Hyperventilation Provocation Test (HVPT): Guidelines, Instructions, and Effects

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Hyperventilation Provocation Test (HVPT): Guidelines, Instructions, and Effects 1By Dr. Artour Rakhimov, Alternative Health Educator and Author

- Medically Reviewed by Naziliya Rakhimova, MD

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

HVPTThe Hyperventilation Provocation Test (HVPT) has been used by medical doctors for many decades in order to identify the body’s most vulnerable system. The test can be dangerous in some situations; such cases are explained below.

What are the effects? Voluntary over-breathing in asthmatics causes asthma attacks; in people with hypertension, heart attacks; in people with epilepsy, epileptic seizures, etc. Below are references to several medical studies, for various health conditions, in which researchers observed that over-breathing increased symptoms. Note the 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.

Dr. Buteyko, MD, Ph.D. spoke about the HPVT during his famous 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 doubt that breathing lots of air is good for health, or provides more oxygen to the body, perform the deep breathing test yourself. For many decades, Western doctors have been using this test to discover a patient’s “weakest link” without any restrictions. However, Russian Buteyko doctors found that, in certain cases, some precautions are required.

Warning sign Warning for asthmatics. People with asthma should never do the HVPT through the mouth. This makes the test unsafe and increases the likelihood of an asthma attack. More details about this are explained below to members only.

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Warning sign Warning for heart disease patients. If you suffer from heart disease, you should also be very careful. HVPT may cause heart rate to rise excessively. This can provoke serious heart problems. The exact guidelines for patients with heart disease can be found in the members-only content below.

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Procedure for the Hyperventilation Provocation Test

To conduct the HVPT, sit in a chair and begin breathing 2 to 3 times deeper than you usually breathe. As the test proceeds, pay attention to your symptoms. What is happening to your thinking process? What kinds of sensations do you feel in your body? When you notice any specific negative symptoms (chest tightness, wheezing, angina pain, skin itching, dizziness, etc.), stop the test.

The next step is to reverse the equation. To eliminate these negative symptoms, try breathing less than usual. While actively relaxing breathing muscles and all other body parts, take about 80-90% of your normal inhalation and try to increase relaxation on exhalation. Continue this pattern of reduced breathing (i.e., breathing less air) until your symptoms disappear. Symptoms should reduce or vanish within 3 to 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 below 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 in the overall success of later 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 a 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 to 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) were first administered the HVPT (with a breathing frequency of 60 times per minute, for 3 mins. maximum, breathing through both mouth and nose as vigorously as possible). Over 95% of patients recognized their symptoms, which were more severe than 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 able 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 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, 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 hyperventilation provocation test (HVPT) has been used by Russian doctors for all patients, and is conducted repeatedly until the patient realizes the simple connection between their health state and their breathing (which can be self-regulated).

Due to possible complications, doctors perform the test while constantly monitoring the patient’s pulse (e.g., every 10-15 secs). If the pulse increases by more than 30% during the HVPT, the test is stopped to prevent possible heart problems.

For asthmatics, this test should be done only through the nose. Otherwise, inflammatory processes can appear, due to large movements of cool air in the airways, which can make stopping an asthma attack difficult.

According to Dr. Buteyko, the test helps to define the most damaged system or organ of the organism (Buteyko, 1991a). In some cases, HVPT has diagnosed other serious or even life-threatening conditions in a patient. “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).

Most importantly, the hyperventilation provocation test has a lasting and profound impact on students’ understanding of breathing. It shatters students’ misconceptions about the usefulness of deep, big breathing, because it allows the student to practically experience the negative effects breathing too much air.

Immediately after the test, patients are taught how to eliminate the negative symptoms and conditions induced by the HVPT by using the Emergency Procedure, which is described in this chapter. If the patient does not realize the connection between over-breathing and his or her condition, the HVPT, followed by the Emergency Procedure (for recovery), is repeated. Sometimes, it must be done several times in a row, until the patient gains insight. (Repeated use of the HVPT by Russian doctors is possible, since afterwards the Emergency Procedure is immediately applied).

Awareness about normal and abnormal breathing is not a recommendation to only briefly 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 respiration and prevent CO2 losses, which is vital to healthy, whole body oxygenation.