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Breathing exercises for asthma


Clinical bottom line:

Improvement in mean daily PEFR, and a reduction in usage of rescue beta-2-agonists and inhaled corticosteroids was shown with breathing retraining. Results were based on limited patient information.

Poor breathing technique can exacerbate the symptoms of asthma. Breathing re-training involves manipulation of the breathing pattern and may include relaxation sessions, advice and exercises. If effective, this would provide a simple self-help intervention for asthmatics.

Systematic review

Holloway E, Ram FSF. Breathing exercises for asthma (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: update Software.

Date review completed : March 2000

Number of trials included : Five

Number of patients : Active 125 patients; control 116

Control groups : waiting list control, no treatment, lectures and discussions on the philosophy of yoga, voluntary nose and stomach wash techniques, asthma education classes, relaxation and abdominal breathing exercises not involving hypoventilation.

Main outcomes : forced expiratory volume (FEV1), PEFR.

Inclusion criteria were randomised controlled trials of breathing retraining in patients of all ages with asthma diagnosed by internationally established criteria. Breathing retraining had to be a major component of the intervention. Treatment had to be supervised by either a general practitioner or respiratory specialist.

Comprehensive searches were conducted using a variety of databases including the Cochrane Airways Group database, MEDLINE, Cochrane Complimentary Medicine Field, EMBASE, and AMED. The Association of Chartered Physiotherapists in respiratory Care Journals were hand-searched and relevant specialists were contacted. Trails were assessed for quality and data were extracted independently by two reviewers. Weighted mean differences, with 95% confidence intervals, were calculated using pooled data.

Findings

Five randomised trials were included; two were double blind. The studies used multiple interventions of which breathing retraining was the major component. These included breathing exercises to reduce the depth and frequency of breathing, breath holding exercises, physical and respiratory exercises to enlarge the thoracic cage and increase lung capacity for maximum efficiency during exhalation, yoga loosening exercises, mediation and devotional sessions including chanting, and physical exercises without emphasis on deep diaphragmatic breathing. Treatment sessions varied in duration, from 90 minutes for seven days to three one hour sessions weekly for 16 weeks. Few data could be pooled.

Information on FEV1 (Litres) was pooled from two studies. No significant difference in FEV1 (Litres) was shown with breathing retraining compared with control over 3-16 weeks (41 patients). The weighted mean difference was -0.19 (95% confidence interval -0.07 to 0.3).

Three studies reported PEFR as Litres/minute. Significant improvements in mean daily PEFR were reported with breathing retraining compared with control (breathing exercises without hypoventilation or nose and stomach wash) in two studies (245 patients); weighted mean difference 60.2 L/min (95% confidence interval 33.2 to 87.1). In the third study, PEFR was recorded in the morning and evening, with no significant effect.

A significant reduction in beta-2-agonist usage was shown with breathing retraining compared with control in one study (106 patients); weighted mean difference 5.82 (2.9 to 8.7).

A significant reduction in inhaled corticosteroid usage was shown with breathing retraining compared with control in one study (39 patients); weighted mean difference 49% (43 to 55).

Adverse effects

Not mentioned.

Comment

Breathing retraining techniques used in the trials were diverse and most studies were small; one had fewer than 10 patients per group. Most studies assessed different techniques and different outcomes so little information could be pooled. The two studies which assessed FEV1 showed a slight, but insignificant reduction with breathing retraining; these trials did not describe the control intervention. Studies which assessed PEFR, beta-2-agonist and inhaled corticosteroid usage were more positive. At present the amount of high quality evidence is limited; current results show a mixed response. This may be partly explained by the diversity of the interventions, inadequate descriptions of controls and different intensities and durations of treatment.

Identifier 7968 - BREATHING EXERCISES FOR ASTHMA: Apr-2001