Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Asthma and hyperventilation
- Robert Gorman (8 May 2001)
-
Brisbane trial shows benefits of Buteyko breathing techniques
- Dick Kuiper (13 May 2001)
-
Pause before you Puff
- Roger L Price (21 May 2001)
|
|
|||
|
Robert Gorman, Research Assistant Prnce of Wales Medical Research Institute
Send response to journal:
|
Several studies have recently pointed to a link between asthma and hyperventilation (1,2). However, the comments presented by Keeley (3) try to force a separation between the symptoms of each without considering a causal or contributory effect of hyperventilation on asthma. While "hyperventilation syndrome" may be largely discredited by some, the effects of reduced breathing training (Buteyko breathing technique) have recently been demonstrated to improve the symptoms of asthma and reduce bronchodilator use (4,5). This is in contrast to Keeley's assertion that "there is no good evidence that breathing therapy benefits patients with asthma". However, Keeley favours assessing and treating anxiety in asthmatics and "sympathetic explanation" despite offering no references that such an approach has been scientifically validated. 1. Thomas M, McKinley RK, Freeman E, Foy C. Prevalence of dysfunctional breathing in patients treated for asthma in primary care. BMJ 2001; 322: 1098-1100 2. Han JN, Hu Z, Zhu YJ, Van den Bergh O, Van de Woestijne KP. The complaints in patients with asthma are compounded by hyperventilation [abstract]. Am J Respir Crit Care Med 1999; 159: A788. 3. Keeley D, Liesl Osman L. Dysfunctional breathing and asthma. BMJ 2001; 322: 1075-1076. 4. Bowler SD, Green A, Mitchell CA. Buteyko breathing techniques in asthma: a blinded randomised controlled trial, Med J Australia 1998; 169: 575-578. 5. Opat AJ, Cohen MM, Bailey MJ, Abramson MJ. A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video, J Asthma 2000; 37:557-564. |
|||
|
|
|||
|
Dick Kuiper, Director Buteyko Instituut Nederland
Send response to journal:
|
In the Editorial written by Duncan Keeley and Liesl Osman you suggest “there is no good evidence that breathing therapy benefits patients with asthma”. I am not sure if you are familiar with the medical trial which ran in 1994 at the Mater Hospital, Brisbane, Australia, which clearly showed that asthma patients derive great benefits from learning the Buteyko breathing techniques. For example, usage of reliever medication in the Buteyko group was reduced by an average of 90% after 6 weeks, and usage of steroid preventer medication was reduced by an average of 49% after 3 months (with no significant changes in medication usage in the control group). Interestingly, the 39 asthma patients who participated in this double-blind trial were not selected on the basis of dysfunctional breathing, but merely on the basis that they all used reliever and preventer medication. The fact that this research has not lead to dozens of follow-up studies, but instead was followed by dead silence, raises many questions in my mind. One of the problems is that the Buteyko approach is "foreign" in the true sense of the word to most asthma specialists. It is a new approach to asthma, and boy do we need a new approach as the the current approach doesn't seem to offer anything that even slightly resembles a "cure" for the ever growing number of asthma- patients. Let's be honest here: many patients end up on a life-long regime of medication. The second issue is that Buteyko cannot be sold over the counter of a drugstore, which is why pharmaceutical companies are not interested - and as a consequence, it seems, so aren't many medical practitioners. The third issue is that the method actually helps many asthma patients to lead a symptom-free and medication-free life. I agree, there isn’t much on-going profit in such an approach – but there is an enormous benefit to the patient, and wasn’t that what medicine was all about? Dick Kuiper
PS. If the reader is interested in the Brisbane trial, it was published in the Medical Journal of Australia, which is on-line (Buteyko breathing techniques in asthma: a blinded randomised controlled trial, Simon D Bowler, Amanda Green and Charles A Mitchell, MJA 1998; 169: 575- 578) http://www.mja.com.au/public/issues/xmas98/bowler/bowler.html |
|||
|
|
|||
|
Roger L Price, CEO Applied Breathing Centres Australia
Send response to journal:
|
As a Respiratory Exercise Physiologist with many years of practical as well as theoretical experience in physiology and pharmacology, it was refreshing to see such an enlightened approach to an issue which is not as complex and complicated as it seems. In my own experience, around 40% of patients presenting at our clinics, who have been diagnosed as, and treated as asthmatic, are not asthmatic. They suffer from chronic hyperventilation which leads to chronic hypocapnia. This consistently low level of retained CO2 in the body causes the breathing trigger in the medulla to reset itself to a lower level. Once at this lower level, even the slightest increase in CO2, be it from dietary, environmental or emotional stress, causes the patient to overbreathe. This hyperventilation further lowers CO2 and the all-too- familiar breathing difficulties emerge. Compounding all of this is the reduced ability of the body to utilise oxygen bonded to haemoglobin, based on the Bohr Effect. The shortage of available oxygen compromises the optimum function of cells, particularly at the periphery, so it is not uncommon to find people with respiratory disorders also suffering from paraesthesia, eczema and other conditions of the extremeties. What is not commonly recognised however, is the link between stress, chronic hyperventilation and other disorders. The "Flight-Fight" response is triggered by exposure to a potentially dangerous or harmful situation. Where this is short-lived and where there is resolution, the body does not suffer as a result of the significant changes brought about by the sudden rush of adrenalin. However, where the situation is not life threatening, such as someone pinching your long- sought parking spot, or living or working in a situation of conflict, the body is unaware of the severity of the threat and still acts according to the natural "Fight-Flight" response. It is this constant exposure to higher than normal levels of adrenalin that cause the sufferer to develop a chronic hyperventilation pattern. The "Flight-Fight" response also causes an increase in clotting factor, increase in endorphins and shutting down of the immune and digestive systems. Could it not be that this constant up-and-down effect could contribute to such common ailments as immune and digestive disorders, tendency to strokes, the feeling of numbness or apathy and general malaise? Whilst current diagnostic tools do not provide a method for diagnosing dysfunctional breathing, Professor Buteyko, as far back as the early 1950s, found a simple way to assess the breathing pattern of a patient. This is non-invasive, non-stressful and provides a rapid and accurate measure of breathing functionality. As is common with most 'new' ideas, they go through three phases. The first is ridicule, the second is violent opposition and finally, it is accepted as self evident. The Buteyko Institute Method, as practiced by Buteyko Institute trained and registered practitioners is NOT an alternative therapy. It is strongly complementary from the point of view that all Buteyko Institute practitoners recognise the benefit of medication in treating an asthma attack. Where the approach differs though, is that greater emphasis is placed on retraining the patient's breathing pattern so as to prevent hyperventilation, thus preventing the attack from happening. Patients are instructed to keep their relievers with them at all times but, at the first sign of breathlessness to do the prescribed exercises to see if they can forestall the attack. If they can, well and good, the puffer goes back into the pocket and life resumes. If they are not able to head off an attack, then they follow the prescribed treatment. The results of the clinical trial held at the Mater Hospital in Brisbane Australia in January 1995 bear out all of the above. Several other trials have since been held, all with the same type of results. This latest report in the distinguished BMJ just serves to further highlight the benefits of this simple, natural and common-sense approach to what has become a major problem. Roger L. Price Respiratory Exercise Physiologist Kind regards Roger Price
B.Sc. Pharm (Rhodes) Dip. Pharmacol (Colorado) M.A.T.M.S. M.B.I.B.H
Roger Price is the Executive Secretary of the Buteyko Institute for Breathing and Health, a registered not-for-profit organisation which represents the interests of BIBH trained practitioners world-wide. |
|||