Hyperventilation

Physicians' and specialists' continued failure to recognise, diagnose and treat adequately the majority of hyperventilators is a disgrace. Hyperventilation Syndrome (H.V.S.), incorrectly labelled myalgic encephalomyelitis (M.E.), is the latest example of the profession's incompetence. Reasons for failure to teach doctors about H.V. are discussed followed by its incidence, and the tendency for patients to gravitate to Specialist Departments where general history and a complete physical examination have become more perfunctory as sophisticated tests have multiplied. Signs which should alert a clinician's suspicion are listed, which if present should lead to a series of suggested facilitating questions. Controversial aspects of tests to confirm diagnosis are discussed, and also recent work on the relationship of panic attacks to hyperventilation and vice versa. The need for understanding and how to elicit the typical psychopathogenesis is stressed. Lastly, a form of management is described which requires combined competent physiotherapy and competent psychological management. The latter involves uncovering the underlying psychopathology and then helping the patient resolve early loss or alienation which when reawakened by further losses or anticipated loss or surrogates, precipitate symptomatic H.V.