{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T06:35:53Z","timestamp":1778394953827,"version":"3.51.4"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T00:00:00Z","timestamp":1688428800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Whether dysfunctional breathing (DB) subtype classification is useful remains undetermined. The hyperventilation provocation test (HVPT) is used to diagnose DB. This test begins with a 3-min phase of hyperventilation during which fractional end-tidal CO<jats:sub>2<\/jats:sub> (FETCO<jats:sub>2<\/jats:sub>) decreases that could be an assessment of plant gain, which relies on CO<jats:sub>2<\/jats:sub> stores. Our aim was to assess 1) whether the children suffering from different subtypes of DB exhibit decreased plant gain and 2) the relationships between HVPT characteristics and plant gain.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We retrospectively selected 48 children (median age 13.5\u00a0years, 36 females, 12 males) who exhibited during a cardiopulmonary exercise test either alveolar hyperventilation (transcutaneous PCO<jats:sub>2<\/jats:sub> &amp;lt; 30\u00a0mmHg, <jats:italic>n<\/jats:italic> = 6) or inappropriate hyperventilation (increased VE\u2019\/V\u2019CO<jats:sub>2<\/jats:sub> slope) without hypocapnia (<jats:italic>n<\/jats:italic> = 18) or dyspnea without hyperventilation (<jats:italic>n<\/jats:italic> = 18) compared to children exhibiting physiological breathlessness (dyspnea for sports only, <jats:italic>n<\/jats:italic> = 6). These children underwent tidal-breathing recording (ventilation and FETCO<jats:sub>2<\/jats:sub> allowing the calculation of plant gain) and a HVPT.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The plant gain was significantly higher in the physiological group as compared to the dyspnea without hyperventilation group, <jats:italic>p<\/jats:italic> = 0.024 and hyperventilation without hypocapnia group, <jats:italic>p<\/jats:italic> = 0.008 (trend for the hyperventilation with hypocapnia group, <jats:italic>p<\/jats:italic> = 0.078). The slope of linear decrease in FETCO<jats:sub>2<\/jats:sub> during hyperventilation was significantly more negative in physiological breathlessness group as compared to hyperventilation without hypocapnia group (<jats:italic>p<\/jats:italic> = 0.005) and dyspnea without hyperventilation group (<jats:italic>p<\/jats:italic> = 0.049).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The children with DB, regardless of their subtype, deplete their CO<jats:sub>2<\/jats:sub> stores (decreased plant gain), which may be due to intermittent alveolar hyperventilation, suggesting the futility of our subtype classification.<\/jats:p>","DOI":"10.3389\/fphys.2023.1217391","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T15:46:58Z","timestamp":1688485618000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["A decrease in plant gain, namely CO2 stores, characterizes dysfunctional breathing whatever its subtype in children"],"prefix":"10.3389","volume":"14","author":[{"given":"Plamen","family":"Bokov","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudine","family":"Peiffer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Gallego","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jade","family":"Pautrat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boris","family":"Matrot","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christophe","family":"Delclaux","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"379","DOI":"10.3389\/fped.2020.00379","article-title":"Pediatric dysfunctional breathing: Proposed components, mechanisms, diagnosis, and management","volume":"8","author":"Barker","year":"2020","journal-title":"Front. Pediatr."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1152\/japplphysiol.00859.2015","article-title":"Increased ventilatory variability and complexity in patients with hyperventilation disorder","volume":"120","author":"Bokov","year":"2016","journal-title":"J. Appl. Physiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1152\/japplphysiol.00010.2018","article-title":"Comparison of methods of chemical loop gain measurement during tidal ventilation in awake healthy subjects","volume":"125","author":"Bokov","year":"2018","journal-title":"J. Appl. Physiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.sleep.2020.01.023","article-title":"Cross-sectional study of loop gain abnormalities in childhood obstructive sleep apnea syndrome","volume":"69","author":"Bokov","year":"2020","journal-title":"Sleep. Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1183\/16000617.0088-2015","article-title":"Dysfunctional breathing: A review of the literature and proposal for classification","volume":"25","author":"Boulding","year":"2016","journal-title":"Eur. Respir. Rev."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1152\/jappl.1988.65.3.1400","article-title":"A minimal mathematical model of human periodic breathing","volume":"65","author":"Carley","year":"1988","journal-title":"J. Appl. Physiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1203\/00006450-198706000-00012","article-title":"Coupling of ventilation and CO2 production during exercise in children","volume":"21","author":"Cooper","year":"1987","journal-title":"Pediatr. Res."},{"key":"B8","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1152\/jappl.1984.56.3.628","article-title":"Aerobic parameters of exercise as a function of body size during growth in children","volume":"56","author":"Cooper","year":"1984","journal-title":"J. Appl. Physiol. Respir. Environ. Exerc Physiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"CD011142","DOI":"10.1002\/14651858.CD011142.pub2","article-title":"Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults","volume":"11","author":"Dessel","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"B10","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/0022-3999(85)90042-x","article-title":"Efficacy of Nijmegen Questionnaire in recognition of the hyperventilation syndrome","volume":"29","author":"Dixhoorn","year":"1985","journal-title":"J. Psychosom. Res."},{"key":"B11","doi-asserted-by":"publisher","first-page":"00001","DOI":"10.1183\/23120541.00001-2015","article-title":"The Nijmegen Questionnaire and dysfunctional breathing","volume":"1","author":"Dixhoorn","year":"2015","journal-title":"ERJ Open Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e001126","DOI":"10.1136\/bmjresp-2021-001126","article-title":"Dysfunctional breathing diagnosed by cardiopulmonary exercise testing in \u201clong COVID\u201d patients with persistent dyspnoea","volume":"9","author":"Fr\u00e9sard","year":"2022","journal-title":"BMJ Open Respir. Res."},{"key":"B13","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1164\/rccm.202005-1687OC","article-title":"Mobilizing carbon dioxide stores. An experimental study","volume":"203","author":"Giosa","year":"2021","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1183\/09031936.00130212","article-title":"Dysfunctional breathing in children with asthma: A rare but relevant comorbidity","volume":"41","author":"Groot","year":"2013","journal-title":"Eur. Respir. J."},{"key":"B15","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1183\/09031936.97.10010167","article-title":"Unsteadiness of breathing in patients with hyperventilation syndrome and anxiety disorders","volume":"10","author":"Han","year":"1997","journal-title":"Eur. Respir. J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/s0140-6736(96)02024-7","article-title":"Double-blind placebo-controlled study of the hyperventilation provocation test and the validity of the hyperventilation syndrome","volume":"348","author":"Hornsveld","year":"1996","journal-title":"Lancet"},{"key":"B17","doi-asserted-by":"publisher","first-page":"620955","DOI":"10.3389\/fphys.2020.620955","article-title":"Cardiopulmonary exercise testing in the assessment of dysfunctional breathing","volume":"11","author":"Ionescu","year":"2020","journal-title":"Front. Physiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1164\/rccm.200207-720OC","article-title":"Ventilatory responses to inhaled carbon dioxide, hypoxia, and exercise in idiopathic hyperventilation","volume":"170","author":"Jack","year":"2004","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1002\/ppul.22905","article-title":"Cross-sectional assessment of exertional dyspnea in otherwise healthy children","volume":"49","author":"Mahut","year":"2014","journal-title":"Pediatr. Pulmonol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"6482","DOI":"10.3390\/jcm11216482","article-title":"Validation criteria for PETCO2 kinetics during the hyperventilation provocation test in the diagnosis of idiopathic hyperventilation syndrome","volume":"11","author":"Pauwen","year":"2022","journal-title":"J. Clin. Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"2428","DOI":"10.1002\/ppul.26052","article-title":"Diagnostic tests and subtypes of dysfunctional breathing in children with unexplained exertional dyspnea","volume":"57","author":"Peiffer","year":"2022","journal-title":"Pediatr. Pulmonol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1186\/2193-1801-3-426","article-title":"Endurance-training in healthy men is associated with lesser exertional breathlessness that correlates with circulatory-muscular conditioning markers in a cross-sectional design","volume":"3","author":"Plantier","year":"2014","journal-title":"Springerplus"},{"key":"B23","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1097\/00001648-199001000-00010","article-title":"No adjustments are needed for multiple comparisons","volume":"1","author":"Rothman","year":"1990","journal-title":"Epidemiology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"105894","DOI":"10.1016\/j.rmed.2020.105894","article-title":"The impact of dysfunctional breathing on the level of asthma control in difficult asthma","volume":"163","author":"Sedeh","year":"2020","journal-title":"Respir. Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"106329","DOI":"10.1016\/j.rmed.2021.106329","article-title":"Comparative analysis between available challenge tests in the hyperventilation syndrome","volume":"179","author":"Tiotiu","year":"2021","journal-title":"Respir. Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1183\/09031936.93.04040393","article-title":"Diagnostic tests of hyperventilation syndrome","volume":"4","author":"Vansteenkiste","year":"","journal-title":"Eur. Respir. J."},{"key":"B27","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1080\/17843286.1991.11718157","article-title":"Evaluation of the clinical usefulness of capnography curves during a hyperventilation provocation test in the diagnosis of hyperventilation syndrome","volume":"46","author":"Vansteenkiste","year":"","journal-title":"Acta Clin. Belg."}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2023.1217391\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T15:47:01Z","timestamp":1688485621000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2023.1217391\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,4]]},"references-count":27,"alternative-id":["10.3389\/fphys.2023.1217391"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2023.1217391","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,4]]},"article-number":"1217391"}}