Breathing retraining for dysfunctional breathing in asthma: a randomised controlled trial

Abstract

Background: Functional breathing disorders may complicate asthma and impair quality of life. This study aimed to determine the effectiveness of physiotherapy based breathing retraining for patients treated for asthma in the community who have symptoms suggestive of dysfunctional breathing. Methods: 33 adult patients aged 17-65 with diagnosed and currently treated asthma and Nijmegen questionnaire scores >23 were recruited to a randomised controlled trial comparing short physiotherapy breathing retraining and an asthma nurse education control. The main outcome measures were asthma specific health status (Asthma Quality of Life questionnaire) and Nijmegen questionnaire scores Results: Of the 33 who entered the study, data were available on 31 after 1 month and 28 at 6 months. The median (interquartile range) changes in overall asthma quality of life score at 1 month were 0.6 (0.05-1.12) and 0.09 (-0.25-0.26) for the breathing retraining and education groups, respectively (p=0.018), 0.42 (0.11-1.17) and 0.09 (-0.58-0.5) for the symptoms domain (p=0.042), 0.52 (0.09-1.25) and 0 (-0.45-0.45) for the activities domain (p=0.007), and 0.50 (0-1.50) and -0.25 (-0.75-0.75) for the environment domain (p=0.018). Only the change in the activities domain remained significant at 6 months (0.83 (-0.10-1.71) and -0.05 (-0.74-0.34), p=0.018), although trends to improvement were seen in the overall score (p=0.065), the symptoms domain (p=0.059), and the environment domain (p=0.065). There was a correlation between changes in quality of life scores and Nijmegen questionnaire scores at 1 month and at 6 months. The number needed to treat to produce a clinically important improvement in health status was 1.96 and 3.57 at 1 and 6 months. Conclusion: Over half the patients treated for asthma in the community who have symptoms suggestive of dysfunctional breathing show a clinically relevant improvement in quality of life following a brief physiotherapy intervention. This improvement is maintained in over 25% 6 months after the intervention.

Does manual therapy provide additional benefit to breathing retraining in the management of dysfunctional breathing? A randomised controlled trial

“…DeGuire et al reported breathing retraining through paced diaphragmatic breathing had both short term [16] and lasting effects [17] on respiratory physiology and highly correlated with a reduction in reported functional cardiac symptoms in 41 patients with cardiac disease and associated DB. The results of our study concur with an earlier RCT [6]; evaluating physiotherapy based breathing retraining versus nurse-led asthma education for asthmatic patients with DB. This group reported half their subjects showed a fall in Nijmegen score, which correlated with a clinically relevant improvement in quality of life following physiotherapy; this improvement was maintained in a quarter of subjects' 6-months later.…”

Exercise-induced bronchoconstriction in athletes – A qualitative assessment of symptom perception

“…The possibility also exists that some EIB-Dys+ athletes experiencing dyspnoea may have functional syndromes such as dysfunctional breathing, and may benefit from non-pharmacological approaches such as physiotherapy and/or breathing re-training techniques (24). Indeed posture and core stability exercises and/or inspiratory muscle training interventions have previously been shown to provide utility in eliminating dyspnoea in athletes when dysfunctional breathing is suspected (25,26).…”

Asthma-related comorbidities

“…This syndrome is often called the 'hyperventilation syndrome', because patients frequently over-breathe [160] or have an increased respiratory rate [161]. In subjects with symptoms of dysfunctional breathing, Thomas et al showed that breathing retraining from physiotherapy intervention resulted in clinically significant improvement in health-related quality of life scores after only 1 month of treatment with a trend after 6 months [162].…”