Evaluation of breath holding in hypercapnia as a simple clinical test of respiratory chemosensitivity

Abstract

Breath holding was used as the basis of a simple test of respiratory chemosensitivity. Breath holding was begun at selected degrees of hypercapnia produced by CO2 rebreathing. In 16 healthy control subjects there was a linear regression of the log of breath holding time on the PCO2 at the start of breath holding. Breath holding time (BHT) and the slope of a log BHT/PCO2 plot were closely correlated with the ventilatory response to CO2. In 5 cases of the idiopathic hypoventilation syndrome, CO2 retention and reduced ventilatory response to CO2 were accompanied by prolonged breath holding time and the regression of log BHT on PCO2 was abnormally flat. However, in 17 patients with chronic airways obstruction, breath holding time was never prolonged and the log BHT/PCO2 relationship was normal, even though 13 had a diminished ventilatory response to CO2 and 4 had chronic CO2 retention. It is concluded that the BHT/PCO2 relationship provides a useful index of respiratory chemosensitivity which is not influenced by airways obstruction. This may be helpful in the detection of impaired chemosensitivity as a cause of CO2 retention even when the ventilation CO2 response is reduced nonspecificity by coexisting airways obstruction.