A Multisite Benchmarking Trial of Capnometry Guided Respiratory Intervention for Panic Disorder in Naturalistic Treatment Settings

Abstract

Panic disorder (PD) is associated with hyperventilation. The efficacy of a brief respiratory feedback program for PD has been established. The aim of the present study was to expand these results by testing a similar program with more clinically representative patients and settings. Sixty-nine adults with PD received 4 weeks of Capnometry Guided Respiratory Intervention (CGRI) using Freespira, which provides feedback of end-tidal CO2 (PETCO2) and respiration rate (RR), in four non-academic clinical settings. This intervention is delivered via home use following initial training by a clinician and provides remote monitoring of client adherence and progress by the clinician. Outcomes were assessed post-treatment and at 2- and 12-month follow-up. CGRI was associated with an intent-to-treat response rate of 83% and a remission rate of 54%, and large decreases in panic severity. Similar decreases were found in functional impairment and in global illness severity. Gains were largely sustained at follow-up. PETCO2 moved from the slightly hypocapnic range to the normocapnic range. Benchmarking analyses against a previously-published controlled trial showed very similar outcomes, despite substantial differences in sample composition and treatment settings. The present study confirms prior clinical results and lends further support to the viability of CGRI in the treatment of PD.

The Importance of Respiratory Rate Monitoring: From Healthcare to Sport and Exercise

“…Other patients that would benefit from respiratory biofeedback therapies are those with hypertension [263,273,[281][282][283] or panic disorders [284,285]. Substantial evidence shows a significant reduction in blood pressure with the administration of biofeedback-guided slow deep breathing exercises [273,281,282].…”

“…This system is suitable for self-treatment at home and is made up of a sensor registering chest-wall movements embedded in an elastic belt, a computerized display, and headphones [282]. Differently, patients with panic disorders are usually treated with capnometry guided respiratory biofeedback because these patients hyperventilate and need to restore isocapnia [284,285]. Capnometry guided respiratory biofeedback provides values of end-tidal carbon dioxide and f R to the user.…”

“…Capnometry guided respiratory biofeedback provides values of end-tidal carbon dioxide and f R to the user. Tolin et al [285] have documented the feasibility of a remote monitoring service based on home-delivered capnometry-guided biofeedback therapy. The measuring system consisted of a CO 2 sensor, a nasal cannula, and an app installed on a smart device that provided real-time audiovisual feedback of the variables of interest.…”

“…The measuring system consisted of a CO 2 sensor, a nasal cannula, and an app installed on a smart device that provided real-time audiovisual feedback of the variables of interest. Data from each session were streamed on a secure service after each treatment, thus allowing the clinician to remotely evaluate clinical progress and therapeutic adherence [285].…”

Is panic disorder a disorder of physical fitness? A heuristic proposal

“…In patients with PD, breathing therapies improve panic symptoms 111 , 112 as well as restore diaphragmatic breathing with regain of vital capacity 14 – 18 ; although results are inconclusive, voluntary aerobic physical exercise may provide benefit as an adjunctive strategy for the treatment of PD 113 – 115 .…”