Skip to main content

Main menu

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • COVID-19 submission information
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • COVID-19 submission information
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions

Minute ventilation/carbon dioxide production in patients with dysfunctional breathing

Matthew Watson, Maria Florina Ionescu, Karl Sylvester, Jonathan Fuld
European Respiratory Review 2021 30: 200182; DOI: 10.1183/16000617.0182-2020
Matthew Watson
1School of Clinical Medicine, University of Cambridge, Cambridge, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: mw696@cam.ac.uk
Maria Florina Ionescu
1School of Clinical Medicine, University of Cambridge, Cambridge, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Karl Sylvester
2Lung Function, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
3Respiratory Physiology, Papworth Hospitals NHS Foundation Trust, Cambridge, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jonathan Fuld
4Dept of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Figures

  • Tables
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    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
    • Download figure
    • Open in new tab
    • Download powerpoint
    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.

Tables

  • Figures
  • TABLE 1

    Definitions of terms and equations used

    AbbreviationPhysiological parameterSignificance
    PaCO2Arterial carbon dioxide tension (kPa)Reflective of the concentration of CO2 in the arterial blood
    dDead space volume (L)Volume of air that is inhaled that does not take part in gas exchange
    VTTidal volume (L)Volume of air moved into and out of the lungs during each ventilation cycle
    V′EMinute ventilation (L·min−1)Volume of gas exhaled/inhaled in 1 min, equal to the VT multiplied by the RR
    V′CO2Carbon dioxide production (L·min−1)
    d/VTRatio of dead space volume to tidal volumeA higher value indicates a larger proportion of air not engaging in gas exchange within the lungs
    V′E/V′CO2Gradient of the V′E/V′CO2 slopeThe minute ventilation required to exhale 1 L of CO2
    Equation A: Embedded Image
    RRRespiratory rate (min−1)Number of breaths taken per minute
    dsystDead space volume of the apparatus used (L)Volume of air that remains within the CPET apparatus e.g. breathing valve, connectors and mouth piece exterior to the mouth
    VeqCO2Ventilatory equivalent for carbon dioxideMeasures the efficiency of ventilation
    Equation B: Embedded Image

    Equation A describes the relationship of the V′E/V′CO2 slope to the physiological variables of PaCO2, d and VT. Equation B describes the relationship of VeqCO2 to the V′E, dsyst, RR and V′CO2. Definitions and significance of the relevant parameters are also described for the understanding of the presented equations CPET: cardiopulmonary exercise testing.

    • TABLE 2

      Relevant data from studies used to demonstrate the reviews conclusions

      First author [ref.] and parameterHVS suspectsControlsp-value
      Kinnula [28]n=10n=10
       Resting PaCO2 kPa4.10±0.60ND
       Resting pH7.46±0.06ND
       VeqCO2 at 40–50 W exercise41.8±6.0030.0±3.300.01
      Jack [29]n=23n=23
       Resting PaCO2 kPa3.87±0.60ND
       VeqCO2 at 40 W exercise38.4±5.7028.9±2.50ND
      Brat [19]n=29n=29
       Resting arterial PaCO2 kPa4.80 (4.40–4.93)4.80 (4.53–5.07)0.44
       Resting arterial pH7.45 (7.43–7.47)7.44 (7.43–7.45)0.07
       Peak exercise PaCO2 kPa3.87±0.534.67±0.40<0.01
       Peak exercise arterial pH7.47 (7.46–7.50)7.40 (7.37–7.42)<0.01
       Resting d/VT0.21±0.110.22±0.100.77
       Peak exercise d/VT0.18±0.050.13±0.06<0.01
       VeqCO2 at rest38.0 (33.0–44.0)37.0 (32.0–40.0)0.31
       VeqCO2 at peak exercise38.0 (35.0–43.0)31.0 (27.0–34.0)<0.01
       V′E/V′CO2 slope37.0 (33.0–34.0)27.0 (24.0–30.0)<0.01
      Troosters [30]n=24n=20
       NQ scores30.3±9.707.90±5.20<0.001

      Data are presented as mean±sd or median (interquartile range), unless otherwise stated. HVS: hyperventilation syndrome; PaCO2: arterial carbon dioxide tension; VeqCO2: ventilatory equivalent for carbon dioxide; d/VT: ratio of dead space volume to tidal volume; ND: not disclosed in study. V′E/V′CO2 slope: gradient of the V′E (abscissa) and V′CO2 (ordinate) slope; NQ: Nijmegen Questionnaire.

      PreviousNext
      Back to top
      View this article with LENS
      Vol 30 Issue 160 Table of Contents
      European Respiratory Review: 30 (160)
      • Table of Contents
      • Index by author
      Email

      Thank you for your interest in spreading the word on European Respiratory Society .

      NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

      Enter multiple addresses on separate lines or separate them with commas.
      Minute ventilation/carbon dioxide production in patients with dysfunctional breathing
      (Your Name) has sent you a message from European Respiratory Society
      (Your Name) thought you would like to see the European Respiratory Society web site.
      CAPTCHA
      This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
      Print
      Citation Tools
      Minute ventilation/carbon dioxide production in patients with dysfunctional breathing
      Matthew Watson, Maria Florina Ionescu, Karl Sylvester, Jonathan Fuld
      European Respiratory Review Jun 2021, 30 (160) 200182; DOI: 10.1183/16000617.0182-2020

      Citation Manager Formats

      • BibTeX
      • Bookends
      • EasyBib
      • EndNote (tagged)
      • EndNote 8 (xml)
      • Medlars
      • Mendeley
      • Papers
      • RefWorks Tagged
      • Ref Manager
      • RIS
      • Zotero

      Share
      Minute ventilation/carbon dioxide production in patients with dysfunctional breathing
      Matthew Watson, Maria Florina Ionescu, Karl Sylvester, Jonathan Fuld
      European Respiratory Review Jun 2021, 30 (160) 200182; DOI: 10.1183/16000617.0182-2020
      del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
      Full Text (PDF)

      Jump To

      • Article
        • Abstract
        • Abstract
        • Introduction
        • Dysfunctional breathing
        • Can V′E/V′CO2 be used to aid the diagnosis of dysfunctional breathing?
        • Footnotes
        • References
      • Figures & Data
      • Info & Metrics
      • PDF

      Subjects

      • Mechanisms of lung disease
      • Tweet Widget
      • Facebook Like
      • Google Plus One

      More in this TOC Section

      Series

      • New antibiotics for Gram-negative pneumonia
      • Severe community-acquired pneumonia
      • Pulmonary aspergillosis: diagnosis and treatment
      Show more Series

      Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders

      • CPET in ILD and ventilatory efficiency
      • Clinical and prognostic value of ventilatory efficiency in CF
      • Exertional ventilation/carbon dioxide output in COPD
      Show more Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders

      Related Articles

      Navigate

      • Home
      • Current issue
      • Archive

      About the ERR

      • Journal information
      • Editorial board
      • Reviewers
      • Press
      • Permissions and reprints
      • Advertising
      • Sponsorship

      The European Respiratory Society

      • Society home
      • myERS
      • Privacy policy
      • Accessibility

      ERS publications

      • European Respiratory Journal
      • ERJ Open Research
      • European Respiratory Review
      • Breathe
      • ERS books online
      • ERS Bookshop

      Help

      • Feedback

      For authors

      • Instructions for authors
      • Publication ethics and malpractice
      • Submit a manuscript

      For readers

      • Alerts
      • Subjects
      • RSS

      Subscriptions

      • Accessing the ERS publications

      Contact us

      European Respiratory Society
      442 Glossop Road
      Sheffield S10 2PX
      United Kingdom
      Tel: +44 114 2672860
      Email: journals@ersnet.org

      ISSN

      Print ISSN: 0905-9180
      Online ISSN: 1600-0617

      Copyright © 2023 by the European Respiratory Society