Integrated breathing and relaxation training (the Papworth method) for adults with asthma in primary care: a randomised controlled trial

Holloway, Elizabeth A; West, Robert

doi:10.1136/thx.2006.076430

Cited by 142 publications

(105 citation statements)

References 20 publications

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“…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. These findings were supported by a 2007 RCT [15], which concluded that breathing retraining and relaxation (The Papworth Method) significantly reduced respiratory symptoms and DB, while improving health related quality of life and adverse mood, compared with usual care in a group of 36 patients with asthma. In this study, based on literature of other chronic respiratory disease, a clinically significant improvement in HADS [32] was found in both study groups, and the 6-minute walk test [33] in the respiratory management group.…”

Section: Discussionsupporting

confidence: 64%

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

Jones

Troup

Nugus

et al. 2014

Disability and Rehabilitation

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Section: Discussionsupporting

confidence: 64%

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

Jones

Troup

Nugus

et al. 2014

Disability and Rehabilitation

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“…Previous trials of asthma BR have not reported any significant changes in Nijmegen scores (Holloway and West, 2007;Thomas et al, 2009), but in these studies baseline mean group scores were below the threshold for hyperventilation, leaving little room for improvement. The patient's subjective hyperventilation score started high (39) and reduced to well below the threshold for hyperventilation syndrome after the program.…”

Section: Patient Centered Factorsmentioning

confidence: 82%

“…Another RCT by Holloway and West (2007) showed no changes, but involved patients with levels of anxiety and depression within the normal range at baseline, giving no room for improvement. In the patient's case there were reductions in levels of both anxiety and depression, which went from being high enough to be clinically relevant to being 'normal'.…”

Section: Patient Centered Factorsmentioning

confidence: 99%

Breathing pattern recordings using respiratory inductive plethysmography, before and after a physiotherapy breathing retraining program for asthma: A case report

BScPT

2017

Physiotherapy Theory and Practice

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Breathing retraining (BR) improves symptoms, psychological well-being and quality of life in adults with asthma; but there remains uncertainty as to mechanism of effect. One of the intuitively logical theories is that BR works through altering breathing pattern. There is currently no evidence, however, that BR does result in measurable changes in breathing pattern. In this case report we describe the effects of physiotherapy BR on a 57-year-old female with a 10-year history of asthma. Data were collected before and after a physiotherapy BR program comprising three sessions over 18 weeks: breathing pattern (respiratory inductive plethysmography (RIP); physiology (end tidal carbon dioxide (ETCO 2 ), heart rate, oxygen saturations, spirometric lung function); questionnaires (Asthma Control Questionnaire (ACQ), Hospital Anxiety and Depression Score, Nijmegen Questionnaire); and medication usage. After BR, the patient's symptoms improved. Her physiology was largely unchanged, although her FEV 1 increased by 0.12L, peak flow by 21L/min. The patient reported using less Salbutamol, yet her asthma control improved (ACQ down 1.5). Her Nijmegen score dropped from positive to negative for hyperventilation (from 39 to 7). Her anxiety-depression levels both reduced into 'normal' ranges. The patient's expiratory time increased, with longer respiratory cycles and slower respiratory rate. No changes were seen in relative contributions of ribcage and abdomen. Controlled trials are now needed to determine the generalizability of these findings. ARTICLE HISTORY

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“…This study provided provisional evidence that breathing retraining programmes delivered in a self-guided audio-visual format are feasible and may potentially produce beneficial outcomes in asthma. A 2007 UK primary care-based RCT 18 demonstrated that breathing retraining taught by a physiotherapist in face-to-face sessions significantly reduced respiratory symptoms and improved health-related QoL compared with usual care. The population studied consisted of community-treated asthmatics with mild and moderate disease.…”

Section: Fundingmentioning

confidence: 99%

“…[14][15][16] Recent studies have shown clinically important effectiveness of physiotherapist-administered breathing exercises for people with asthma in the UK. [17][18][19] The evidence base for the effectiveness of breathing therapies for treating asthma has been assessed in several reviews. A recent systematic review of the effectiveness of physiotherapist-taught breathing retraining was carried out as part of a review of physiotherapy interventions in the treatment of respiratory diseases in adults.…”

Section: Trial Registrationmentioning

confidence: 99%

A randomised controlled study of the effectiveness of breathing retraining exercises taught by a physiotherapist either by instructional DVD or in face-to-face sessions in the management of asthma in adults

Thomas

Bruton

Little

et al. 2017

Health Technol Assess

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BackgroundAsthma control is suboptimal, resulting in quality of life (QoL) impairment and costs. Breathing retraining exercises have evidence of effectiveness as adjuvant treatment, but are infrequently used.ObjectivesTo transfer the contents of a brief (three-session) physiotherapist-delivered breathing retraining programme to a digital versatile disc (DVD) and booklet format; to compare the effectiveness of the self-guided intervention with that of ‘face-to-face’ physiotherapy and usual care for QoL and other asthma-related outcomes; to perform a health economic assessment of both interventions; and to perform a process evaluation using quantitative and qualitative methods.DesignParallel-group three-arm randomised controlled trial.SettingGeneral practice surgeries in the UK.ParticipantsIn total, 655 adults currently receiving asthma treatment with impaired asthma-related QoL were randomly allocated to the DVD (n = 261), physiotherapist (n = 132) and control (usual care) (n = 262) arms in a 2 : 1 : 2 ratio. It was not possible to blind participants but data collection and analysis were performed blinded.InterventionsPhysiotherapy-based breathing retraining delivered through three ‘face-to-face’ respiratory physiotherapist sessions or a self-guided programme (DVD plus our theory-based behaviour change booklet) developed by the research team, with a control of usual care.Main outcome measuresThe primary outcome measure was asthma-specific QoL, measured using the Asthma Quality of Life Questionnaire (AQLQ). Secondary outcomes included asthma symptom control [Asthma Control Questionnaire (ACQ)], psychological state [Hospital Anxiety and Depression Scale (HADS)], hyperventilation symptoms (Nijmegen questionnaire), generic QoL [EuroQol-5 Dimensions (EQ-5D)], assessments of airway physiology (spirometry) and inflammation (exhaled nitric oxide) and health resource use and costs. Assessments were carried out at baseline and at 3, 6 and 12 months post randomisation. Patient engagement and experience were also assessed using quantitative and qualitative methods.ResultsPrimary efficacy analysis was between-group comparison of changes in AQLQ scores from baseline to 12 months in the intention-to-treat population with adjustments for prespecified covariates. Significant improvements occurred in the DVD group compared with the control group [adjusted mean difference 0.28, 95% confidence interval (CI) 0.11 to 0.44;p < 0.001] and in the face-to-face physiotherapy group compared with the control group (adjusted mean difference 0.24, 95% CI 0.04 to 0.44;p < 0.05), with equivalence between the DVD and the face-to-face physiotherapy groups (adjusted mean difference 0.04, 95% CI –0.16 to 0.24). In all sensitivity analyses, both interventions remained significantly superior to the control and equivalence between the interventions was maintained. In other questionnaire outcome measures and in the physiological measures assessed, there were no significant between-group differences. Process evaluations showed that participants engaged well with both of the active interventions, but that some participants in the DVD arm would have liked to receive tuition from a professional. Asthma health-care costs were lower in both intervention arms than in the control group, indicating ‘dominance’ for both of the interventions compared with the control, with lowest costs in the DVD arm. The rate of adverse events was lower in the DVD and face-to-face physiotherapy groups than in the control group.ConclusionsOnly 10% of the potentially eligible population responded to the study invitation. However, breathing retraining exercises improved QoL and reduced health-care costs in adults with asthma whose condition remains uncontrolled despite standard pharmacological therapy, were engaged with well by patients and can be delivered effectively as a self-guided intervention. The intervention should now be transferred to an internet-based platform and implementation studies performed. Interventions for younger patients should be developed and trialled.Trial registrationCurrent Controlled Trials ISRCTN88318003.FundingThis project was primarily funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 53. See the NIHR Journals Library website for further project information. Additional financial support was received from Comprehensive Local Research Networks.

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Integrated breathing and relaxation training (the Papworth method) for adults with asthma in primary care: a randomised controlled trial

Cited by 142 publications

References 20 publications

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

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

Breathing pattern recordings using respiratory inductive plethysmography, before and after a physiotherapy breathing retraining program for asthma: A case report

A randomised controlled study of the effectiveness of breathing retraining exercises taught by a physiotherapist either by instructional DVD or in face-to-face sessions in the management of asthma in adults

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