I have recently come across the paper by Malmberget al 1 and the accompanying editorial by Gardner2 of orthostatic increase of respiratory gas exchange in hyperventilation syndrome. Gardner concludes that “the physiological basis for these responses requires investigation and may provide useful insights into mechanisms by which postural changes can influence control of breathing and respiratory sensations”.

Should the work of Yates et al 3-5 have not yet come to your notice, I present it to you for your consideration. I have found it to be fascinating and relevant work with regard to altered breathing patterns in patients with changes of posture, and also it has founded an understanding of why many patients with vestibular and balance disorders also hyperventilate. The rehabilitation of these patients appears to be improved when the hyperventilation component is recognised and the breathing pattern re-educated.