Breathing exercises for asthma: a randomised controlled trial

• Published in: Thorax Vol. 64; no. 1; pp. 55 - 61
• Main Authors: Thomas, M, McKinley, R K, Mellor, S, Watkin, G, Holloway, E, Scullion, J, Shaw, D E, Wardlaw, A, Price, D, Pavord, I
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01.01.2009; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Anxiety; Asthma; Asthma - therapy; Biological and medical sciences; Breathing Exercises; Bronchoconstrictor Agents; Cardiology. Vascular system; Chronic obstructive pulmonary disease, asthma; Confidence intervals; Female; Forced Expiratory Volume - drug effects; Humans; Hyperventilation; Hyperventilation - etiology; Male; Medical sciences; Methacholine Chloride; Middle Aged; Nitric oxide; Nitric Oxide - analysis; Physiology; Pneumology; Quality of Life; Questionnaires; Single-Blind Method; Sputum - cytology; Steroids; Treatment Outcome; United Kingdom > UK; Physical exercise; Lung disease; Respiratory disease; Bronchus disease; Anesthesia; Exercise tolerance test; Clinical trial; Obstructive pulmonary disease; Circulatory system; Cardiology; Asthma
• ISSN: 0040-6376; 1468-3296; 1468-3296
• DOI: 10.1136/thx.2008.100867

Background:The effect of breathing modification techniques on asthma symptoms and objective disease control is uncertain.Methods:A prospective, parallel group, single-blind, randomised controlled trial comparing breathing training with asthma education (to control for non-specific effects of clinician attention) was performed. Subjects with asthma with impaired health status managed in primary care were randomised to receive three sessions of either physiotherapist-supervised breathing training (n = 94) or asthma nurse-delivered asthma education (n = 89). The main outcome was Asthma Quality of Life Questionnaire (AQLQ) score, with secondary outcomes including spirometry, bronchial hyper-responsiveness, exhaled nitric oxide, induced sputum eosinophil count and Asthma Control Questionnaire (ACQ), Hospital Anxiety and Depression (HAD) and hyperventilation (Nijmegen) questionnaire scores.Results:One month after the intervention there were similar improvements in AQLQ scores from baseline in both groups but at 6 months there was a significant between-group difference favouring breathing training (0.38 units, 95% CI 0.08 to 0.68). At the 6-month assessment there were significant between-group differences favouring breathing training in HAD anxiety (1.1, 95% CI 0.2 to 1.9), HAD depression (0.8, 95% CI 0.1 to 1.4) and Nijmegen (3.2, 95% CI 1.0 to 5.4) scores, with trends to improved ACQ (0.2, 95% CI 0.0 to 0.4). No significant between-group differences were seen at 1 month. Breathing training was not associated with significant changes in airways physiology, inflammation or hyper-responsiveness.Conclusion:Breathing training resulted in improvements in asthma-specific health status and other patient-centred measures but not in asthma pathophysiology. Such exercises may help patients whose quality of life is impaired by asthma, but they are unlikely to reduce the need for anti-inflammatory medication.