References
Hyperventilation syndrome: diagnosis and reassurance
Abstract
This article provides an overview of hyperventilation syndrome (HVS). Hyperventilation is to breathe in excess of metabolic requirements; in the absence of an underlying organic cause, it is defined as HVS. Alternative terms used in literature are panic or anxiety attack, panic or anxiety disorder, dysfunctional breathing and breathing pattern disorder. This article explores HVS signs and symptoms beyond the familiar clinical signposts of tachypnoea, chest tightness, paraesthesia and anxiety. It will also discuss differential diagnoses and pre-hospital treatment of HVS, focusing on reassuring patients and assisting them in establishing a good respiratory pattern. Patients with HVS use a significant amount of hospital and emergency service resources, ideally placing paramedics to diagnose and treat HVS in the pre-hospital setting to avoid unnecessary and costly hospital admissions. Further research is needed to evaluate the pre-hospital prevalence and diagnostic accuracy of HVS, identify clear diagnostic criteria and design screening tools.
Hyperventilation is defined as ‘breathing in excess of metabolic requirements’. This is illustrated by an irregular and disorganised breathing pattern with an increased rate and depth of respirations, known as tachypnoea (Gardner, 2003; College of Paramedics (CoP), 2016). Hyperventilation has many causes; however, this review will focus on acute episodes of primary or idiopathic hyperventilation, meaning there is no underlying organic cause (Pfortmueller et al, 2015; Clarke and Townsend, 2016).
The term hyperventilation syndrome (HVS) was first mentioned in 1938 by Kerr et al who attributed their patients' tetany to hyperventilation associated with anxiety. Since then, the term has been misused to represent a wide variety of medically unexplained symptoms, which has turned HVS into a ‘fashionable disease that is not to be taken seriously’ (Hornsveld and Garssen, 1997). Consequently, Hornsveld and Garssen (1997) suggested abandoning the term HVS despite acknowledging that patients present with HVS symptoms. It is evident from the literature that the term HVS has slowly disappeared in favour of panic or anxiety attack, panic or anxiety disorder, dysfunctional breathing or breathing pattern disorder (Thomas et al, 2001; 2005; Warburton and Jack, 2006; Todd et al, 2018). However, for this review, HVS was preferred as it is used in the UK Joint Royal Colleges Ambulance Liaison Committee (JRCALC) national ambulance service guidelines (Brown et al, 2016).
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