Breathing Retraining Aids Asthma Not Controlled by Medication

Mike Thomas, PhD

Self-guided, physiotherapy-based breathing retraining techniques help improve symptom management for asthma patients who experience incompletely-controlled asthma despite taking medicine on a regular basis, according to a new study.

There is currently a strong interest from patients in non-drug asthma therapies, study corresponding author Mike Thomas, PhD, Professor of Primary Care Research, Medicine at the University of Southampton, told MD Magazine. However, evidence and guidelines have been lacking for most non-drug interventions.

“There is now a good evidence base for breathing retraining programs supervised by an appropriately trained physiotherapist to improve patient’s experience of asthma,” Thomas said. “Breathing retraining is now recommended in both UK national and international asthma guidelines.”

In the study, researchers found that while asthma medication can help some people fully control their symptoms, surveys show that many treated patients’ asthma are not effectively managed, impacting their quality of life.

A total of 655 patients with asthma participated in the study. Participants were between 16 and 70 years old, received at least 1 anti-asthma medication within the previous year, and had an impaired Asthma Quality of Life Questionnaire (AQLQ) score of less than 5.5 (on a scale of 1 to 7, higher numbers indicating a better quality of life).

A multidisciplinary team that included physicians, physiotherapists, communications technology specialists and patient representatives, developed an evidence-based, self-guided intervention based on an existing breathing retraining program and shown to be effective in treating poorly controlled asthma. These materials were in the form of a DVD and printed booklet (DVDB).

Participants were divided into 3 groups and randomly assigned to either the DVDB intervention, 3 face-to-face breathing retraining sessions, or standard care for a period of 12 months.

Results showed that AQLQ scores at 12 months were significantly higher in the DVDB group (mean 5.40, SD 1.14) than in the standard care group (5.12, SD 1.17; adjusted mean difference 0.28; 95% CI; 0.11 to 0.44) and in the face-to-face group (5.33, SD 1.06) than in the standard care group (adjusted mean difference 0.24; 95% CI; 0.04 to 0.44). AQLQ scores were similar between the DVDB group and the face-to-face group (0.04; 95% CI; -0.16 to 0.24).

“The key findings are that adults with asthma can be helped by learning some fairly simple breathing exercises, that it’s possible to teach them these techniques effectively through a video digital program in their home at their convenience, and that the modest cost of providing this to patients are highly likely to be more than covered by reduced asthma-related healthcare costs,” Thomas said.

This study also showed, as has been the case in previous studies, that there were no disease-modifying changes, suggesting that breathing retraining simply provides a technique for better coping with the continuous effects of partially controlled asthma.

“We have excellent pharmacological treatments for asthma, so we do not view current non-pharmacological treatments, such as the breathing retraining exercises we have investigated here, as being a cure for asthma or as replacing the need for effective medication,” Thomas said. “Rather, they should be used in addition to medication.”

Thomas added that further research is needed to discover the effectiveness of breathing retraining techniques in children and adolescents and to adapt them for other languages and cultures.