Breathing exercises for asthma: a randomised controlled trial

BACKGROUND: The effect of breathing modification techniques on asthma symptoms and objective disease control is uncertain. METHODS: Prospective parallel-group single-blinded randomised controlled trial comparing breathing training with asthma education (to control for non-specific effects of clinician attention). Primary care managed asthmatic subjects with impaired health status were randomised to 3 sessions of either physiotherapist supervised breathing training (n=94) or asthma nurse delivered asthma education (n=89). The main outcome was Asthma Quality of Life Questionnaire (AQLQ) score, with secondary outcomes including spirometry, bronchial hyperresponsiveness, exhaled nitric oxide, induced sputum eosinophil count, and Asthma Control Questionnaire (ACQ), Hospital Anxiety and Depression (HAD) and hyperventilation (Nijmegen) questionnaire scores. RESULTS: 1-month post-intervention, similar improvements in AQLQ scores from baseline occurred in both groups, but at 6 months significant between-group difference favouring breathing training were observed (0.38, 95% confidence interval 0.08 to 0.68 units). At the 6-month assessment, significant between-group differences favouring breathing training were seen in HAD-anxiety (1.1, 0.2 to 1.9), HAD-depression (0.8, 0.1 to 1.4) and Nijmengen (3.2, 1.0 to 5.4) scores, with trends to improved ACQ (0.2, 0.0 to 0.4). No significant between-group differences were seen at 1 month. Breathing training was not associated with significant changes in airways physiology, inflammation or hyperresponsiveness. CONCLUSION: Breathing training resulted in improvements in asthma-specific health status and other patient-centred measures but not in asthma pathophysiology. Such exercises may help patients whose quality of life is impaired by asthma but are unlikely to reduce the need for anti-inflammatory medication.