The BREATHE study: Breathing REtraining for Asthma — Trial of Home Exercises. A protocol summary of a randomised controlled trial

Bruton, Anne; Kirby, Sarah; Arden‐Close, Emily; Taylor, Lynda; Webley, Frances; George, Steve; Yardley, Lucy; Price, David; Moore, Michael; Little, Paul; Holgate, Stephen T.; Djukanović, Ratko; Lee, Amanda; Raftery, James; Chorozoglou, Maria; Versnel, Jenny; Pavord, Ian D.; Stafford-Watson, Mark; Thomas, Mike

doi:10.4104/pcrj.2013.00047

Cited by 13 publications

(11 citation statements)

References 12 publications

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“…In this section, we highlight four points (presenting breathing training as something for everyone, the design of the front cover, the importance of continuing with medication and use of personal stories) that arose during the development of the Breathing Freely booklet, which was used in BREATHE, a trial of breathing training for asthma [15]. Semi-structured think-aloud interviews were carried out with 29 individuals with asthma to explore their views of breathing training in general and reactions to the booklet (see [8]).…”

Section: Resultsmentioning

confidence: 99%

The person-based approach to enhancing the acceptability and feasibility of interventions

Yardley

Ainsworth

Arden‐Close

et al. 2015

Pilot Feasibility Stud

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273

269

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BackgroundThis paper provides three illustrations of how the “person-based approach” can be used to assess and enhance the acceptability and feasibility of an intervention during the early stages of development and evaluation. The person-based approach involves using mixed methods research to systematically investigate the beliefs, attitudes, needs and situation of the people who will be using the intervention. The in-depth understanding of users’ perspectives derived from this research then enables intervention developers to design or modify the intervention to make it more relevant, persuasive, accessible and engaging.MethodsThe first illustration describes how relevant beliefs and attitudes of people with asthma were identified from the existing qualitative and quantitative literature and then used to create guiding principles to inform the design of a web-based intervention to improve quality of life. The second illustration describes how qualitative “think-aloud” interviews and patient and public involvement (PPI) input are used to improve the acceptability of a booklet for people with asthma. In the third illustration, iterative think-aloud methods are used to create a more accurate and accessible activity planner for people with diabetes.ResultsIn the first illustration of the person-based approach, we present the guiding principles we developed to summarise key design issues/objectives and key intervention features to address them. The second illustration provides evidence from interviews that positive, non-medical messages and images were preferred in booklet materials for people with asthma. The third illustration demonstrates that people with diabetes found it difficult to complete an online activity planner accurately, resulting in incorrect personalised advice being given prior to appropriate modification of the planner.ConclusionsThe person-based approach to intervention development can complement theory- and evidence-based development and participant input into intervention design, offering a systematic process for systematically investigating and incorporating the views of a wide range of users.Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-015-0033-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

The person-based approach to enhancing the acceptability and feasibility of interventions

Yardley

Ainsworth

Arden‐Close

et al. 2015

Pilot Feasibility Stud

Self Cite

273

269

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“…There is now a compelling body of evidence showing that instruction in fairly simple breathing exercises provided by a trained therapist can improve patients' experience of their disease and 5. Breathing exercises for asthma patients should be confined to: a) Those with evidence of hyperventilation such as hypocapnia or raised minute volume b) Those with a diagnosis of anxiety or depression c) Those with impaired asthmarelated quality of life d) Those with high scores on a hyperventilation questionnaire Figure 2 Example of patient self-help material from the BREATHE (Breathing Retraining for Asthma: Trial of Home Exercises) study [57] Breathing exercises for asthma Breathe | December 2014 | Volume 10 | No 4 320…”

Section: Resultsmentioning

confidence: 99%

Breathing exercises for asthma

Thomas

Bruton

2014

Breathe

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• Asthma is frequently poorly controlled despite effective modern medication • Psychological factors can be as important as physiological ones in affecting symptom perception and disease impact • Breathing exercises can improve patient-reported outcomes and psychological state • Breathing exercises should be offered to all asthma patients with symptoms or impaired quality of life despite standard treatment Breathing exercises for asthma Educational aims N To summarise the evidence of the role of breathing control approaches in the management of asthma N To provide information on the content of evidence-based breathing exercises programmes Summary Asthma is a complex, multi-dimensional condition that affects patients in many ways. Having asthma is inherently stressful and psychological problems are common and associated with poor asthma outcomes. Although most patients in clinical trials can achieve high levels of control with optimised pharmacotherapy, in ''real-life'' practice, poor control is common, with over-reliance on rescue bronchodilator medication and ongoing symptoms and quality-of-life impairment. Many patients are interested in non-pharmacological treatments to improve asthma control, particularly breathing control exercises but, until recently, the evidence base has been inadequate. The place of breathing exercises has been controversial, partly because some proponents have made exaggerated, implausible claims of effectiveness. Recent evidence, however, has resulted in endorsement of breathing exercises as add-on treatment in asthma in systematic reviews and guidelines. This review summarises the current evidence of effectiveness of breathing exercises programmes as an adjuvant treatment to pharmacological strategies for people with asthma. The types of breathing training programmes used and the content of effective programmes are discussed. We conclude that patients whose asthma continues to cause symptoms and quality-of-life impairment, despite adequate pharmacological treatment, or who have high bronchodilator use, should be offered access to an effective breathing training programme as a part of holistic, integrated asthma care. Statement of Interest None declared. ERS 2014

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“…At present, there is a need for larger studies validating the efficacy of specific breathing retraining programs that are easily implementable in the clinical setting, and studies of such programs are ongoing. For example the BREATHE (Breathing Retraining for Asthma Trial of Home Exercise) project developed by Anne Bruton and her team, where digital formats are used to provide breathing retraining for patients with asthma [25]. Furthermore, future studies are needed to evaluate whether a physiotherapeutic intervention may reduce the need for inhaled corticosteroids in asthma patients with DB, without loss of asthma control.…”

Section: Discussionmentioning

confidence: 99%