HVPT - Hyperventilation Provocation Test
(Part 1-A. Learning the Buteyko method by modules)
Hyperventilation 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 –
an 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
Warning 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 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
"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.
According to Buteyko, the hyperventilation provocation test helped to define the most damaged system or
organ in the body. 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 deep breathing test, not an asthma attack, but
dizziness and other symptoms of brain vessel spasms or spasms of pain near the
heart (angina pectoris), then it is not lung damage, but stroke that is the main
threat to their life" 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
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
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
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
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.
Cases, when deep and big breathing (voluntary hyperventilation) improved the
health state, while decreased breathing made it worse, have never been
observed during over 30 years of clinical practice (Buteyko, 1991a).
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.
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