Disclosures: Ostacher reports having received grant support from Otsuka America and Palo Alto Health, as well as having received personal fees for advisory board membership for Alkermes, Janssen (Johnson & Johnson) and Sage Therapeutics in the past 36 months. Please see the study for all other authors’ relevant financial disclosures.
September 22, 2021
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Guided respiratory therapeutic promising for PTSD symptoms

Disclosures: Ostacher reports having received grant support from Otsuka America and Palo Alto Health, as well as having received personal fees for advisory board membership for Alkermes, Janssen (Johnson & Johnson) and Sage Therapeutics in the past 36 months. Please see the study for all other authors’ relevant financial disclosures.
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A digital guided respiratory therapeutic intervention used for panic disorder was safe, acceptable and well-tolerated for individuals with PTSD, according to study results published in Applied Psychophysiology and Biofeedback.

“One marker of panic-related respiratory dysfunction is lowered end-tidal CO2 (EtCO2) levels,” Michael J. Ostacher, MD, MPH, of Veterans Affairs Palo Alto Health Care System in California, and colleagues wrote. “Capnometry Guided Respiratory Intervention (CGRI) is a digital therapeutic that gives users feedback of EtCO2 levels and respiration rate, with the goal of increasing EtCO2 levels and decreasing [respiration rate]. Foundational research has shown this to be effective in the treatment of [panic disorder] by reducing symptoms that arise from breathing abnormalities.”

Studies showed one CGRI system, developed by Freespira, effectively reduced panic symptoms. Because of the symptomatic and epidemiological overlap between PTSD and panic disorder, the researchers noted the plausibility of a CGRI treatment reducing PTSD symptoms.

Ostacher and colleagues conducted a single-arm study of the Freespira CGRI system among 55 individuals with PTSD who received 4 weeks of twice-daily, 17-minute at-home sessions via a sensor and tablet with pre-loaded software. They evaluated PTSD and related symptoms at baseline, end of treatment and 2 and 6 months after treatment. Fifty percent of participants having a six-point or higher decrease in Clinician Administered PTSD Scale (CAPS-5) score at 2-month follow-up served as the primary efficacy outcome. The researchers also evaluated tolerability, usability, safety and adherence.

Results showed CGRI was well-tolerated. A total of 88% (95% CI, 74-96) of participants exhibited the six-point or higher decrease in CAPS-5 scores at 2 months post-treatment follow-up. Ostacher and colleagues noted a decrease in mean CAPS-5 scores from 49.5 at baseline to 27.1 at 2 months.. Further, they observed a decrease in respiratory rate and an increase in EtCO2 levels, as well as an improvement in related mental and physical health symptoms. Overall, the intervention proved safe, acceptable and well-tolerated for improving PTSD symptoms.

“The combination of clinical improvement to 6 months and high adherence and participant satisfaction rates suggests that this noninvasive, digital therapeutic is a promising intervention for PTSD,” Ostacher and colleagues wrote. “Further study of this CGRI system for PTSD against an appropriate comparator treatment is warranted.”