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Objective: To investigate the importance of hyperventilation in the pathogenesis of panic attacks., Design: Descriptive., Setting: The Jelgersma Outpatient Clinic at Oegstgeest and the University Hospital Leiden, the Netherlands., Method: In 57 psychiatric patients with a panic disorder and 96 somatic patients with unexplained somatic complaints suggestive of hyperventilation, a Hyperventilation Provocation Test (HVPT) was conducted. Of the somatic patients, 33 had recently experienced a panic attack. During the test, various physiological and symptom criteria for the Hyperventilation Syndrome were assessed. Several measures for concomitant psychopathology were collected as well., Results: No significant differences were found in physiological criteria for the Hyperventilation Syndrome between psychiatric patients with a panic disorder (PD) and somatic patients with (PA+) or without (PA-) a recent panic attack. On all symptom criteria, however, PD and PA+ patients obtained comparable scores, while both groups scored higher than PA- patients. On most measures for concomitant psychopathology, PD patients scored higher than PA+ patients, who on their part scored higher than PA- patients., Conclusion: Hyperventilation is of secondary importance in the pathogenesis of panic attacks and an early diagnosis of panic attacks or panic disorder may be conducive to more adequate treatment.