Inspiratory muscle strength and Borg dyspnoea score.

In our original article we outlined the type of somato-psychosomatic feedback cycle occurring in panic attacks in chronic obstructive pulmonary disease (COPD) that F. Kummer has further elaborated in his correspondence. In fact, this type of feedback cycle is described in the most widely accepted theory of panic attacks and panic disorder in the physically healthy, the cognitive (or ‘‘catastrophic interpretation’’) model [1], and our recent research has supported the applicability of this model to panic in COPD [2–4]. We agree with F. Kummer that some of the most helpful advice respiratory physicians can give their patients with COPD to prevent them entering the feedback cycle of panic is to use ‘‘pursed-lip breathing’’ to help manage their dyspnoea, and to avoid excessive use of shortacting b-agonists.