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The Complete CP Table for sick people

Abbreviations for the Table: "max" - maximum; "in" - inhalation; "out" - outhale or exhalation; "norm" - normal.

Condition # of
subj.
CP,
s
BHT,
s
Test conditions
(order of actions
before BHT test)
% of
BHT
for CP
Reference
Hypertension 95 12 s 12 s Norm out, stress 100% Ayman et al, 1939
Neurocircular. asthenia 54 16 s 40 s Max in 40% Friedman, 1945
Anxiety states 62 20 s 28 s Norm in 73% Mirsky et al, 1946
Class 1 heart patients 16 16 s 48 s Max: in, out, in 33.3% Kohn & Cutcher, 1970
Class 2-3 heart patients 53 13 s 39 s Max: in, out, in 33.3% Kohn & Cutcher, 1970
Pulmonary emphysema 3 8 s 23 s Max: in, out, in 33.3% Kohn & Cutcher, 1970
Functional heart disease 13 5 s 15 s Max: in, out, in 33.3% Kohn & Cutcher, 1970
Asymptom. asthmatics 7 20 s 55 s Max out, max in 38 % Davidson et al, 1974
Asthmatics with sympt 13 11 s 27 s Max in 40 % Perez-Padilla .., 1989
Panic attack 14 11 s 34 s Deep breath:50%O2 33.3% Zandbergen .., 1992
Anxiety disorders 14 16 s 49 s Deep breath:50%O2 33.3% Zandbergen .., 1992
Outpatients 25 17 s 43 s Max in 40 % Gay et al, 1994
Inpatients 25 10 s 25 s Max in 40 % Gay et al, 1994
COPD or CHF 7 8 s 21 s Max in 40 % Gay et al, 1994
12 heavy smokers 12 8 s 21 s Max in 40 % Gay et al, 1994
Panic disorder 23 16 s 16 s Norm out 100% Asmudson..., 1994
Sleep apnoea 30 20 s 20 s Norm out 100% Taskar et al, 1995
Success. lung transpl. 9 23 s 23 s Norm out 100% Flume et al, 1996
Success. heart transpl. 8 28 s 28 s Norm out 100% Flume et al, 1996
Outpatients with COPD 87 8 s 9.2 s Norm out, supine 90% Marks et al, 1997
Asthma 55 14 s 24 Norm out, trained 60 % Nannini et al, 2007


Notes. * “Handbook of physiology”, after analysing numerous relevant publications, suggested the following proportions for BHT measurements (Mithoefer, 1965). If BHT after full inhalation is 100%; then BHT after normal inhalation is 55%; BHT after normal exhalation is 40%; BHT after full exhalation is 24%. Taking an additional full exhalation or inhalation before starting the test increases BHT by about 5 or 15% respectively for each manoeuvre. Subjects, who have repetitive breath holds in a day, experience the “training” effect that gradually increases maximum breath holding time (up to 30%), but the BHT test done until first stress or initial discomfort is not improved using such training. This information allows us to compare different BHT tests done during almost a century of clinical investigations, if we use some standard conditions for the test. In order to do that, let me introduce the CP (Control Pause): the CP is BHT after quiet or usual expiration and only until first sensation of air-hunger (a stress-free version of the test). For people who practiced breath holding many times per day, BHT for as long as possible after usual exhalation is about 2 times longer then the CP due to the “training effect”. For naïve people, it is only about 30% greater.
**. Zandbergen et al, 1992 conducted their experiments with the mixture of 50% O2 and 50% N2. According to Ferris with his colleagues (1945), such mixture increases normal BHT by about 50%.

References (in the same order)

Ayman et al, 1939

Ayman D, Goldshine AD, The breath-holding test. A simple standard stimulus of blood pressure, Archives of Intern Medicine 1939, 63; p. 899-906.


Friedman, 1945

Friedman M, Studies concerning the aetiology and pathogenesis of neurocirculatory asthenia III. The cardiovascular manifestations of neurocirculatory asthenia, Am Heart J 1945; 30, 378-391.


Mirsky et al, 1946

Mirsky I A, Lipman E, Grinker R R, Breath-holding time in anxiety state, Federation proceedings 1946; 5: p. 74.


Kohn & Cutcher, 1970

Kohn RM & Cutcher B, Breath-holding time in the screening for rehabilitation potential of cardiac patients, Scand J Rehabil Med 1970; 2(2): p. 105-107.


Davidson et al, 1974

Davidson JT, Whipp BJ, Wasserman K, Koyal SN, Lugliani R, Role of the carotid bodies in breath-holding, New England Journal of Medicine 1974 April 11; 290(15): p. 819-822.


Perez-Padilla et al, 1989

Perez-Padilla R, Cervantes D, Chapela R, Selman M, Rating of breathlessness at rest during acute asthma: correlation with spirometry and usefulness of breath-holding time, Rev Invest Clin 1989 Jul-Sep; 41(3): p. 209-213.


Zandbergen et al, 1992

Zandbergen J, Strahm M, Pols H, Griez EJ, Breath-holding in panic disorder, Compar Psychiatry 1992 Jan-Feb; 33(1): p. 47-51.


Gay et al, 1994

Gay SB, Sistrom C1L, Holder CA, Suratt PM, Breath-holding capability of adults. Implications for spiral computed tomography, fast-acquisition magnetic resonance imaging, and angiography, Invest Radiol 1994 Sep; 29(9): p. 848-851.


Asmudson & Stein, 1994

Asmundson GJ & Stein MB, Triggering the false suffocation alarm in panic disorder patients by using a voluntary breath-holding procedure, Am J Psychiatry 1994 Feb; 151(2): p. 264-266.


Taskar et al, 1995

Taskar V, Clayton N, Atkins M, Shaheen Z, Stone P, Woodcock A, Breath-holding time in normal subjects, snorers, and sleep apnea patients, Chest 1995 Apr; 107(4): p. 959-962.


Flume et al, 1996

Flume PA, Eldridge FL, Edwards LJ, Mattison LE, Relief of the 'air hunger' of breathholding. A role for pulmonary stretch receptors, Respir Physiol 1996 Mar; 103(3): p. 221-232.


Marks et al, 1997

Marks B, Mitchell DG, Simelaro JP, Breath-holding in healthy and pulmonary-compromised populations: effects of hyperventilation and oxygen inspiration, J Magn Reson Imaging 1997 May-Jun; 7(3): p. 595-597.


Nannini et al, 2007

Nannini LJ, Zaietta GA, Guerrera AJ, Varela JA, Fernandez AM, Flores DM, Breath-holding test in subjects with near-fatal asthma. A new index for dyspnea perception, Respiratory Medicine 2007, 101; p.246–253.


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