Comparison of Buteyko Technique and Pursed Lip Breathing in Asthma

Comparison of Buteyko Breathing Technique and Pursed Lip Breathing to Improve Pulmonary Function in Asthma

The objective of the study was to compare the effects of Buteyko breathing technique and pursed lip breathing technique in the management of asthma. A randomized controlled trial was conducted on 60 asthmatic patients randomly allocated to Buteyko technique group and pursed lip breathing group. Both the groups received 4 weeks of treatment, 3 times per week. Data was collected at base line, 2nd week and 4th week. Outcome measurements included FVC, FEV, PEFR and Asthma Control Test Questionnaire scores. Data analysis was carried out on Statistical Package for the Social Sciences (SPSS) v.21.0. Confidence interval was kept at 95% and a p-value of less than 0.05 was considered significant.

Asthma is an inflammatory condition in which narrowing and swelling of the airways occur, accompanied with extra mucus production. This results in difficulty in breathing and triggers coughing, wheezing and dyspnea. In some cases asthma is a minor irritation, but on the other end of the spectrum it may interfered with activities of daily living and can even become life threatening in severe asthma attacks. According to a study conducted in Pakistan, the prevalence of asthma in adults was found to be 10.8% in adults, working in tanneries with 5.3% of them reporting their symptoms to be work related. Non-pharmacological management of asthma includes patient education, guidance and physiotherapy. It is suggested that physical therapy may have positive effects in patients with asthma, as they possess dysfunctional breathing patterns accompanied with poor physical condition. Numerous reviews by Cochrane have been published in the recent years regarding the effects of physical therapy in patients with asthma, focusing on the effects of numerous techniques including Alexander technique, manual therapy, physical training, breathing exercises and inspiratory muscle training. In terms of specific effects of different physical therapy treatment techniques in patients with asthma, in light of the existing literature, breathing exercises have found to improve quality of life, reduce symptoms of anxiety, depression and hyperventilation, and decrease respiratory rate and medication use. Moreover, inspiratory muscle training is found to improve symptoms, decrease medication use and also improve inspiratory pressure. Buteyko technique is a specialized breathing technique developed to reduce chronic hyperinflation. A pre and post design quasi experimental study conducted was conducted in 2014 to determine the effects of Buteyko breathing technique on asthma control and QOL in school aged children with asthma where Buteyko breathing technique group showed significant improvements terms of asthma control and quality of life. Based upon the review of the literature, evidence is inadequate in terms of comparison of Buteyko breathing technique with pursed lip breathing technique in the management of patients with asthma except for a single randomized controlled trial. For this reason the purpose of the current study is to compare the effects of Buteyko technique with pursed lip breathing in the management of patients with asthma.

Buteyko breathing technique was performed by asking the patient to take a small breath in and then out and hold his/her breath and count the time in seconds, as long as he or she can, until first signs of air hunger start to appear, followed by normal breathing once again. This procedure was repeated 15 times, three sets of 15 repetitions were given to the patient per day, 3 days per week and the treatment was continued for 4 weeks.

Pursed lip breathing was performed as nasal inspiration followed by expiratory blowing against partially closed lips. Participants received a total of 3 sets of 15 repetitions per day, 3 times a week and the treatment was continued for 4 weeks.

Peak expiratory flow rate (PEFR) measured through digital spirometer. Peak Expiratory Flow Rate (PEFR) measured through digital spirometer. Three zones of measurement are commonly used to interpret peak flow rates. Normal value of PEFR is (80-100%). Green zone indicates 80 to 100 percent of the usual or normal peak flow reading, yellow zone indicates 50 to 79 percent of the usual or normal peak flow readings, and red zone indicates less than 50 percent of the usual or normal peak flow readings.

Forced vital capacity (FVC) measured through digital spirometer. If the value of FVC is within 80% of the reference value, the results are considered normal.

Forced expiratory volume in 1sec (FEV1) measured through digital spirometer. If the value of FEV1 is within 80% of the reference value, the results are considered normal.

FVC/FEV1 measured through digital spirometer. The normal value for the FEV1/FVC ratio is 70% (and 65% in persons older than age 65).

Asthma Control questionnaire is a self-reported subjective outcome measurement tool that is used to measure the sufficiency of asthma symptom control and changes in asthma symptoms. It is 5 point scale with scores ranging from 0 to 5 for each item. The greater the score of Asthma Control questionnaire, the better the prognosis and outcome.

Inclusion Criteria: Patients categorized as mild to moderate persistent asthma category according to the "National Asthma Education and Prevention Program" Exclusion Criteria: Use of oral steroids within the four-week run-in period, Change in inhaled steroid dose and type, Other significant unstable medical conditions, They have undertaken Buteyko breathing technique previously.

Davies SJ, Jackson PR, Ramsay LE. Dysfunctional breathing and asthma. Panic disorder needs to be considered. BMJ. 2001 Sep 15;323(7313):631; author reply 631-2. No abstract available.

Stoodley I, Williams L, Thompson C, Scott H, Wood L. Evidence for lifestyle interventions in asthma. Breathe (Sheff). 2019 Jun;15(2):e50-e61. doi: 10.1183/20734735.0019-2019.

Arden-Close EJ, Kirby SE, Yardley L, Bruton A, Ainsworth B, Thomas DM. Evaluation of a breathing retraining intervention to improve quality of life in asthma: quantitative process analysis of the BREATHE randomized controlled trial. Clin Rehabil. 2019 Jul;33(7):1139-1149. doi: 10.1177/0269215519832942. Epub 2019 Feb 27.

Singh V, Wisniewski A, Britton J, Tattersfield A. Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma. Lancet. 1990 Jun 9;335(8702):1381-3. doi: 10.1016/0140-6736(90)91254-8.

Zampogna E, Centis R, Negri S, Fiore E, Cherubino F, Pignatti P, Heffler E, Canonica GW, Sotgiu G, Saderi L, Migliori GB, Spanevello A, Visca D. Effectiveness of pulmonary rehabilitation in severe asthma: a retrospective data analysis. J Asthma. 2020 Dec;57(12):1365-1371. doi: 10.1080/02770903.2019.1646271. Epub 2019 Aug 13.

Barker NJ, Jones M, O'Connell NE, Everard ML. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in children. Cochrane Database Syst Rev. 2013 Dec 18;(12):CD010376. doi: 10.1002/14651858.CD010376.pub2.

Wang Q, Zhang W, Liu L, Yang W, Liu H. Effects of physical therapy on lung function in children with asthma: Study protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2019 Apr;98(15):e15226. doi: 10.1097/MD.0000000000015226.