar N, Leibovici H, Finander P, et al. Mechanisms of hypophosphatemia during acute hyperventilation. Clin Res 1980; 28:387A
81. Perkins GD, Joseph R. Neurological manifestations of the hyperventilation syndrome. J R Soc Med 1986; 79:448-50
82. Allen TE, Agus B. Hyperventilation leading to hallucinations. Am J Psych 1968; 125:632-37
83. Tavel ME. Hyperventilation syndrome with unilateral somatic symptoms. JAMA 1964; 187:301-03
84. Blau JN, Wiles CM. Unilateral somatic symptoms due to hyperventilation. BMJ 1983; 286:1108
85. O'Sullivan G, Harvey I, Bass C, et al. Psychophysiological investigations of patients with unilateral symptoms in the hyperventilation syndrome. Br J Psychiatry 1992; 160:664-67
86. Kety SS, Schmidt CF. The effects of active and passive hyperventilation on cerebral blood flow, cerebral oxygen consumption, cardiac output, and blood pressure of normal young men. J Clin Invest 1946; 25:107-19
87. Raichle ME, Posner JB, Plum F. Cerebral blood flow during and after hyperventilation. Arch Neurol 1970; 23:394-403
88. Plum F, Posner JB. Blood and cerebrospinal fluid lactate during hyperventilation. Am J Physiol 1967; 212:864-70
89. Mountz JM, Modell JC, Wilson MW, et al. Positron emission tomographic evaluation of cerebral blood flow during state anxiety in simple phobia: 141st annual meeting of the American Psychiatric Association (1988, Montreal, Canada). Arch Gen Psychiatry 1989; 46:501-04
90. 2-breathing measured transcutaneously in humans by a bidirectional, pulsed, ultrasound Doppler blood velocity meter. Acta Physiol Scand 1980; 110:167-73
91. Raichle ME, Plum F. Hyperventilation and cerebral blood flow. Stroke 1972; 3:566-75
92. Gotoh F, Meyer JS, Takagi Y. Cerebral effects of hyperventilation in man. Arch Neurol 1965; 12:410-23
93. Burnum JF, Hickam JB, McIntosh HD. The effect of hypocapnia on arterial blood pressure. Circulation 1954; 9:89-95
94. McGregor M, Donevan RE, Anderson NM. Influence of carbon dioxide and hyperventilation on cardiac output in man. J Appl Physiol 1962; 17:933-37
95. Kontos HA, Richardson DW, Raper AJ, et al. Mechanisms of action of hypocapnic alkalosis on limb blood vessels in man and dog. Am J Physiol 1972; 223:1296-1307
96. Richardson DW, Kontos HA, Raper AJ, et al. Systemic circulatory responses to hypocapnia in man. Am J Physiol 1972; 223:1308-12
97. Cruz JC, Cerretelli P, Farhi LE. Role of ventilation in maintaining cardiac output under positive-pressure breathing. J Appl Physiol 1967; 22:900-04
98. Zwillich CW, Pierson DJ, Cregh EM, et al. Effects of hypocapnia and hypocapnic alkalosis on cardiovascular function. J Appl Physiol 1976; 40:333-37
99. Clarke RSJ. The effect of voluntary overbreathing on the blood flow through the human forearm. J Physiol 1952; 118:537-44
100. Roddie IC, Shepherd JT, Whelan RF. Humoral vasodilatation in the forearm during voluntary hyperventilation. J Physiol 1957; 137:80-5
101. Foex P, Ryder WA, Bennett MJ. Carbon dioxide and coronary blood flow: direct effects or consequences of altered dynamics of the systemic circulation. Bull Eur Physiopathol Respir 1980; 16:185-94
102. Rowe GC, Castillo CA, Crumpton CW. Effects of hyperventilation on systemic and coronary hemodynamics. Am Heart J 1962; 63:67-77
103. 2 supply due to hyperventilation. Circulation 1975; 52:854-56
104. Matalon S, Dashkoff N, Nesarajah MS, et al. Effects of hyperventilation on pulmonary blood flow and recirculation time of humans. J Appl Physiol 1982; 52:1161-66
105. Wood P. Da Costa's syndrome (or effort syndrome). BMJ 1941; 1:767-72
106. Evans DW, Lum LC. Hyperventilation: an important cause of pseudoangina. Lancet 1977; 1:155-57
107. Bass C, Cawley R, Wade C, et al. Unexplained breathlessness and psychiatric morbidity in patients with normal and abnormal coronary arteries. Lancet 1983; 1:605-09
108. Mayou, R. Invited review: atypical chest pain. J Psychosom Res 1989; 33:393-406
109. Chambers JB, Bass C. Chest pain with normal coronary anatomy: a review of natural history and possible etiologic factors. Prog Cardiovasc Dis 1990; 33:161-84
110. Wheatley CE. Hyperventilation syndrome: a frequent cause of chest pain. Chest 1975; 68:195-99
111. Rasmussen K, Ravnsbaek J, Funch-Jensen P, et al. Oesophageal spasm in patients with coronary artery spasm. Lancet 1986; 1:174-76
112. Folgering H, Sistermans H. Hyperventilation and aerophagia: a negative report. Eur J Respir Dis 1986; 68:173-76
113. Lary D, Goldschlager N. Electrocardiographic changes during Ilyperventilation resembling myocardial ischemia in patients with normal coronary arteriograms. Am Heart J 1974; 87:383-90
114. Bass C, Chambers JB, Kiff P, et al. Panic anxiety and hyperventilation in patients with chest pain: a controlled study. Q J Med 1988; 69:949-59
115. Chambers JB, Kiff PJ, Gardner WN, et al. Value of measuring end tidal partial pressure of carbon dioxide as an adjunct to treadmill exercise testing. BMJ 1988; 296:1281-85
116. Bass C, Chambers JB, Gardner WN. Hyperventilation provocation in patients with chest pain and a negative treadmill exercise test. J Psychosom Res 1991; 35:83-9
117. Bertrand ME, Lablanche JM, Tilmant PY, et al. Frequency of provoked coronary arterial spasm in 1,089 consecutive patients undergoing coronary angiography. Circulation 1982; 65:1299-1306
118. Yasue H, Omote S, Takizawa A, et al. Comparison of coronary arteriographic findings during angina pectoris associated with S-T elevation or depression. Am J Cardiol 1981; 47:539-46
119. Yasue H, Nagao M, Omote S, et al. Coronary arterial spasm and Prinzmetal's variant form of angina induced by hyperventilation and Tris-buffer infusion. Circulation 1978; 58:56-62
120. Mortensen SA, Vilhelmsen R, Sandoe E. Prinzmetal's variant angina (PVA): circadian variation in response to hyperventilation. Acta Med Scand 1981; suppl 644:38-41
121. Brown EB. Ventricular fibrillation following a rapid fall in alveolar carbon dioxide concentration. Am J Physiol 1952; 169:56-60
122. Wildenthal K, Fuller DS, Shapiro W. Paroxysmal atrial arrhythmias induced by hyperventilation. Am J Cardiol 1968; 21:436-41
123. McKell TE, Sullivan AJ. The hyperventilation syndrome in gastroenterology. Gastroenterology 1947; 9:6-16
124. Burns BH, Howell JBL. Disproportionately severe breathlessness in chronic bronchitis. Q J Med 1969; 38:277-94
125. Christie RV. Some types of respiration in the neuroses. Q J Med 1935; 28:427-32
126. Tobin MJ. Dyspnea: pathophysiologie basis, clinical presentation, and management. Arch intern Med 1990; 150:1604-13
127. 2 measured by expiration into the rapid response infrared gas analyser. J Appl Physiol 1952; 4:526-34
128. 2. Biofeedback Self Regul 1994; 19:103-13
129. Saisch SGN. An introduction to capnography. Biofeedback Self Regul 1994; 19:115-34
130. 2 in exercise. J Appl Physiol 1979; 47:954-60
131. Perez W, Tobin MJ. Separation of factors responsible for change in breathing pattern induced by instrumentation. J Appl Physiol 1985; 59:1515-20
132. Shea SA, Walter J, Pelley C, et al. The effect of visual and auditory stimuli upon resting ventilation in man. Respir Physiol 1987: 68:345-47
133. 2. Bull Eur Physiopathol Respir 1987; 23:9-13
134. 2 level in normal subjects. J Appl Physiol 1988; 64:1858-63
135. Hibbert G, Pilsbury D. Hyperventilation in panic attacks: ambulant monitoring of transcutaneous carbon dioxide. Br J Psychiatry 1988; 153:76-80
136. Nixon P, Freeman L. The 'think test': a further technique to elicit hyperventilation. J R Soc Med 1990; 83:705-07
137. Bass C, Lelliott P, Marks I. Fear talk versus voluntary hyperventilation in agoraphobics and normals: a controlled study. Psychol Med 1989; 19:669-76
138. Fowler WS. Breaking point of breath-holding. J Appl Physiol 1954; 6:539-45
139. Klocke FJ, Rahn H. Breath holding after breathing oxygen. J Appl Physiol 1959; 14:689-93
140. Lin YC, Lally DA, Moore TO, et al. Physiological and conventional breath-hold breaking points. J Appl Physiol 1974; 37:291-96
141. Pearson MG, Qadiri MR, Finn R. Hypokalaemia in the chronic hyperventilation syndrome. Brit J Clin Pract 1986; 40:28-9
142. Rapoport S, Stevens CD, Engel GL, et al. The effect of voluntary overbreathing on the electrolyte equilibrium of arterial blood in man. J Biol Chem 1946; 163-411-27
143. Adrogue HJ, Madias NE. Changes in plasma potassium concentration during acute acid-base disturbances. Am J Med 1981; 71:456-67
144. Bass C, Kartsounis L, Lelliott P. Hyperventilation and its relationship to anxiety and panic. Integr Psych 1987; 5:274-91
145. Stevenson I, Ripley HS. Variations in respiration and in respiratory symptoms during changes in emotion. Psychosom Med 1952; 14:476-90
146. Dudley DL, Martin CJ, Holmes TH. Psychophysiologic studies of pulmonary ventilation. Psychosom Med 1964; 26:645-60
147. Tobin MJ, Chadha TS, Jenouri G, et al. Breathing patterns: II. Diseased subjects. Chest 1983; 84:286-94
148. Suess WM, Alexander AB, Smith DD, et al. The effects of psychological stress on respiration: a preliminary study of anxiety and hyperventilation. Psychophysiology 1980; 17:535-40
149. Garssen BW. Role of stress in the development of the hyperventilation syndrome. Psychother Psychosom 1980; 33:214-25
150. Damas Mora J, Grant L, Kenyon P, et al. Respiratory ventilation and carbon dioxide levels in syndromes of depression. Br J Psychiatry 1976; 129:457-64
151. Arrindell WA. Dimensional structure and psychopathology correlates of the fear survey schedule (FSS-III) in a phobic population: a factorial definition of agoraphobia. Behav Res Ther 1980; 18:229-42
152. Hallam RS, Hafner RJ. Fears of phobic patients: factor analysis of self-report data. Behav Res Ther 1978; 16:1-6
153. Clark DM, Hemsley DR. The effects of hyperventilation; individual variability and its relation to personality. J Behav Ther Exp Psychiatry 1982; 13:41-7
154. Ley R. The many faces of pan: psychological and physiological differences among three types of panic attacks. Behav Res Ther 1992; 30:347-57
155. Nutt D, Lawson C. Panic attacks: a neurochemical overview of models and mechanisms. Br J Psychiatry 1992; 160:165-78
156. Clark DM. A cognitive approach to panic. Behav Res Ther 1986; 24:461-70
157. Salkovskis PM, Clark DM. Affective responses to hyperventilation: a test of the cognitive model of panic. Behav Res Ther 1990; 28:51-61
158. Ley R. Dyspneic-fear and catastrophic cognitions in hyperventilatory panic attacks. Behav Res Ther 1989; 27:549-54
159. Klein DF. False suffocation alarms, spontaneous panics and related conditions. Arch Gen Psychiatry 1993; 50:306-17
160. Sietsema KE, Simon JI, Wasserman K. Pulmonary hypertension presenting as a panic disorder. Chest J 1987; 91:910-12
161. Treasure RAR, Fowler PBS, Millington HT, et al. Misdiagnosis of diabetic ketoacidosis as hyperventilarion syndrome. BMJ 1987; 294:630
162. Bendixen HH, Smith GM, Mead J. Pattern of ventilation in young adults. J Appl Physiol 1964; 19:195-98
163. Tucker WI. Diagnosis and treatment of the phobic reaction. Am J Psychiatry 1956; 112:825-30
164. 2 in mechanically ventilated quadriplegics. Respir Physiol 1989; 76:53-68
165. McFadden ER, Lyons HA. Arterial blood gas tension in asthma. N Engl J Med 1968; 278:1027-32
166. Kassabian J, Miller KD, Lavietes MH. Respiratory center output and ventilatory timing in patients with acute airway (asthma) and alveolar (pneumonia) disease. Chest 1982; 81:536-43
167. Kesten S, Maleki-Yazdi MR, Sanders BR, et al. Respiratory rate during acute asthma. Chest 1990; 97:58-62
168. Zackon H, Despas PJ, Anthonisen NR. Occlusion pressure responses in asthma and chronic obstructive pulmonary disease. Am Rev Respir Dis 1976; 114:917-27
169. Tobin MJ, Birch S, Jenouri G, et al. Acute effects of aerosolized metaproterenol on breathing pattern of patients with symptomatic bronchial asthma. J Allergy Clin Immunol 1985; 76:166-72
170. Saisch SGN, Sullivan P, Gardner WN. Hyperventilation due to acute and delayed responses to house dust mite antigen challenge [abstract]. Eur Respir J 1994; 7(suppl 18):395S
171. Bleecker ER, Cotton DJ, Fischer SP, et al. The mechanism of rapid, shallow breathing after inhaling histamine aerosol in exercising dogs. Am Rev Respir Dis 1976; 114:909-16
172. Cotton DJ, Bleecker ER, Fischer SP, et al. Rapid, shallow breathing after Ascaris suum antigen inhalation: role of vagus nerves. J Appl Physiol 1977; 42:101-06
173. Cochrane GM, Prior JG, Wolff CB. Chronic stable asthma and the normal arterial pressure of carbon dioxide in hypoxia. BMJ 1980; 281:705-07
174. Muller N, Bryan AC, Zamel N. Tonic inspiratory muscle activity as a cause of hyperinflation in asthma. J Appl Physiol 1981; 50:279-82
175. Gardner WN, Bass C, Moxham J. Recurrent hyperventilation tetany due to mild asthma. Respir Med 1992; 86:349-51
176. Herxheimer H. Hyperventilation asthma. Lancet 1946; 1:83-7
177. Deal EC Jr, McFadden ER, Ingram RH Jr, et al. Role of respiratory heat exchange in production of exercise-induced asthma. J Appl Physiol 1979; 46:467-75
178. Doubt TJ. Physiology of exercise in the cold. Sports Med 1991; 11:367-81
179. Loveridge B, West P, Kryger MH, et al. Alteration in breathing pattern with progression of chronic obstructive pulmonary disease. Am Rev Respir Dis 1986; 134:930-34
180. Shea SA, Winning AJ, McKenzie E, et al. Does the abnormal pattern of breathing in patients with interstitial lung disease persist in deep, non-rapid eye movement sleep? Am Rev Respir Dis 1989; 139:653-58
181. Turino GM, Lourenco RV, Davidson LAG. The control of ventilation in patients with reduced pulmonary distensibility. Ann NY Acad Sci 1963; 109:932-40
182. Stockley RA, Lee KD. Estimation of the resting reflex hypoxic drive to respiration in patients with diffuse pulmonary infiltration. Clin Sci 1976; 50:109-14
183. Javaheri S, Sicilian L. Lung function, breathing pattern, and gas exchange in interstitial lung disease. Thorax 1992; 47:93-7
184. Baldwin EF, Cournand A, Richards DW. Pulmonary insufficiency: II. A study of 39 cases of pulmonary fibrosis. Medicine 1949; 28:1-25
185. Gardner WN, Bass C. Chronic hyperventilation and sleep [abstract]. Clin Sci 1984; 67:7P
186. Trenchard D, Gardner D, Guz A. Pulmonary vagal afferent nerve fibres in the development of rapid shallow breathing in lung inflammation. Clin Sci 1972; 42:251-63
187. Phillipson EA, Murphy E, Kozar LF, et al. Role of vagal stimuli in exercise ventilation in dogs with experimental pneumonitis. J Appl Physiol 1975; 39:76-85
188. Avery WG, Samet P, Sackner MA. The acidosis of pulmonary edema. Am J Med 1970; 48:320-24
189. Szucs MM, Brooks HL, Grossmnan W, et al. Diagnostic sensitivity of laboratory findings in acute pulmonary embolism. Ann Intern Med 1971; 74:161-66
190. Lee MC, Klassen AC, Heaney LM, et al. Respiratory rate and pattern disturbances in acute brain stem infarction. Stroke 1976; 7:382-85
191. Lange LS, Laszlo G. Cerebral tumour presenting with hyperventilation. J Neurol Neurosurg Psychiatry 1965; 28:317-19
192. Rodriguez, M, Bade PL, Marsh HM, et al. Central neurogenic hyperventilation in an awake patient with brainstem astrocytoma. Ann Neurol 1982; 11:625-28
193. Plum F, Leigh RJ. Abnormalities of central mechanisms. In: Hornbein, ed. Regulation of breathing (lung biology in health and disease, vol 17). New York: Dekker, 1981; 989-1067
194. Glynn CJ, Lloyd JW, Folkhard S. Ventilatory response to intractable pain. Pain 1981; 11:201-11
195. Duranti R, Pantaleo T, Bellini F, et al. Respiratory responses induced by the activation of somatic nociceptive afferents in humans. J Appl Physiol 1991; 71:2440-48
196. Geddes IC, Gray TC. Hyperventilation for the maintenance of anaesthesia. Lancet 1959; 2:4-6
197. Temple AR. Acute and chronic effects of aspirin toxicity and their treatment. Arch Intern Med 1981; 141:364-69
198. Vanamee P, Poppell JW, Glicksman AS, et al. Respiratory alkalosis in hepatic coma. Arch Intern Med 1956; 97:762-67
199. Steel JM, Masterton G, Patrick AW, et al. Hyperventilation or hypoglycaemia? Diabetes Med 1989; 6:820-21
200. Ayres J, Rees J, Clark TJH, et al. Thyrotoxicosis and dyspnoea. Clin Endocrinol 1982; 16:65-71
201. Engel LA, Ritchie B. Ventilatory response to inhaled carbon dioxide in hyperthyroidism. J Appl Physiol 1971; 30:173-77
202. Damas-Mora J, Davies L, Taylor W, et al. Menstrual respiratory changes and symptoms. Br J Psychiatry 1980; 136:492-97
203. Hannhart B, Pickett CK, Moore LG. Effects of estrogen and progesterone on carotid body neural output responsiveness to hypoxia. J Appl Physiol 1990; 68:1909-16
204. Bunn JC, Mead J. Control of ventilation during speech. J Appl Physiol 1971; 31:870-72
205. Fadic R, Larrain C, Zapata P. Thermal effects on ventilation in cats: participation of carotid body chemoreceptors. Respir Physiol 1991; 86:51-63
206. Timmons BH, Ley R, eds. Behavioral and psychological approaches to breathing disorders. New York: Plenum Press, 1994
207. Waites TF. Hyperventilation - chronic and acute. Arch Intern Med 1978; 138:1700-01
208. Saisch SGN, Gardner WN. Acute hyperventilation presenting to an accident and emergency department [abstract]. Am Rev Respir Dis 1993; 147:A162
209. Callahan M. Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Ann Emerg Med 1989; 18:622-28
210. Rosen SD, King JO, Wilkinson JB, et al. Is chronic fatigue syndrome synonymous with effort syndrome. J R Soc Med 1990; 83:761-64
211. Saisch SGN, Deale A, Gardner WN, et al. Hyperventilation and chronic fatigue syndrome. Q J Med 1994; 87:63-7
212. Ferguson A, Addington WW, Gaensler EA. Dyspnea and bronchospasm from inappropriate postexercise hyperventilation. Ann Intern Med 1969; 71:1063-72
213. Garssen B, Rijken H. Clinical aspects and treatment of the hyperventilation syndrome. Behav Psychother 1986; 14:46-68
214. De Guire S, Gevirtz R, Kawahara Y, et al. Hyperventilation syndrome and the assessment of treatment for functional cardiac symptoms. Am J Cardiol 1992; 70:673-77
215. de Ruiter C, Rijken H, Garssen B, et al. Breathing retraining, exposure and a combination of both, in the treatment of panic disorder with agoraphobia. Behav Res Ther 1989; 27:647-55
216. Salkovskis PM, Clark DM, Hackmann A. Treatment of panic attacks using cognitive therapy without exposure or breathing retraining. Behav Res Ther 1991; 29:161-66
217. Folgering H, Cox A. Beta-blocker therapy with metoprolol in the hyperventilation syndrome. Respiration 1981; 41:33-8
218. Aronson PR. Evaluation of psychotropic drug therapy in chronic hyperventilation syndrome. J New Drugs 1966; 6:305-07
219. Pare CMB. The present status of monoamine oxidase inhibitors. Br J Psychiatry 1985; 146:576-84
220. Lydiard RB, Ballenger JC. Antidepressants in panic disorder und agoraphobia. J Affect Disord 1987; 13:153-68
221. Hoes MJ, Colla P, Folgering H. Clomipramine treatment of hyperventilation syndrome. Pharmacopsychiatry 1980; 13:25-8