Self-taught breathing re-training boosts QOL in people with asthma

By Marilynn Larkin

NEW YORK (Reuters Health) – Self-taught breathing re-training improves quality of life (QOL) in people with asthma as much as training by a respiratory therapist, UK researchers say.

“People with asthma consistently express great interest in learning about things they can do for themselves to help control their asthma - particularly non-drug approaches,” Dr. Mike Thomas of the University of Southampton told Reuters Health.

“There is a long history of the use of breathing control exercises to try to help control asthma, but it’s only in recent years that such techniques have been properly scientifically investigated and found to be helpful for many people,” he said by email.

“There is now strong evidence that breathing exercises taught by a suitably trained physiotherapist can help improve asthma symptoms and reduce the negative impact that asthma can have on quality of life,” he observed. “But most patients find it hard to gain access to a suitably trained physiotherapist.”

“In this study, we confirmed that physiotherapist-taught breathing re-training exercises can improve quality of life for people with asthma,” he said, “but we were also able to show that a self-help version of the program . . . that people could do at home with a DVD and a booklet were just as effective as the face-to-face program.”

“The exercises don’t cure asthma," he noted, "but help people cope better with having asthma, and may reduce their need for ‘rescue’ inhalers."

“We saw reductions in healthcare costs, in people who did the DVD program, that more than covered the costs of providing the program to them,” he added.

Dr. Thomas and colleagues recruited 655 people with asthma ages 16 to 70 from 34 general practices in the UK, after sending invitations to 15,203 patients. All participants had been prescribed at least one anti-asthma medication in the previous year and had impaired asthma-related QOL, as reflected by a score of less than 5.5 on the Asthma Quality of Life Questionnaire (AQLQ).

Participants (mean age, 57; 64% women) were randomly assigned for one year to one of three groups: a self-guided intervention, developed by the team from an existing physiotherapy program, that included a DVD plus printed booklet (DVDB; 261 patients); three face-to-face, 40-minute breathing re-training sessions with a respiratory physiotherapist (132 patients); or usual medical care (262 patients).

As reported in The Lancet Respiratory Medicine, online December 13, mean AQLQ score at 12 months (the primary outcome) was significantly higher in the DVDB group (5.40) and in the face-to-face group (5.33) than in the usual care group (5.12).

The largest AQLQ improvements were in the emotion subdomain, with both the DVDB and face-to-face groups improving more than the usual care group. DVDB also showed significant advantages over usual care in the symptom, activities, and environment subdomains; the face-to-face intervention exceeded usual care on symptom improvement.

No significant differences were observed among the groups for FEV1 or fraction of exhaled nitric oxide.

A total of 744 adverse events occurred in 272 patients: 39% of those in the DVDB group, 42% in the face-to-face group, and 50% of the usual care group, with some patients reporting one or more events. Four percent of the DVDB group, 3% of the face-to-face group, and 8% of the usual care group had a serious adverse event.

Dr. John Blakey of the University of Liverpool, coauthor of a related commentary, called the findings "important."

"The intervention could readily be scaled up for use across large populations, and potentially adapted for on-demand digital platforms, which may facilitate use by younger people who were underrepresented in the trial," he told Reuters Health by email.

"It is therefore a key step toward improved asthma outcomes," he said.

"It is worth noting that dysfunctional breathing can make asthma itself worse, most usually by mouth breathing, (when) air is not humidified and warmed via the nasal route," he explained. "This cold, dry air leads to increased contraction of airways."

"It is important to emphasize that breathing techniques are an additional tool in asthma care, not a replacement for medicines," he added. "The aim of using these techniques is to try to address symptoms as they begin to come on, and ensure one or two puffs of a reliever doesn’t unnecessary escalate to 10 or 12."

"When people become more familiar with breathing techniques, they often become better at differentiating when their asthma is worse from when breathlessness is being caused by dysfunctional breathing, and so are better at making that initial choice," Dr. Blakey concluded.

The program, called Breathing Freely, is available for free at http://bit.ly/2BM6hKs.

SOURCES: http://bit.ly/2BngkFH and http://bit.ly/2AH6jUm

Lancet Respir Med 2017.

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