Breathing exercises are effective, easy-to-teach techniques
that can help asthma patients get their chronic condition
under control, according to research published online
June 5 in Thorax. "The patients in the study dramatically
reduced their asthma reliever use by approximately 80%
and reduced their preventer use by 30%," says Dr Christine
Jenkins, one of the authors and the head of the asthma
group at the Woolcock Institute of Medical Research in
Concord, Australia.
The benefits of breathing exercises
to manage asthma are hotly debated. Supporters of such
breathing techniques (BTs) often downplay the use of
meds. "In Australia, as I suspect elsewhere, proponents
of BTs have suggested asthma patients can do without
their preventer medications — this had concerned
us greatly," says Dr Jenkins.
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Breathing the Buteyko way
Russian doctor Konstantin Buteyko
developed the technique in the 50s. It's based
on the theory that asthmatics breathe too frequently;
this leads to irritation, inflammation and constriction
of the airways. Central to the theory is that
the lungs of asthmatics contain too little carbon
dioxide. Low levels of CO2 prevent proper oxygenation
of the tissues.
The Buteyko technique involves
exercises to normalize breathing. The key is to
increase the amount of time between exhaling and
having to breathe again — what Dr Buteyko
called "control pause". Most people either learn
the method from a licensed instructor or a video.
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But for many patients BTs are a
breath of fresh air, reducing their dependence on drugs
and the number of attacks. They're the most popular
type of complementary therapy used by asthmatics. Yet
there is little scientific evidence to support their
value. The Cochrane Review published a report in 2004
that found "no reliable conclusions can be drawn concerning
the use of breathing exercises for asthma in clinical
practice." However, the Cochrane authors did
say that trends do show that BTs might have an impact,
"notably in quality of life measurements." They argued
that large-scale trials are needed before they could
vouch for the technique's usefulness.
HUNT
FOR CLUE
In her study, Dr Jenkins and colleagues were looking
to find out if BTs could help asthmatics control their
disease. The 57 study participants were divided into
two groups: one used Buteyko-like breathing technique
(see sidebar "Breathing the Buteyko way"); the other
used natural breathing techniques. But how can simple
changes in breathing patterns actually help the asthma
sufferer?
"We believe the BTs gave patients
a sense of control, they were calming and allowed the
patients to delay using a reliever," explains Dr Jenkins.
"Patients then discovered that the symptoms were actually
mild enough to go without the reliever." She is quick
to note that during the study patients were encouraged
to take their reliever if the breathing techniques didn't
help their asth-ma symptoms.
DON'T
HOLD YOUR BREATH
For Dr Kenneth Chapman, a Toronto respirologist and
professor at the U of T, the evidence in favour of BTs
isn't as convincing. "I was surprised a little bit at
how the article concluded," he says. He believes that
essentially this study shows that "proven" breathing
techniques like the Buteyko method — a handful
of clinical trials have been done — are no better
than sham techniques. "There were positive results.
People did take a little less of their quick release
medicine," he admits. "But what does that mean? If you
distract people and tell them to do some manoeuvre,
whether it's a breathing exercise or patting their head
and rubbing their tummy, they'll be able to forego taking
their puffer."
Dr Chapman says that breathing
isn't something that can be retrained. "But if you draw
somebody's attention to their breathing they can, in
the short-term while they're aware of it, adjust it
but as soon as they stop thinking about it their breathing
goes back to their baseline," he adds.
PSYCHOSOMATIC
EFFECT
The findings in Dr Jenkin's study do raise the issue
that it's not necessarily the BTs themselves but rather
the process that has an effect on disease management.
"The similarity of the improvements seen in both groups,
despite the widely disparate nature of the breathing
exercises they were using, suggest that the observed
changes were more likely attributed to one or more of
the shared process elements — such as the instruction
to use the exercises initially in place of reliever
for symptoms," she writes in the study.
Regardless of the controversy,
more and more evidence is pointing to the usefulness
of BTs. "They're quite easy to learn and patients like
them," says Dr Jenkins. "But they need to be practised
regularly so patients can use them whenever needed to
control symptoms instead of using reliever." Dr Jenkins
believes that these exercises can be something that
GPs can pass along to their patients suffering from
mild asthma. "We're making a video now which we hope
will be useful for patients and GPs to learn the techniques
and help patients to use them effectively," she says.
But Dr Chapman suggests proceeding
a little more carefully. "I have a general answer for
people who talk about alternative therapies, 'by all
means do it as long as it's not outrageously expensive
or harmful but I'd hope you'd do it alongside the conventional
method and if there are some remarkable results for
the better or for worse, keep me informed'."
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