PubMed · 2496870
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1989-03-25. Chest physiotherapy.. https://pubmed.ncbi.nlm.nih.gov/2496870/
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OBJECTIVE: To determine the effect of breathing and relaxation instruction of patients after a myocardial infarction on the occurrence of cardiac events during 5 years. DESIGN: Prospective randomised. SETTING: Kennemer Gasthuis, Haarlem, the Netherlands. METHOD: In the period 1981-1983, 156 myocardial infarction patients were randomly assigned to either rehabilitation plus relaxation therapy (six weekly sessions of breathing and relaxation instruction) (n = 76) or cardiac rehabilitation alone (n = 80). The occurrence of cardiac events and the amount of medical consumption on the two treatments was compared during 5 years. RESULTS: At five-year follow-up, 12 cardiac deaths had occurred, 5 in the relaxation group and 7 in the control group, reinfarction was observed in 10 and 12 patients, and cardiac surgery was performed in 2 and 11, respectively. In total 15 (20%) and 26 patients (33%), respectively, had at least one of these events (odds ratio (OR) for the relaxation group: 0.51; 95% confidence interval (CI): 0.25-1.06). Medical consumption (counted as cardiac events and cardiac hospitalisations) was 30 patients (39%) experiencing 52 cardiac events in the relaxation group, for which the patients were hospitalized for a total of 476 days, and 38 patients (48%) experiencing 78 cardiac events in the control group (OR: 0.72; 95% CI: 0.38-1.36) with a total of 719 hospitalisation days; the total number of hospitalisations was reduced by 31% by relaxation instruction. CONCLUSION: In the long run, the disease course after myocardial infarction is probably influenced favourably by adding relaxation instruction to cardiac rehabilitation. The extra costs are compensated for by a decrease in hospitalisation for cardiac problems.
There are good reasons for supposing that the problem of 'gagging' for some patients is analogous to a panic attack and is best understood from a cognitive perspective. In my experience, teaching patients to acquire a relaxed abdominal breathing pattern can provide a useful coping strategy for some individuals with a 'gagging' problem.
There is now an impressive body of research to suggest that the concept of a discrete hyperventilation syndrome is no longer tenable. The evidence for this has been carefully gathered and the scientific studies have employed innovative methodological techniques and have introduced a key psychological dimension. Both have led to a greater understanding of the respiratory correlates of anxiety, but in the process have revealed the "hyperventilation syndrome" to be a chimera. Furthermore, there is no evidence to support the view that panic attacks and hyperventilation are synonymous: on the contrary, hyperventilation rarely accompanies panic and, when it does, it is more likely to be a consequence than a cause of the panic. Finally, there is no evidence that "breathing therapy" works by normalizing pCO2; its nonspecific effects on anxiety appear to be mediated in part by slowing respiratory rate. Further research in this field might be more profitably focused on the nature of the association between anxiety disorders and organic lung disease, especially asthma.