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Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey

BMJ 2001; 322 doi: (Published 05 May 2001) Cite this as: BMJ 2001;322:1098

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Dysfunctional breathing in asthma, anxiety and Buteyko

EDITOR- By connecting dysfunctional breathing in asthma with the
anxiety related hyperventilation syndrome Thomas et al (1) may have
inadvertently led to some misunderstanding regarding the intended role of
breathing exercises such as Buteyko in the treatment of this condition.

Physiological hyperventilation is a common finding in patients with
mild, symptomatic asthma as shown by a raised minute volume of
respiration, lowered arterial pCO2 and consequent respiratory
alkalosis(2,3). However, this does not in itself imply that such patients
suffering from excessive anxiety. In many cases the desire of an asthmatic
patient to breathe deeply can be seen as a natural response to the feeling
of restricted breathing. This is entirely analogous to the way in which a
patient with eczema develops a habit of scratching, or a patient with
mechanical back pain adopts an abnormal posture. In each case the
patient's own behaviour, whilst understandable, can nevertheless lead to
an exacerbation of the underlying condition.

Reviewing the literature there is substantial evidence that
hyperventilation in itself can lead to significant increases in the
resistance of human airways (4). Several possible mechanisms have been put
forward to explain this including stimulation of autonomic reflexes
or even as a direct effect of lowered carbon dioxide levels. The emphasis
of breathing pattern modification is therefore directed towards the
prevention of such hyperventilation induced bronchospasm. The crucial
point is that this approach is effective irrespective of whether or not
the underlying hyperventilation is related to anxiety.

This latter point is entirely consistent with my own experience of
teaching the Buteyko method which has shown that the majority of well
motivated, asthmatic patients derive significant benefit in terms of
improved symptom control and reduction in medication use. In particular,
although entirely subjective, my impression is that less anxious patients
tend to respond more favourably.

We all know that changing patients' behaviour can be difficult.
Therefore any attempt must be well-organised and involve adequate support.
However, taking into account the current high expenditure on asthma I
believe that the Buteyko method offers a serious and cost effective
adjunct to conventional care. It should not simply be seen as
treatment reserved for the worried well.

James Oliver
General Practitioner

Mullion Health Centre, Cornwall TR12 7HS

1. Thomas M, McKinley RK, Freeman E, Foy C. Prevalence of
dysfunctional breathing in patients treated for asthma in primary care:
cross sectional survey. BMJ 2001;322:1098-100

2. Tobin MJ, Tejvir SC, Jenouri G, Birch SJ, Hacik B, Gazeroglu BS,
Sackner MA. Breathing Patterns 2. Diseased subjects. Chest 1983;84(3):286

3. McFadden ER, Lyons HA. Arterial blood gas tension in asthma. NEJM

4. Sterling GM. The mechanism of bronchoconstriction due to
hypocapnia in man. Clin. Sci. 1968;34:277-285

Competing interests: No competing interests

16 May 2001
James Oliver
General Practitioner
Mullion Health Centre, Mullion, Cornwall. TR12 7HS