Breathing and relaxation technique cut asthma symptoms by one third

BMJ 2007; 335 doi: (Published 19 July 2007) Cite this as: BMJ 2007;335:119
  1. Susan Mayor
  1. London

    A sequence of breathing and relaxation exercises in patients with mild asthma reduced asthma symptoms by one third, according to results from a randomised controlled trial (Thorax 2007 Jun 15 doi: 10.1136/thx.2006.076430).

    Eighty five people with mild or moderate asthma were recruited from the asthma register of a semirural general practice in the United Kingdom. They were randomly assigned to a breathing and relaxation technique known as the Papworth method, in addition to their usual drug, or simply to remain on their usual drug therapy.

    Patients assigned to the breathing method attended five one hour training sessions with a respiratory physiotherapist. It combines diaphragmatic breathing, breathing through the nose, and relaxation exercises to reduce anxiety and symptoms arising from hypocapnia.

    Patients using the Papworth method showed a significantly lower score for asthma symptoms after the programme, with a mean score of 21.8 (standard deviation 18.1) on the symptom subscale of the St George's respiratory symptom questionnaire, compared with 32.8 (20.1) for patients who had not received the treatment (P=0.001)

    The improvement in symptoms was maintained at one year, with patients using the Papworth method showing a mean symptom score of 24.9 (17.9) compared with 33.5 (15.9) for patients who took their usual drug treatment alone (P=0.007).

    Use of the Papworth method was associated with less depression and anxiety, and symptoms from inappropriate breathing habits were also reduced. The technique improved patients' relaxed breathing rate but there was no significant improvement in specific measures of lung function.

    Elizabeth Holloway, research physiotherapist at the Royal Free and University College Medical School, London, and lead author, said, “The Papworth method appears to ameliorate respiratory symptoms, dysfunctional breathing, and adverse mood compared with usual care.”

    She said that the size of the reduction in mean respiratory symptom score was almost double that considered clinically relevant.

    The fact that the Papworth method improved asthma symptoms but did not improve measures of lung function showed that it did not affect the underlying physiological causes of asthma, but their manifestation, Ms Holloway hypothesised.

    Martyn Partridge, professor of respiratory medicine, Imperial College and National Heart and Lung Institute at Charing Cross Hospital, London, said, “The duration of benefit is interesting. This is a worthwhile result but not surprising and may or may not be extrapolable to the wider asthma community.”

    He cautioned that it was a small study of patients who knew they were being recruited to a study of a non-pharmacological breathing exercise. “Some people with asthma also hyperventilate and they are likely to be helped by such an intervention but there is no hard data here regarding a beneficial effect on lung function and no evidence that the intervention reduced need for medication.”

    Ms Holloway acknowledged that she had been unable to look at a wide range of parameters, such as drugs, because she funded the study as part of her doctoral research. She emphasised that the technique was not designed to replace asthma drugs and should be taught by a trained physiotherapist.

    But she concluded, “The study showed a number of advantages—with a significant reduction in symptoms, anxiety, and depression and symptoms from dysfunctional breathing as well as a reduction in breathing rate—an indication that patients were being able to regulate their breathing rate.”

    Studies have shown that breathing techniques might alter bronchial irritability and influence patients' use of rescue drugs, Professor Partridge added. “There is also increasing research interest in how asthma is perceived in the brain and the mechanisms by which the mind and body interact.” But he noted, “While we recognise patients' desire to be on less medication and their desire for a full discussion regarding side effects, the fact is that medication is extremely effective and very safe for most people with asthma.”

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