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HVPT - Hyperventilation Provocation Test

(Part 1-A. Learning the Buteyko method by modules)

Man with chest painHyperventilation provocation test has been used by medical doctors for many decades in order to identify the most vulnerable system in the human body. It can be dangerous in some situations and such cases are explained below. What are the effects? Voluntary over-breathing in asthmatics causes an asthma attack, in people with hypertension – a heart attack, in epileptics – epilepsy seizures, etc. Here is a short summary of some medical studies regarding different health conditions, a number of patients investigated, and the percentage of patients who reproduced their specific health problem:
- coronary artery spasms (Nakao et al, 1997) 206 patients, 100% specific;
- bronchial asthma (Mojsoski N & Pavicic F, 1990) 90 patients, 100% specific;
- panic attacks (Bonn & Readhead, 1984; Holt PE, Andrews, 1989; Nardi et al, 2000), 95-100% specific;
- epileptic absence seizures (Esquivel, 1991; Wirrel, 1996), 95-100% specific.

Here is Dr. Buteyko, MD, PhD who speaks about the HPVT (hyperventilation provocation test) during his 1969 Lecture at the Moscow State University:

We give instructions to breathe deeper, our main and favorite instruction. As Sokolov wrote in the “Literaturnaya gazeta” [“Literary newspaper”], “Breathe deeper, but is it necessary?”
*This was the title of the article about Buteyko's discoveries published in this very popular Soviet newspaper on 1 May 1967.
We say “it is necessary”! [Do it] again, in order to cause these attacks. How soon? In 1-5 minutes. The sick patient sees that it is not hypnosis or psychotherapy, it is the law of physiology. And we again cause attacks of asthma, stenocardia, and epileptic seizures. For over 50 years it has been known that deep breathing triggers epileptic seizures.
Somehow, nobody could come up with the idea to try to reduce breathing and observe: maybe, they [seizures] will not appear? No, they do not appear in most patients. We checked that.
There is nothing surprising in this. The attack is induced. We then ask, “Well, how are you? Do not breathe!“ The patient again reduces his breathing and again the attack is gone. “Understood?” “No, I do not understand”… “Breathe deeper!”. .. And so on until he understands that his asthma or hypertension doesn’t come from somewhere out of the blue, but he himself causes it, i.e. his disease, and, indeed, he can cause it at any moment.

If you still have doubts and believe that deep or big breathing is good for health or provides more oxygen for the body, perform the deep breathing test. Western doctors have been using this test for many decades without any restrictions in order to find the most vulnerable part of the body. However, Russian Buteyko doctors found that in certain cases some precautions are required.

Warning signWarning for asthmatics. People with asthma should not hyperventilate through their mouth. Heavy mouth-breathing can trigger a real acute episode (or asthma attack) in these people due to irritation of airways. Hence, mouth hyperventilation is dangerous for them, and asthmatics can do the deep breathing test while breathing only through the nose.

Warning signWarning for heart diseases patients. If you suffer from heart disease, you should be very careful. Heart rate may rise by over 30% during this test. It can provoke serious heart problems. For your safety, do the test with a heart-rate monitor so that you can observe your pulse during the test. If your heart rate increases by 30% or more, you need to stop the test immediately. Hyperventilation can be dangerous for this group of people.

Hyperventilation provocation test (procedure)

To conduct the hyperventilation provocation test, start to breathe 2-3 times deeper than you usually do while sitting in a chair. Pay attention to your symptoms. What is going on with your ability to control thoughts and bodily sensations? When you get your specific negative symptoms (chest tightness, wheezing, angina pain, skin itching, dizziness, etc.), stop the test. Try to eliminate these negative symptoms by breathing less. Take about 80-90% of your usual inhalation and relax breathing muscles and all other body parts. Continue this reduced breathing (or breathe less) until the symptoms disappear. You should be able to achieve this in 3-5 minutes.

"If a patient has not understood the essence of a testing procedure or has not been convinced that their disease was caused by deep breathing, then the test will be repeated. In the event that a patient has not assimilated the VEDB method [volitional elimination of deep breathing] and cannot control the breathing process (this is primarily observed in adults who suffer mental disorders or in children under 3) then they are not able to use this method." Buteyko KP, The method of volitional elimination of deep breathing [Translation of the Small Buteyko Manual], Voskresensk, 1994.
Cases when deep and big breathing (voluntary hyperventilation) improved the health state, while decreased breathing made it worse, have never been observed in over 30 years of clinical practice (Buteyko, ibid.).

Here is additional reading for very curious breathing students:

Western research about the hyperventilation provocation test

Magarian GJ, Hyperventilation syndrome: infrequently recognized common expressions of anxiety and stress, Medicine 1982; 61: 219-236.
Magarian GJ, Middaugh DA, Linz DH, Hyperventilation syndrome: a diagnosis begging for recognition, West J Med 1983; 38: 733-736.

As a first practical step with this approach, it was "important that the patients be confronted with the cause-and-effect relationship and their symptoms. A hyperventilation trial is crucial for therapeutic success" (p. 736, Magarian et al, 1983). During the HVPT the patient breathed deeply at a rate of 30 to 40 times per minute. Most patients experienced their symptoms within minutes or seconds. Such recognition was a major factor for the overall successful outcome of the therapy.
Given its nature, the test should be conducted cautiously for patients with ischemic coronary disease, sickle cell disease, cerebrovascular insufficiency and baseline hypoxemia. Meanwhile, "it is of far greater detriment for the patient not to recognize the relationship between over-breathing and their symptoms than the potential risks of performing the test” (p.231, Magarian, 1982). The suggested duration of the test was 4-5 minutes.
When the HVPT was done, breathing into a bag resulted in quick alleviation of the symptoms. Finally, the patients were encouraged to use relaxation therapy and also taught how to retrain their own breathing pattern, from thoracic to diaphragmatic. The authors reported the low efficiency of different medications for the normalization of breathing.

St. Bartholomew's Hospital, London, UK
Bonn JA, Readhead CP, Timmons BH, Enhanced adaptive behavioral response in agoraphobic patients pretreated with breathing retraining, Lancet 1984 Sep 22; 2(8404): 665-669.

21 patients with agoraphobia (sensations of fear, panic, and terror), first, were administered the HVPT (with breathing frequency 60 times per minute, for 3 min maximum, breathing through both mouth and nose as vigorously as possible). Over 95% of patients recognized their symptoms, which were not as severe as usual. Two thirds of the patients were unable to complete the 3-min HVPT due to dizziness and distress. In contrast, only 4% of the normal subjects were unable to hyperventilate for 3 minutes. The authors emphasized the importance of the HVPT and the subsequent helpful "shock of recognition".

Institute of Stress Research, Netherlands
Grossman P, de Swart JCG, Defares PB, A controlled study of a breathing therapy for the treatment of hyperventilation syndrome, J Psychosom Res 1985; 29 (1): 49-58.

The researchers employed the HVPT for 3 minutes with the goal of reaching 2.5% etCO2 (end-tidal CO2). Then the physical and psychological symptoms, experienced by the patients, were discussed.

Department of Psychiatry, University of Utrecht, Netherlands
Ruiter de C, Ryken H, Garssen B, Kraaimaat F, Breathing retraining, exposure and a combination of both, in the treatment of panic disorder with agoraphobia, Behav Res Ther 1989; 27(6): 647-655.

The study was completed with 40 patients diagnosed with agoraphobia. All participants were selected on the basis of their ability to recognize their symptoms during the HVPT. The patients were informed as to how hyperventilation and, catastrophic thinking and worrying could cause panic attacks.

Extract from the book "Normal Breathing: the Key To Vital Health" by Dr. Artour Rakhimov:

6.1 The HVPT (hyperventilation provocation test)

The HVPT (hyperventilation provocation test) was done by Russian doctors for all patients and could be done repeatedly until the patient realized the simple connection between their health state and their breathing, which they can regulate.

Due to possible complications, this test was performed with constant monitoring of the patient's pulse (e.g., every 10-15 s). If the pulse increased by more than 30% during the HVPT, the test was stopped to prevent possible heart problems.

For asthmatics this test should be done through the nose only, otherwise, inflammatory processes can appear, due to large movements of cool air in the airways, and it would be much more difficult to stop the asthma attack.

According to Dr. Buteyko, the test helped to define the most damaged system or organ of the organism (Buteyko, 1991a). In some cases, it helped to diagnose a patient with another, more serious or life-threatening condition. "For example, if an asthmatic gets, during the HVPT, not an asthma attack, but dizziness and other symptoms of brain vessel spasms or spasms of pain near the heart (angina pectoris), then not the lungs' damage, but stroke is the main threat to his life" (Buteyko, 1991a).

In addition, the hyperventilation provocation test has lasting and profound impact on the misconception of the student about the usefulness of deep or big breathing. The student can practically experience its effects.

Immediately after the test, it was suggested to the patient how to eliminate the symptoms of the HVPT and his condition, using the Emergency Procedure described in this chapter. If the patient did not realize the connection between over-breathing and his/her condition, the HVPT, followed by the Emergency Procedure (in order to recover), was repeated. Sometimes, it was done several times in a row, until the patient gained insight. (Repeated use of the HVPT by Russian doctors was possible due to the following and immediate application of the efficient Emergency Procedure).

Awareness about normal and abnormal breathing was not just a recommendation or some information to consider. The patient, according to Doctor Buteyko, should constantly, day and night, pay attention to their breathing and use different methods, measures, and actions to normalize their respiration and prevent CO2 losses.

New breathing students with terminal conditions (end-stage disease) are accepted on with Dr. Artour's Triple Guarantee.

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