Presence of hyperventilation in patients with asthma-like symptoms but negative asthma test responses:: Provocation with voluntary hyperventilation and mental stress

Background: A group of patients reporting asthma-like symptoms but with negative asthma tests has been identified. Objective: The objective of this study was to determine whether hyperventilation might explain these symptoms and whether the tests could be used as diagnostic tools. Methods: A hyperventilation provocation test (HVPT), a mental stress test, and the Word Color Conflict Test (WCCT) were performed on 10 patients with asthma-like symptoms, 10 patients with asthma, and 10 healthy subjects. End-tidal PCO2 (PETCO2) was recorded 10 minutes after the HVPT and during the WCCT Blood pressure, heart rate, and respiratory rate were also studied. The Nijmegen symptom questionnaire was used in the assessment of symptoms. Results: After the HVPT, the PETCO2 values recovered most slowly in the study group, the difference being significant compared with the healthy group (P < .01), During the WCCT, the study group had the lowest PETCO2 values at the 10- and 15-minute measurements, the difference again being significant compared with the healthy group (P < .05). The study group more often experienced symptoms before the test than the group with asthma (P < .05) and the healthy group (P < .001). The study group recognized significantly more symptoms previously experienced during the HVPT than the group with asthma (P < .05) and the healthy group (P < .01) and during the WCCT than the healthy group (P < .05). The study group showed a negative correlation between the PETCO2 level and the number of symptoms after the HVPT at 8 (r = -0-72; P < .05) and 10 minutes (r = -0.76; P < .05) and after the WCCT (r = -0.59; P < .05). Blood pressure, heart rate, and respiratory rate shelved small differences between the groups. Conclusion: Patients with asthma-like symptoms may experience hyperventilation when provoked. Mental stress might be 1 trigger factor. The HVPT and WCCT can be used as diagnostic instruments.