Dysfunctional breathing and hyperventilation complaints

1. Dysfunctional breathing and hyperventilation complaints For how many hyperventilation patients are the complaints due to Dysfunctional Breathing ? Van Leeuwen, Van Dixhoorn,1993

2. Dysfunctional breathing and hyperventilation complaints Three year follow-up of breathing therapy What is the longterm outcome for patiënts with and without Dysfunctional Breathing?

3. 76 patiënts, referred for breathing therapy in 1989-90 with a diagnosis of hyperventilation or an elevated score on Nijmegen Questionnaire

4. Follow-up questionnaire in 1993 response by 54 (71%) 19 men and 35 women 35.5 ± 15 years of age

5. No difference between respondents and non-respondents

9. Although studies of breathing therapy for hyperventilation complaints have positive outcomes, the response in breathing is rarely included

13. Thus, dysfunctional breathing plays a role in the etiology of hyperventilation complaints in 61% of the patiënts, in between half and threequarters of the patients

14. What characteristics are associated with DB? Is it dependent upon medical or psychological factors or does it play an independent role?

17. Dysfunctional breathing is an independent factor absence of medical diagnosis is not required psychological problems may partly obscure its role

19. When there is no response to breathing therapy and little or no change in main complaints, the score in Nijmegen Questionnaire is elevated; there is probably psychopathology that dominates the role of dysfunctional breathing

20. Three year follow-up of breathing therapy What is the longterm outcome for patiënts with and without Dysfunctional Breathing?

21. What interventions occurred in the 3 - 4 years of follow-up because of the initial complaints?

23. One cardiac patiënt received a PTCA for chest pain, 16 patiënts received psychological treatment 4 patiënts followed a second round of breathing therapy

24. Does the effect on Nijmegen questionaire differ between categories of DB?

28. When the complaints are probably due to DB, there is a lasting effect. The average score at follow-up is normal or slightly elevated. When DB does not play a role, the changes are small and the score at follow-up is high.

29. The NQ score at follow-up is highly predictable (MR=0.80) by two predictors: NQ score: beta = 0.60 DB: beta= -0.42 Thus, a low score and high probability of DB predict low scores after 3-4 years

30. Does the effect on Nijmegen questionaire differ between DB and subsequent psychotherapy?

33. When the complaints are not due to DB, psychotherapy tends to make a difference: with PT there is improvement, without PT the complaints worsen.

34. When the complaints are due to DB, psychotherapy does not make a difference, with PT the initial complaints are a little higher than without PT

35. The occurrence of PT is moderately predictable (MR=0.52): response to breathing therapy: beta = -0.33 PT at entry: beta= 0.32 Patients who receive PT and do not respond to breathing therapy will have subsequent PT.

36. To conclude When hyperventilation complaints are due to dysfunctional breathing, breathing therapy is sufficient to a high degree.

37. When the role of dysfunctional breathing is not clear, there is probably psychopathology. Psychological treatment is helpful, but the complaints remain high.

38. Thus, based on the response to breathing therapy, hyperventilation complaints can be differentiated into a disorder of ‘dysfunctional breathing’ and a more complex psychopathological disorder.

39. This differentiation can probably be made early in breathing therapy, after for instance four sessions. When dysfunctional breathing plays an important role the initial response to breathing therapy is already positive to some degree. This needs future investigation.