Breathing Exercises for Patients with Asthma in Specialist Care: A Multicenter Randomized Clinical Trial

Abstract

Rationale Moderate to severe asthma is associated with impaired asthma control and quality of life (QoL) despite access to specialist care and modern pharmacotherapy. Breathing exercises (BrEX) improve QoL in incompletely controlled mild asthma, but impact in moderate to severe asthma is unknown. Objectives To investigate the effectiveness of BrEX as adjuvant treatment on QoL in patients with uncontrolled moderate to severe asthma. Methods Adult patients with incompletely controlled asthma attending respiratory specialist clinics were randomized to usual specialist care (UC) or UC and BrEX (UC + BrEX) with three individual physiotherapist-delivered sessions and home exercises. Primary outcome was asthma-related QoL (Mini-Asthma Quality of Life Questionnaire [Mini-AQLQ]) at 6 months on the basis of intention-to-treat analysis. Secondary outcomes: Mini-AQLQ at 12 months, lung function, 6-minute-walk test, physical activity level, Nijmegen Questionnaire, Hospital Anxiety and Depression Scale, and adverse events. Repeated-measures mixed-effects models were used to analyze data. Poisson regression models were used to analyze adverse event incidence rate ratio. Results A total of 193 participants were allocated to UC + BrEX ( n = 94) or UC ( n = 99). UC + BrEX was superior in the primary outcome (adjusted mean change difference, 0.35; 95% confidence interval [CI], 0.07 to 0.62). Superiority in Mini-AQLQ was sustained at 12 months (0.38; 95% CI, 0.12 to 0.65). A minor improvement in Hospital Anxiety and Depression Scale depression score at 6 months favoring UC + BrEX (−0.90; 95% CI, −1.67 to −0.14) was observed. Asthma-related adverse events occurred similarly in UC + BrEX and UC participants: 14.9% versus 18.1% ( P = 0.38). Conclusions BrEX as add-on to usual care improve asthma-related QoL in incompletely controlled asthma regardless of severity and with no evidence of harm. Clinical trial registered with www.clinicaltrials.gov (NCT 03127059).

The treatable traits approach to adults with obstructive airways disease in primary and secondary care

“…25 Both pharmacological and non-pharmacological treatments are available for comorbid psychological dysfunction when recognized. Breathing control exercises have been shown to improve the quality of life in patients with asthma of all levels of severity who remain uncontrolled on standard treatments, [45][46][47] and simple on-line self-help programmes are clinically and cost effective, 48 yet are frequently not a part of usual clinical care.…”

Mild asthma: Conundrums, complexities and the need to customize care

“…Identifying smoking as an issue and offering support to people with asthma who smoke is a key intervention to improve asthma control, reduce treatment needs and improve long-term lung health. 51 Mild asthma may also be more responsive to symptom management through techniques that minimize SABA use 52,53 and promote better health behaviours overall. 54 Asthma with moderate airflow limitation in childhood may be unlikely to remit even in the presence of optimal management, 55 as clinical outcomes in adult life are strongly determined by asthma severity in childhood.…”

“…Mild asthma may also be more responsive to symptom management through techniques that minimize SABA use 52,53 and promote better health behaviours overall 54 . Asthma with moderate airflow limitation in childhood may be unlikely to remit even in the presence of optimal management, 55 as clinical outcomes in adult life are strongly determined by asthma severity in childhood.…”

Penatalaksanaan Fisioterapi dengan Breathing Exercise dan Mobilisasi Sangkar Thoraks Pada Pasien Asma Bronkial: Case Report

“…Pada kasus asma bronkial terdapat peradangan dan penyempitan saluran udara dengan tingkat keparahan yang bermacam-macam, mulai dari mengi yang sangat ringan hingga penutupan saluran napas akut yang dapat mengancam jiwa (Aggarwal et al, 2018). Menurut (Andreasson et al, 2022) breathing exercise yang meliputi breathing control bermanfaat untuk meningkatkan kualitas hidup pada pasien dengan asma bronkial. Latihan pernapasan juga mengurangi untuk gejala hiperventilasi.…”