Breathing therapies for asthma: Buteyko and Eucapnic breathing training

Townsend Letter for Doctors and Patients,  April, 2003  by Rosalba Courtney

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Breathing re-education and breathing-based therapies have begun to re-emerge as a means of helping asthmatics and others suffering from breathing disorders. Recent research studies on several breathing based therapies, show that asthmatics who undertake these types of breathing training show a substantial decrease in medication needs, better quality of life, and improved asthma control. (1-4)

In the days before effective asthma medication, breathing exercises were taught to most asthmatics and sufferers of respiratory diseases. Over the last few decades breathing training seems to have been dropped from treatment programs, perhaps as more powerful and specific drugs came onto the market. Even Complementary and Alternative Medicine (CAM) practitioners have not put much serious emphasis on breathing as therapy for asthmatics despite the strong influences that CAM practitioners have had from vitalistic philosophies of healing such as Naturopathy, Ayurveda, Yoga and Traditional Chinese Medicine. These traditional medicines have always put major importance on the cultivation of healthy breathing and the use of breathing as a tool for regaining health in general.

Research Trials into Breathing and Asthma

Recent clinical research on breathing therapies for asthma have shown potential benefits of breathing training for sufferers, and should turn our attention again to questions about the role of breathing training in pulmonary conditions. An Australian controlled clinical trial evaluating the breathing re-training protocol called the Buteyko Breathing Technique showed that asthmatics utilizing this method were able to achieve a 90% reduction in bronchodilator or relief medication and a 50% reduction in steroid medication. Despite the fact that no improvement of FEV1 was measured in the subjects, it is very interesting to note that that there was no deterioration in lung function as measured by FEV1, despite such a huge drop in medication intake by the participants. (1) Another trial conducted by Australian researchers, where the Buteyko Breathing Technique was taught by Video, also showed asthmatics gained a significant improvement in quality of life as well as a significant reduction in bronchodilator use. (4) Preliminary results reported in the July, 2002 issue of the Australian Medical Observer from a large (300 participants) placebo-controlled trial taking place in Glasgow, show that of the active Buteyko group, 98% reduced their use of relief medications and 96% used less oral preventive medication. No significant changes were seen in the placebo group who received conventional asthma management.

Dr. Buteyko himself conducted several studies in Russia on various conditions, including one on asthmatic children. This open trial on 52 children was conducted over three months in a Moscow Children's Hospital. All children responded positively to some degree with self reported improvements in asthma, rhinitis and nasal mucus. Children learned to control their own symptoms of asthma by using the breathing exercises after 5 days; 73% were able to discontinue all medication and 15% were able to reduce medication. (20)

Trials done with various Yoga breathing techniques also have shown decreased histamine response in asthmatics, decreased medication intake, less attacks per week and improved lung function as measured by FEV1. (2,3) A breathing and biofeedback protocol used to increase parasympathetic nervous system activity and respiratory sinus arrhythmia called the Smetankin method was taught to asthmatics in an uncontrolled trial, and promising results were seen before and after spirometry readings. A surge in public and media interest in Australia and the UK in breathing therapies and the Buteyko method in particular, has resulted in at least 2 other trials and possibly one other being conducted by major teaching university hospitals. The results of these trials will hopefully be published in medical journals in the near future allowing further scientific evaluation of this particular method.

Dysfunctional Breathing in Asthmatics

The exclusion of breathing reeducation from treatment strategies for asthmatics may have been an unfortunate oversight. It appears that people with asthma and other lung disease frequently have dysfunctional breathing patterns that may complicate or contribute to the symptoms they experience, or even to the disease process itself. For example it has been known for some time that asthmatics hyperventilate during mild to moderate asthma attacks resulting in decreased arterial carbon dioxide levels. (5,6) In severe attacks (only 11% of cases studied by McFadden (5)), the trend is reversed with carbon dioxide starting to increase above normal.

Hyperventilation has been shown to contribute to ventilation, perfusion inequality, (17) which is a major cause of hypoxemia in asthmatics. (7) One could speculate that the repeated, episodic hyperventilation during the average mild to moderate attack in asthmatics, may lead over time to a shifting in the normal homeostatic mechanisms controlling breathing, resulting in asthmatics developing the habitual breathing pattern of chronic hidden hyperventilation. Fear of breathlessness and anxiety about their asthma symptoms appears to worsen the tendency to hyperventilation in asthmatics.