Hyperventilation: The Real Story

What is hyperventilation?

Hyperventilation (or alveolar hyperventilation), since it has the prefix "hyper-", is breathing more air per minute than the medical norm. The values for normal minute ventilation (or respiratory minute volume) at rest for a 70-kg man range from 4-6 L/min for older physiological textbooks and up to 6-9 L/min for some modern textbooks. Obviously, anything that is more 9-10 L/min is defined as hyperventilation.

Hyperventilation causes hypocapnia (CO2 deficiency) in the alveoli of the lungs and, if there is no ventilation-perfusion mismatch, in the arterial blood and other body cells. In any case (too high or too low arterial CO2 - arterial hypercapnia or hypocapnia), hyperventilation always leads to tissue hypoxia (low oxygen levels in cells).

Hyperventilation in the sick and normal breathing rates in healthy subjects

Hyperventilation, as nearly all medical sources imply (e.g., Wikipedia, Emedicine.com, or University of Maryland Medical Center article Hyperventilation), happens rarely, in such cases as anxiety panic, or other more exotic situations. These medical sources cannot even provide the correct definition of hyperventilation or "hyper" + "ventilation". What do we know about exact numbers for ventilaiton at rest in people with chronic diseases? Do healthy people have normal minute ventilation rates? How common is hyperventilation? What is the real story related to hyperventilation?

Minute ventilation rates (chronic diseases)

Condition	Minute ventilation	Number of people	All references or click below for abstracts
Normal breathing	6 L/min	-	Medical textbooks
Healthy Subjects	6-7 L/min	>400	Results of 14 studies
Heart disease	15 (±4) L/min	22	Dimopoulou et al, 2001
Heart disease	16 (±2) L/min	11	Johnson et al, 2000
Heart disease	12 (±3) L/min	132	Fanfulla et al, 1998
Heart disease	15 (±4) L/min	55	Clark et al, 1997
Heart disease	13 (±4) L/min	15	Banning et al, 1995
Heart disease	15 (±4) L/min	88	Clark et al, 1995
Heart disease	14 (±2) L/min	30	Buller et al, 1990
Heart disease	16 (±6) L/min	20	Elborn et al, 1990
Pulm hypertension	12 (±2) L/min	11	D'Alonzo et al, 1987
Cancer	12 (±2) L/min	40	Travers et al, 2008
Diabetes	12-17 L/min	26	Bottini et al, 2003
Diabetes	15 (±2) L/min	45	Tantucci et al, 2001
Diabetes	12 (±2) L/min	8	Mancini et al, 1999
Diabetes	10-20 L/min	28	Tantucci et al, 1997
Diabetes	13 (±2) L/min	20	Tantucci et al, 1996
Asthma	13 (±2) L/min	16	Chalupa et al, 2004
Asthma	15 L/min	8	Johnson et al, 1995
Asthma	14 (±6) L/min	39	Bowler et al, 1998
Asthma	13 (±4) L/min	17	Kassabian et al, 1982
Asthma	12 L/min	101	McFadden & Lyons, 1968
COPD	14 (±2) L/min	12	Palange et al, 2001
COPD	12 (±2) L/min	10	Sinderby et al, 2001
COPD	14 L/min	3	Stulbarg et al, 2001
Sleep apnea	15 (±3) L/min	20	Radwan et al, 2001
Liver cirrhosis	11-18 L/min	24	Epstein et al, 1998
Hyperthyroidism	15 (±1) L/min	42	Kahaly, 1998
Cystic fibrosis	15 L/min	15	Fauroux et al, 2006
Cystic fibrosis	10 L/min	11	Browning et al, 1990
Cystic fibrosis*	10 L/min	10	Ward et al, 1999
CF and diabetes*	10 L/min	7	Ward et al, 1999
Cystic fibrosis	16 L/min	7	Dodd et al, 2006
Cystic fibrosis	18 L/min	9	McKone et al, 2005
Cystic fibrosis*	13 (±2) L/min	10	Bell et al, 1996
Cystic fibrosis	11-14 L/min	6	Tepper et al, 1983
Epilepsy	13 L/min	12	Esquivel et al, 1991
CHV	13 (±2) L/min	134	Han et al, 1997
Panic disorder	12 (±5) L/min	12	Pain et al, 1991
Bipolar disorder	11 (±2) L/min	16	MacKinnon et al, 2007
Dystrophia myotonica	16 (±4) L/min	12	Clague et al, 1994

Sick patients with hyperventilation This data explain the pathological changes and high prevalence of chronic disorders (or diseases of civilization), due to hyperventilation, in modern population. Since modern people breathe about 2 times more than the medical norm, they usually suffer from low CO2 values in the arterial blood (ventilation-perfusion mismatch is not a very common condition). Carbon dioxide is a potent dilator of blood vessels (vasodilator) and is crucial for the Bohr effect (O2 transport from red blood cells to tissues). As a result of hyperventilation, modern people experience reduced oxygen levels in the brain, heart, kidneys and all other vital organs. Cell hypoxia causes or favors inflammatory conditions, production of free radicals and suppression of the immune system. Apart from these effects, there are devastating effects of hyperventilation syndrome on the brain due to hypocapnia or lack of CO2 that has calming or sedative properties on nerve cells. These and other hyperventilation-related physiological effects promote pathological changes and advance of chronic health problems.

Is hyperventilation common on ordinary people?

Chronic hyperventilation is very common for ordinary people (or "normal subjects") these days. Their average minute ventilation values are much greater than the normal value, which used to be the norm about 80-100 years ago.

Minute ventilation (or respiratory minute volume, or flow of air) is the volume of air which can be inhaled (inhaled minute volume) or exhaled during 1 minute. It is used as a measure of hyperventilation.

Hyperventilation Prevalence Table
(or respiratory minute volume) at rest for normal subjects

Condition	Minute ventilation	Age	N. of subjects	Reference
Healthy Subjects	6-7 L/min	-	>400	Results of 14 studies
Normal breathing	6	-	-	Medical textbooks
Normal subjects	4.9	-	5	Griffith et al, 1929
Normal males	5.3±0.1	27-43	46	Shock et al, 1939
Normal females	4.6±0.1	27-43	40	Shock et al, 1939
Normal subjects	6.9±0.9	-	100	Matheson et al, 1950
Normal subjects	9.1±4.5	31±7	11	Kassabian et al, 1982
Normal subjects	8.1±2.1	42±14	11	D'Alonzo et al, 1987
Normal subjects	6.3±2.2	-	12	Pain et al, 1988
Normal males	13±3	40 (av.)	12	Clague et al, 1994
Normal subjects	9.2±2.5	34±7	13	Radwan et al, 1995
Normal subjects	15±4	28-34	12	Dahan et al, 1995
Normal subjects	12±4	55±10	43	Clark et al, 1995
Normal subjects	12±2	41±2	10	Tantucci et al, 1996
Normal subjects*	11±3	53±11	24	Clark et al, 1997
Normal subjects	8.1±0.4	34±2	63	Meessen et al, 1997
Normal females	9.9	20-28	23	Han et al, 1997
Normal males	15	20-28	47	Han et al, 1997
Normal females	10	29-60	42	Han et al, 1997
Normal males	11	29-62	42	Han et al, 1997
Normal subjects	13±3	36±6	10	Tantucci et al, 1997
Normal subjects	12±1	65±2	10	Epstein et al, 1996
Normal subjects	12±1	12-69	20	Bowler et al, 1998
Normal subjects	10±6	39±4	20	DeLorey et al, 1999
Normal seniors	12±4	70±3	14	DeLorey et al, 1999
Normal elderly*	14±3	88±2	11	DeLorey et al, 1999
Normal subjects	17±1	41±2	15	Tantucci et al, 2001
Normal subjects	10±0.5	-	10	Bell et al, 2005
Normal subjects	8.5±1.2	30±8	69	Narkiewicz, 2006
Normal females	10±0.4	-	11	Ahuja et al, 2007
Normal subjects	12±2	62±2	20	Travers et al, 2008
Condition	Minute ventilation	Age	N. of subjects	Reference

Prevalence of hyperventilation in modern population

Based on standard deviations for the above studies related to normal subjects, we can state that over 90% of modern normal subjects breathe more than the medical norms. Therefore, more than 90% of modern normals suffer from chronic hyperventilation.

Technical note. If we consider Wikipedia or some other sources saying 5-8 or 6-8 L/min as a normal range for minute ventilation, then hyper means more than 8 L/min. With numerous studies that found about 12 L/min as an average and bell-shape or Gaussian distribution with standard deviation 2-3 L/min (also common), we know that about 90% will be in the range from 10 to 14 or 9 to 15 L/min. The remaining part will have less than the lower range 9 or 10, or higher than the upper range that 14 or 15 L/min. Therefore, less than 10% of subjects (even less than 5%) are within or less than the norm. We can get the same result even if you assume 6-9 or 5-9 as normal values. These are basics of the theory of probability.

What are hyperventilation causes, symptoms and treatment?

Main causes of hyperventilation are lifestyle risk factors, such as sedentary lifestyle (lack of physical exercise), mouth breathing, chest breathing, poor posture, overeating, stress, ... Learn more:

Causes of hyperventilation

Common symptoms of hyperventilation include: bronchospasm, constipation, coughing, muscle cramps, anxiety, fatigue, insomnia, nasal congestion, sighing, shortness of breath, angina pain, ... Read more:

Symptoms of hyperventilation

Successful treatment of hyperventilation is based on those breathing exercises that reduce minute ventilation at rest and increase alveolar CO2 levels. Correction of lifestyle risk factors is necessary too. More info:

Treatment of hyperventilation

Reference Web Pages: Breathing norms, Medical Graphs and Tables about Breathing Rates (Minute Ventilation) and Body Oxygen in Healthy, Normal and Sick People
Breathing norms Parameters, graph, and description of the normal breathing pattern
6 breathing myths 6 myths about breathing and body oxygenation (prevalence: over 90%)
Hyperventilation Definitions of hyperventilation: their advantages and weak points
Hyperventilation Syndrome in the Sick. Table 1. Western scientific evidence about prevalence of CHV (chronic hyperventilation) in patients with various chronic conditions (34 medical studies)
Normal Minute Ventilation in Healthy Subjects: Easy and Light Breathing (14 Studies)
Hyperventilation Prevalence Present in Over 90% of Normal People (24 medical publications)
HV and hypoxia How and why deep breathing reduces oxygenation of cells and tissues of all vital organs
Body oxygen test How to measure your own breathing and body oxygenation (a simple DIY test)
Body oxygen in healthy Table 4. CP (body oxygen level) in healthy people (27 medical studies)
Body oxygen in sick Table 5. CP (body oxygen level) in sick people (14 medical studies)
Buteyko Table of Health Zones with clinical description of most common zones
Morning HV Morning hyperventilation effect or how and why critically ill people are most likely to die during early morning hours

References: CO2 Effects Web Pages
Vasodilation: CO2 expands arteries and arterioles facilitating perfusion (or blood supply) to all vital organs
The Bohr effect How and why oxygen is released by red blood cells in tissues
Cell Oxygen Levels and oxygen transport are controlled by alveolar CO2 and breathing
Oxygen Transport depends on breathing and these two effects (Vasoconstriction-Vasodilation and the Bohr effect) are parts of two diagrams that summarize influences of hypocapnia (low CO2 content in the blood and cells) on circulation and O2 delivery
Free Radical Generation takes place due to anaerobic cell respiration caused by cell hypoxia. Hence, antioxidant defenses of the human body are also regulated by CO2 and breathing
Inflammatory Response is controlled by breathing since hypoxia leads to or intensifies chronic inflammation through over-expression of the hypoxia-inducible factor 1, while normal breathing reduces these processes
Nerve stabilization takes place due to calmative or sedative effects of carbon dioxide in neurons or nerve cells
Muscle relaxation or relaxation of muscle cells is normal at high CO2, while hypocapnia causes muscular tension, poor posture and, sometimes, aggression and violence
Brochodilation - dilation of airways (bronchi and bronchioles) by carbon dioxide, and their constriction due to hypocapnia
CO2: Best Natural Cough Suppressant and "home remedy" since it calms urge-to-cough nerve receptors located in the tracheobronchial tree and larynx
Blood pH regulation and regulation of other bodily fluids
CO2: Lung Damage Healer: Elevated carbon dioxide prevents injury and promotes healing of lung tissues
CO2: Skin and Tissue Healer
Synthesis of Glutamine in the Brain, CO2 fixation, and other chemical reactions
CO2 myth "CO2 is a toxic waste gas" myth
Breathing control How is our breathing regulated? Why hypocapnia makes breathing uneven and erratic?

References for Hyperventilation Prevalence Table

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Department of Physiology, University of Buffalo, Buffalo, N. Y., USA

Shock NW, Soley MH, Average Values for Basal Respiratory Functions in Adolescents and Adults, J. Nutrition, 1939, 18, p. 143.
Departments of Physiology and Medicine, Medical School, University of California, Berkeley, California, USA.

Matheson HW, Gray JS, Ventilatory function tests. III Resting ventilation, metabolism, and derived measures, J Clin Invest 1950 June; 29(6): p. 688–692.
Department of Physiology, Northwestern University Medical School, Chicago, USA.

Kassabian J, Miller KD, Lavietes MH, Respiratory center output and ventilatory timing in patients with acute airway (asthma) and alveolar (pneumonia) disease, Chest 1982 May; 81(5): p.536-543.
Pulmonary Division, Department of Medicine, College of Medicine and Dentistry of New Jersey, New Jersey hfedical School, College Ho ital, Newark, USA.

Burki NK, Ventilatory effects of doxapram in conscious human subjects, Chest 1984 May; 85(5): p.600-604.
Pulmonary Division, Department of Medicine, and Department of Physiology and Biophysics, University of Kentucky Medical Center, Lexington, UK

D'Alonzo GE, Gianotti LA, Pohil RL, Reagle RR, DuRee SL, Fuentes F, Dantzker DR, Comparison of progressive exercise performance of normal subjects and patients with primary pulmonary hypertension, Chest 1987 Jul; 92(1): p.57-62.
Divisions of Pulmonary Medicine and Cardiology, Department of Internal Medicine, University of Texas Medical School, and Hermann Hospital, Houston, USA

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Department of Thoracic Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.

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Department of Anesthesiology and Department of Physiology, University of Leiden, Leiden, The Netherlands.

Clark AL, Chua TP, Coats AJ, Anatomical dead space, ventilatory pattern, and exercise capacity in chronic heart failure, Br Heart J 1995 Oct; 74(4): p. 377-380.
Department of Cardiac Medicine, National Heart and Lung Institute, London

Tantucci C, Bottini P, Dottorini ML, Puxeddu E, Casucci G, Scionti L, Sorbini CA, Ventilatory response to exercise in diabetic subjects with autonomic neuropathy, J Appl Physiol 1996, 81(5): p.1978–1986.
Clinica di Semeiotica Metodologia Medica, University of Ancona,
Ospedale Regionale Torrette, Ancona 60020; and Istituto di Medicina
Interna e Scienze Endocrine e Metaboliche, University of Perugia, Perugia 06100, Italy

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Departnent of Cardiac Medicine, National Heart and Lung Institute, London, UK

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Dept of Pulmonary Diseases and Dept of Pulmonology, University Hospital Nijmegen, Dekkerswald, Groesbeek, The Netherlands.

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