Changes in pCO2, Symptoms, and Lung Function of Asthma Patients During Capnometry-assisted Breathing Training

  • Thomas Ritz
  • Alicia E. Meuret
  • Frank H. Wilhelm
  • Walton T. Roth
Article

Abstract

In a recent pilot study with asthma patients we demonstrated beneficial outcomes of a breathing training using capnometry biofeedback and paced breathing assistance to increase pCO2 levels and reduce hyperventilation. Here we explored the time course changes in pCO2, respiration rate, symptoms and lung function across treatment weeks, in order to determine how long training needs to continue. We analyzed in eight asthma patients whether gains in pCO2 and reductions in respiration rate achieved in home exercises with paced breathing tapes followed a linear trend across the 4-week treatment period. We also explored the extent to which gains at home were manifest in weekly training sessions in the clinic, in terms of improvement in symptoms and spirometric lung function. The increases in pCO2 and respiration rate were linear across treatment weeks for home exercises. Similar increases were seen for in-session measurements, together with gradual decreases in symptoms from week to week. Basal lung function remained stable throughout treatment. With our current protocol of paced breathing and capnometry-assisted biofeedback at least 4 weeks are needed to achieve a normalization of pCO2 levels and reduction in symptoms in asthma patients.

Keywords

Asthma Hyperventilation pCO2 Biofeedback Asthma symptoms 

References

  1. Benchetrit, G. (2000). Breathing pattern in humans: Diversity and individuality. Respiration Physiology, 122, 123–129. doi:10.1016/S0034-5687(00)00154-7.PubMedCrossRefGoogle Scholar
  2. Bernardi, L., Porta, C., Spicuzza, L., et al. (2002). Slow breathing increases arterial baroreflex sensitivity in patients with chronic heart failure. Circulation, 105, 143–145. doi:10.1161/hc0202.103311.PubMedCrossRefGoogle Scholar
  3. Bruton, A., & Holgate, S. T. (2005). Hypocapnia and asthma: A mechanism for breathing retraining?. Chest, 127, 1808–1811. doi:10.1378/chest.127.5.1808.PubMedCrossRefGoogle Scholar
  4. Bruton, A., & Lewith, G. T. (2005). The Buteyko breathing technique for asthma: A review. Complementary Therapies in Medicine, 13, 41–46. doi:10.1016/j.ctim.2005.01.003.PubMedCrossRefGoogle Scholar
  5. Butler, J., Caro, C. G., Alcala, R., et al. (1960). Physiological factors affecting airway resistance in normal subjects and in patients with obstructive respiratory disease. The Journal of Clinical Investigation, 39, 584–591. doi:10.1172/JCI104071.PubMedCrossRefGoogle Scholar
  6. Clarke, P. S., & Gibson, J. R. (1980). Asthma hyperventilation and emotion. Australian Family Physician, 9, 715–719.PubMedGoogle Scholar
  7. Del Pozo, J. M., Gevirtz, R. N., Scher, B., et al. (2004). Biofeedback treatment increases heart rate variability in patients with known coronary artery disease. American Heart Journal, 147, E11. doi:10.1016/j.ahj.2003.08.013.PubMedCrossRefGoogle Scholar
  8. Fried, R. (1993). The psychology and physiology of breathing. New York: Plenum Press.Google Scholar
  9. Giardino, N. D., Chan, L., Borson, S., et al. (2004). Combined heart rate variability and pulse oximetry biofeedback for chronic obstructive pulmonary disease: Preliminary findings. Applied Psychophysiology and Biofeedback, 29, 121–133. doi:10.1023/B:APBI.0000026638.64386.89.PubMedCrossRefGoogle Scholar
  10. Herxheimer, H. (1946). Hyperventilation asthma. Lancet, 1, 83–87. doi:10.1016/S0140-6736(46)91225-1.CrossRefGoogle Scholar
  11. Hida, W., Arai, M., Shindoh, C., Liu, Y. N., Sasaki, H., & Takishima, T. (1984). Effect of inspiratory flow rate on bronchomotor tone in normal and asthmatic subjects. Thorax, 39, 86–92.Google Scholar
  12. Hofmann, S. G., Schultz, S., Meuret, A. E., et al. (2006). Sudden gains during therapy of social phobia. Journal of Consulting and Clinical Psychology, 74, 687–697. doi:10.1037/0022-006X.74.4.687.PubMedCrossRefGoogle Scholar
  13. Hormbrey, J., Jacobi, M. S., Patil, C. P., et al. (1988). CO2 response and pattern of breathing in patients with symptomatic hyperventilation, compared to asthmatic and normal subjects. The European Respiratory Journal, 1, 846–851.PubMedGoogle Scholar
  14. Joseph, C. N., Porta, C., Casucci, G., Casiraghi, N., Maffeis, M., Rossi, M., et al. (2005). Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension, 46, 714–718.Google Scholar
  15. Karavidas, M. K., Lehrer, P. M., Vaschillo, E., et al. (2007). Preliminary results of an open label study of heart rate variability biofeedback for treatment of major depression. Applied Psychophysiology and Biofeedback, 32, 19–30. doi:10.1007/s10484-006-9029-z.PubMedCrossRefGoogle Scholar
  16. Lehrer, P., Carr, R. E., Smetankine, A., et al. (1997). Respiratory sinus arrhythmia versus neck/trapezius emg and incentive inspirometry biofeedback for asthma: A pilot study. Applied Psychophysiology and Biofeedback, 22, 95–109. doi:10.1023/A:1026224211993.PubMedCrossRefGoogle Scholar
  17. Lehrer, P. M., Vaschillo, E., Vaschillo, B., et al. (2004). Biofeedback treatment for asthma. Chest, 126, 352–361. doi:10.1378/chest.126.2.352.PubMedCrossRefGoogle Scholar
  18. Ley, R. (1991). The efficacy of breathing retraining and the centrality of hyperventilation in panic disorder: A reinterpretation of experimental findings. Behaviour Research and Therapy, 29, 301–304. doi:10.1016/0005-7967(91)90121-I.PubMedCrossRefGoogle Scholar
  19. Lutchen, K. R., Jensen, A., Atileh, H., et al. (2001). Airway constriction pattern is a central component of asthma severity: The role of deep inspirations. American Journal of Respiratory and Critical Care Medicine, 164, 207–215.PubMedGoogle Scholar
  20. McFadden, E. R., Jr, & Gilbert, I. A. (1994). Exercise-induced asthma. The New England Journal of Medicine, 330, 1362–1367. doi:10.1056/NEJM199405123301907.PubMedCrossRefGoogle Scholar
  21. Meuret, A. E., Wilhelm, F. H., & Roth, W. T. (2001). Respiratory biofeedback-assisted therapy in panic disorder. Behavior Modification, 25, 584–605. doi:10.1177/0145445501254006.PubMedCrossRefGoogle Scholar
  22. Meuret, A. E., Wilhelm, F. H., Ritz, T., et al. (2003). Breathing training in panic disorder treatment: Useful intervention or impediment to therapy? Behavior Modification, 27, 731–754. doi:10.1177/0145445503256324.PubMedCrossRefGoogle Scholar
  23. Meuret, A. E., Wilhelm, F. H., & Roth, W. T. (2004). Respiratory feedback for treating panic disorder. Journal of Clinical Psychology, 60, 197–207. doi:10.1002/jclp.10245.PubMedCrossRefGoogle Scholar
  24. Meuret, A. E., Ritz, T., Dahme, B., et al. (2005). Therapeutic use of ambulatory capnometry. In J. S. Gravenstein, M. Jaffe, & D. Paulus (Eds.), Capnography. Clinical applications. Cambridge: Cambridge University Press.Google Scholar
  25. Meuret, A. E., Ritz, T., Wilhelm, F. H., Roth, W. T., et al. (2007). Targeting pCO2 in asthma: Pilot evaluation of a capnometry-assisted breathing training. Applied Psychophysiology and Biofeedback, 32, 99–109. doi:10.1007/s10484-007-9036-8.PubMedCrossRefGoogle Scholar
  26. Meuret, A. E., Wilhelm, F. H., Ritz, T., et al. (2008). Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder. Journal of Psychiatric Research, 42, 560–568. doi:10.1016/j.jpsychires.2007.06.005.PubMedCrossRefGoogle Scholar
  27. Myrtek, M. (1984). Constitutional psychophysiology. Research in review. Orlando, FL: Academic Press.Google Scholar
  28. National Heart Lung and Blood Institute. (1997). Expert panel report 2: Guidelines for the diagnosis and management of asthma. National asthma education and prevention program. Washington: U.S Department of Health and Human Services.Google Scholar
  29. O’Cain, C. F., Hensley, M. J., McFadden, E. R., Jr, et al. (1979). Pattern and mechanism of airway response to hypocapnia in normal subjects. Journal of Applied Physiology, 47, 8–12.PubMedGoogle Scholar
  30. Osborne, C. A., O’Connor, B. J., Lewis, A., et al. (2000). Hyperventilation and asymptomatic chronic asthma. Thorax, 55, 1016–1022. doi:10.1136/thorax.55.12.1016.PubMedCrossRefGoogle Scholar
  31. Ritz, T., & Roth, W. T. (2003). Behavioral interventions in asthma: Breathing training. Behavior Modification, 27, 710–730. doi:10.1177/0145445503256323.PubMedCrossRefGoogle Scholar
  32. Ritz, T., Kullowatz, A., Bobb, C., et al. (2008a). Psychological triggers and symptoms of hyperventilation in asthma. Annals of Allergy, Asthma & Immunology, 100, 426–432.CrossRefGoogle Scholar
  33. Ritz, T., Rosenfield, D., Meuret, A. E., et al. (2008b). Hyperventilation symptoms are linked to a lower quality of life in asthma patients. Annals of Behavioral Medicine, 35, 97–104.PubMedGoogle Scholar
  34. Sargunaraj, D., Lehrer, P. M., Hochron, S. M., et al. (1996). Cardiac rhythm effects of 125-Hz paced breathing through a resistive load: Implications for paced breathing therapy and the polyvagal theory. Biofeedback and Self-Regulation, 21, 131–147. doi:10.1007/BF02284692.PubMedCrossRefGoogle Scholar
  35. Schein, M. H., Gavish, B., Herz, M., et al. (2001). Treating hypertension with a device that slows and regularises breathing: A randomised, double-blind controlled study. Journal of Human Hypertension, 15, 271–278. doi:10.1038/sj.jhh.1001148.PubMedCrossRefGoogle Scholar
  36. Shea, S. A., Walter, J., Murphy, K., et al. (1987). Evidence for individuality of breathing patterns in resting healthy man. Respiration Physiology, 68, 331–344. doi:10.1016/S0034-5687(87)80018-X.PubMedCrossRefGoogle Scholar
  37. Steen, N., Hutchinson, A., McColl, E., et al. (1994). Development of a symptom based outcome measure for asthma. BMJ (Clinical Research Ed.), 309, 1065–1068.Google Scholar
  38. Sterling, G. M. (1968). The mechanism of bronchoconstriction due to hypocapnia in man. Clinical Science, 34, 277–285.PubMedGoogle Scholar
  39. Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67, 894–904.Google Scholar
  40. van den Elshout, F. J. J., van Herwaarden, C. L. A., & Folgering, H. T. M. (1991). Effects of hypercapnia and hypocapnia on respiratory resistance in normal and asthmatic subjects. Thorax, 46, 28–32.PubMedCrossRefGoogle Scholar
  41. Wientjes, C. J. (1992). Respiration in psychophysiology: Methods and applications. Biological Psychology, 34, 179–203.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Thomas Ritz
    • 1
  • Alicia E. Meuret
    • 1
  • Frank H. Wilhelm
    • 2
  • Walton T. Roth
    • 3
  1. 1.Department of PsychologySouthern Methodist UniversityDallasUSA
  2. 2.University of BaselBaselSwitzerland
  3. 3.Stanford University School of Medicine and the VA Palo Alto Health Care SystemStanfordUSA

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