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Review
. 2021 Apr 13;30(160):200182.
doi: 10.1183/16000617.0182-2020. Print 2021 Jun 30.

Minute ventilation/carbon dioxide production in patients with dysfunctional breathing

Matthew Watson  1 , Maria Florina Ionescu  2 , Karl Sylvester  3   4 , Jonathan Fuld  5
Affiliations
Review

Minute ventilation/carbon dioxide production in patients with dysfunctional breathing

Matthew Watson et al. Eur Respir Rev. .

Abstract

Dysfunctional breathing refers to a multi-dimensional condition that is characterised by pathological changes in an individual's breathing. These changes lead to a feeling of breathlessness and include alterations in the biomechanical, psychological and physiological aspects of breathing. This makes dysfunctional breathing a hard condition to diagnose, given the diversity of aspects that contribute to the feeling of breathlessness. The disorder can debilitate individuals without any health problems, but may also be present in those with underlying cardiopulmonary co-morbidities. The ventilatory equivalent for CO2 (V eqCO2 ) is a physiological parameter that can be measured using cardiopulmonary exercise testing. This review will explore how this single measurement can be used to aid the diagnosis of dysfunctional breathing. A background discussion about dysfunctional breathing will allow readers to comprehend its multidimensional aspects. This will then allow readers to understand how V eqCO2 can be used in the wider diagnosis of dysfunctional breathing. Whilst V eqCO2 cannot be used as a singular parameter in the diagnosis of dysfunctional breathing, this review supports its use within a broader algorithm to detect physiological abnormalities in patients with dysfunctional breathing. This will allow for more individuals to be accurately diagnosed and appropriately managed.

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Conflict of interest statement

Provenance: Commissioned article, peer reviewed. Conflict of interest: M. Watson has nothing to disclose. Conflict of interest: M.F. Ionescu has nothing to disclose. Conflict of interest: K. Sylvester has nothing to disclose. Conflict of interest: J. Fuld has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Graph illustrating the changes in ventilatory equivalent for carbon dioxide (described as V′E/V′CO2 in this study) in hyperventilation syndrome (HVS) suspects who are normocapnic before commencing exercise testing compared to controls. ANOVA values were used to determine significant changes in ventilatory equivalent for carbon dioxide within the groups as exercise intensity increased. **: p<0.01 compared with ventilatory equivalent for carbon dioxide at rest. V′E: minute ventilation; V′CO2: carbon dioxide production. Reproduced from [19] with permission from the publisher.
FIGURE 2
FIGURE 2
A proposed clinical pathway for patients suspected of dysfunctional breathing, based on current practice at the Cambridge University Hospital trust. Values quoted are based on data from cited studies [19, 28, 29]. FEV1: forced expiratory volume in 1 s; VeqCO2: ventilatory equivalent for CO2; PETCO2: end-tidal carbon dioxide tension; VT: tidal volume; RR: respiratory rate.
See this image and copyright information in PMC

Comment in

  • doi: 10.1183/16000617.0244-2020

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