Hyperventilation and Sighing

Hyperventilation and sighing are not typical asthma symptoms. However, these breathing patterns are common in people with asthma.¹

What is hyperventilation?

Hyperventilation is also known as “overbreathing.”² Overbreathing is breathing more quickly or deeply than normal.³ This causes low carbon dioxide levels in your blood. Low carbon dioxide leads to symptoms such as:

• Light-headedness or dizziness
• Fatigue
• Pins and needles sensation
• Numbness
• Anxiety

What causes hyperventilation?

There are some medical problems that cause hyperventilation. It is not clear whether or how asthma might actually cause hyperventilation or sighing.⁴ When hyperventilation and deep sighing are not caused by a medical condition, they are considered “dysfunctional breathing.”¹ About 8% of the general population and 29% of patients with asthma have dysfunctional breathing.¹ Other dysfunctional breathing patterns are frequent yawning and shortness of breath with normal lung function.

It is also not clear why people with asthma might be more prone to dysfunctional breathing. Anxiety may have a role in linking the two conditions. People with asthma and dysfunctional breathing typically have more anxiety. Their quality of life is often lower.¹

Anxiety is a common cause of hyperventilation.² For some people, increasing asthma symptoms may lead to anxiety or panic. Panic then causes hyperventilation.⁴ Research has shown that people who hyperventilate feel that their asthma is not well-controlled.³ More studies are needed to understand how hyperventilation, anxiety, and asthma relate.⁴

What conditions can cause hyperventilation?

The most common cause of hyperventilation is feeling anxious or panicked.² Other causes include:

• Bleeding
• Heart or lung disease
• Drug overdose
• Infection
• Pregnancy
• Severe pain

Hyperventilating in these situations is not considered “dysfunctional” because it is caused by an underlying medical problem.

How is hyperventilation evaluated with asthma?

Your health care provider will ask questions about your medical history and symptoms.² Your provider will also do a physical exam. You may be asked to breathe in a way that causes you to start hyperventilating. You may be asked to do some tests including:²

• Blood tests to check the oxygen and carbon dioxide levels
• Electrocardiogram
• Chest x-ray
• Imaging tests

If no medical cause of hyperventilation is found, the Nijmegen Questionnaire can be used to check for hyperventilation syndrome.⁵ This questionnaire lists 16 different symptoms. You will be asked how often you have each symptom. A score of 23 or more indicates that you may have hyperventilation syndrome. Some of the symptoms on the questionnaire are also typical of asthma, such as shortness of breath or chest tightness. Therefore, people with asthma may have a higher score.¹

How is hyperventilation treated with asthma?

Asthma medications do not treat hyperventilation.³ Even if medications have your asthma symptoms under control, you could still hyperventilate.

You could ask your provider about breathing exercises.³ Breathing exercises train your diaphragm to work better.¹ Your diaphragm is a large muscle at the bottom of your chest cavity that enables you to breathe in and out.

If stress or anxiety cause hyperventilation, you can try:²

• Practicing relaxation and breathing techniques
• Exercise
• Seeing a mental health provider about anxiety and depression

When you are hyperventilating, you need to increase the carbon dioxide in your blood.² You can do this by taking in less oxygen. Try breathing through pursed lips, as if you are blowing out a candle or whistling. An alternative is to cover your mouth and one nostril, and breathe through the other nostril.