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A decrease in plant gain, namely CO2 stores, characterizes dysfunctional breathing whatever its subtype in children.

Plamen Bokov1, Claudine Peiffer2, Jorge Gallego3

  • 1Service de Physiologie Pédiatrique -Centre du Sommeil-CRMR Hypoventilations Alvéolaires Rares, AP-HP, Hôpital Robert Debré, INSERM NeuroDiderot, Université de Paris, Paris, France.

Frontiers in Physiology
|July 20, 2023
PubMed
Summary
This summary is machine-generated.

Children with dysfunctional breathing (DB) deplete their CO2 stores, showing decreased plant gain regardless of subtype. This suggests current DB subtype classifications may not be clinically useful for assessing CO2 regulation during breathing tests.

Keywords:
controller gaindysfunctional breathinghyperventilationhyperventilation provocation testloop gainventilatory control

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Area of Science:

  • Pediatric Pulmonology
  • Respiratory Physiology
  • Clinical Diagnostics

Background:

  • The clinical utility of classifying dysfunctional breathing (DB) subtypes remains unclear.
  • The hyperventilation provocation test (HVPT) is a diagnostic tool for DB, involving a period of hyperventilation that decreases fractional end-tidal CO2 (FETCO2).
  • This decrease in FETCO2 during HVPT may reflect CO2 stores and 'plant gain', a measure of respiratory system control.

Purpose of the Study:

  • To determine if children with different DB subtypes exhibit reduced plant gain.
  • To investigate the relationship between HVPT characteristics and plant gain in pediatric patients.

Main Methods:

  • Retrospective analysis of 48 children diagnosed with various DB subtypes or physiological breathlessness during cardiopulmonary exercise testing.
  • Assessment of tidal breathing and HVPT data, including ventilation and FETCO2, to calculate plant gain.
  • Comparison of plant gain and HVPT parameters across different patient groups.

Main Results:

  • Plant gain was significantly higher in children with physiological breathlessness compared to those with dyspnea without hyperventilation and hyperventilation without hypocapnia.
  • The rate of FETCO2 decrease during HVPT was significantly steeper in the physiological breathlessness group compared to the other DB subtypes.
  • These findings indicate that children with DB, irrespective of subtype, demonstrate diminished CO2 stores, evidenced by decreased plant gain.

Conclusions:

  • Children with dysfunctional breathing, across all identified subtypes, show evidence of depleted CO2 stores, indicated by decreased plant gain.
  • This depletion may result from intermittent alveolar hyperventilation during breathing challenges.
  • The study suggests that current subtype classifications for DB may not be sufficiently distinct or useful for clinical assessment of CO2 regulation.