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April 4, 1980

Hyperventilation Syndrome

Author Affiliations

Chestnut Hill Hospital Philadelphia

JAMA. 1980;243(13):1326. doi:10.1001/jama.1980.03300390011008

To the Editor:—  Missri and Alexander perform a service in calling attention to the surprisingly neglected syndrome of hyperventilation. Considering that almost any "functional" complaint could be caused by hyperventilation, incidences of this problem found in previous studies may be extremely conservative. The authors clearly define the physiological consequences of hyperventilation and the resulting ways in which disturbing symptoms are produced and serious diseases are mimicked or even exacerbated. However, in stating that "acute or chronic anxiety is the causal factor in the majority of patients," the authors beg the question. Not all anxious persons hyperventilate, and it may be unfair to assume that patients who are hyperventilating but "outwardly calm" have underlying emotional problems. The authors themselves admit that cardiac symptoms can be the initial factor, in which case, the "resultant anxiety provokes hyperventilation." This completed circle leaves unclear where and why the patient begins to overbreathe.Control of