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A Summary of the Pathophysiology of Chronic Hyperventilation

by Ira Packman, M.D.

ira-packman-md-on-chronic-hyperventilation

The fact that chronic hyperventilation (CHV) has an effect on the lungs is easily understood and explained. The systemic (whole body) effects however, are physically and physiologically distant from the lungs and therefore are more difficult to understand. The multi-system, wide spread systemic ramifications of chronic hyperventilation are numerous.

These effects are all caused by the initial effect of pulmonary hypocapnia (low CO2) which causes spasm of the airways leading to asthma. The loss of CO2 from the lung on a long term basis causes a compensatory response throughout the body. This concept is called homeostasis which means that the body is always trying to stay in balance and return to its most comfortable state.

A partial list of homeostatic controls would include:

  • Constant body temperature
  • Constant whole body water volume
  • Glucose levels
  • Mineral balance including sodium, potassium, magnesium, zinc etc.
  • Acid base balance (Ph control)

The acid base/Ph control mechanisms are very sensitive and closely controlled, because the Ph of the body affects the function of every body system. It is this system that is activated when patients chronically hyperventilate.

Understanding this concept, we can follow what happens with CHV.

  • The lungs continuously blow off too much CO2 causing local pulmonary hypocapnia (low CO2) and arterial hypocapnia.
  • The arterial hypocapnia immediately changes the Ph of the circulating blood causing an increase in the Ph (alkalosis).
  • The increase in the Ph causes a decrease in the delivery of Oxygen to all the bodies tissues due to the Bohr Effect (In an alkalotic environment, the hemoglobin molecules in the red cells hold onto the oxygen molecules more tightly and will not release the O2 to the tissues).
  • The kidneys see the alkalosis/Ph change and know that it must correct the bodies Ph back towards neutral (neutral Ph is a Ph of 7.40). Once CHV becomes long standing the kidneys response becomes an ongoing process in which the kidneys excrete bicarbonate in an attempt to correct the alkalosis which was created by the CHV.
  • The net result is a depletion of the bicarbonate buffers due to continuous over excretion of bicarbonate which also causes the loss of electrolytes including magnesium and phosphorous which are lost with the bicarbonate.
  • The loss of phosphorous also decreases the production of ATP (adenosine tri-phosphate) and ADP which are the bodies’ main source of energy.
  • This then causes a decrease in the functioning of many organs including the muscles, heart, lungs, bone marrow, immune system and liver.
  • These functional changes, coupled with the arterial spasm that occurs directly due to the low CO2 levels in the blood, are expressed in the long term as muscle fatigue, hypertension due to arterial spasm, decrease in the oxygenation of the brain, migraine headaches due to arterial spasm, spasm of the arteries supplying the gut, decrease brain function with memory changes, alterations in the production of proteins and metabolism of lipids in the liver causing elevated cholesterol.

This is just a partial list of the systems, organs and bodily functions which are affected by CHV and the subsequent low CO2 levels in the lungs and blood.

This concept regarding the origins and causes of these diseases is very radically different from the way medical schools teach about these diseases. It is revolutionary and may be too simple for many academicians to accept or understand.