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The present study addresses the hypothesis consistent with the dyspnea-fear theory of panic, that in a subgroup of panic patients a non-pathological pulmonary obstructive component may induce dyspnea, dyspneic fear and, ultimately, panic. In 38 patients who met DSM-III-R criteria for panic disorder, pulmonary function was assessed and various measurements for panic symptoms and concomitant psychopathology were collected. In comparison to patients with a high Forced Expiratory Flow at 50% (FEF 50%), low FEF 50% patients demonstrated significantly lower levels of Forced Expiratory Volume (first second) and Peak Expiratory Flow and significantly lower FEV1/FVC ratios. None of the differences on psychological measurements for symptom severity between low and high FEF 50% patients proved to be significant. Moreover, FEF 50% scores and FEV1/FVC ratios were not correlated to any of the measures for panic or associated psychopathology. It is concluded that the existence of a distinct subgroup of panic patients with signs of actual airway obstruction leading to uncontrollable dyspnea and fear of suffocation remains questionable.

The 2-week prevalence of panic attacks according to DSM-III-R criteria was assessed in 102 general hospital patients with unexplained somatic symptoms suggestive of the hyperventilation syndrome (HVS). Thirty-six patients were classified as panickers. In comparison to nonpanickers, panickers reported more severe panic and hyperventilation symptoms and state anxiety during anxiety episodes in daily life and also obtained higher scores on measures for depression, generalized anxiety, agoraphobic anxiety, and agoraphobic avoidance. During the Hyperventilation Provocation Test, panickers reported more panic and hyperventilation symptoms and state anxiety and also rated their symptoms to be more similar to those occurring in daily life than nonpanickers. However, no differences were observed between panickers and nonpanickers in base excess values or in minute respiratory volume, respiratory rate, or fraction of end-tidal carbon dioxide during the resting, hyperventilation, and recovery phase. It is concluded that the prevalence of panic attacks in this group of patients is relatively high and that medical specialists must be more attentive to the occurrence of panic attacks or panic disorder in general hospital patients with unexplained somatic symptoms suggestive of HVS.