Physiotherapy breathing retraining for asthma: a randomised controlled trial

Abstract

SummaryBackgroundDespite effective pharmacotherapy, asthma continues to impair quality of life for most patients. Non-pharmacological approaches, including breathing retraining, are therefore of great interest to patients. However, clinicians rarely advocate breathing retraining and access to this intervention is restricted for most patients due to the limited availability of suitable physiotherapists and poor integration of breathing retraining into standard care. We aimed to assess the effectiveness of a digital self-guided breathing retraining intervention.MethodsIn this randomised controlled trial, we recruited patients from 34 general practices in the UK. Eligibility criteria for patients with asthma were broad, comprising a physician diagnosis of asthma, age of 16–70 years, receipt of at least one anti-asthma medication in the previous year, and impaired asthma-related quality of life (Asthma Quality of Life Questionnaire [AQLQ] score of <5·5). We developed a self-guided intervention, which was delivered as a DVD plus a printed booklet (DVDB). Participants were randomly assigned to receive either the DVDB intervention, three face-to-face breathing retraining sessions, or standard care, in a 2:1:2 ratio, for 12 months. Randomisation was achieved using the Southampton Clinical Trials Unit telephone randomisation service by use of random number generators. The primary outcome was the AQLQ score in the intention-to-treat population at 12 months. The trial was powered to show equivalence between the two active intervention groups, and superiority of both intervention groups over usual care. Secondary outcomes included patient-reported and physiological measures of asthma control, patient acceptability, and health-care costs. This trial was registered with International Standard Randomised Controlled Trial Number registry, number ISRCTN88318003.FindingsBetween Nov 5, 2012 and Jan 28, 2014, invitations to participate in the study were sent to 15 203 patients with general practitioner-diagnosed asthma, of whom 655 were recruited into the study. AQLQ scores at 12 months were significantly higher in the DVDB group (mean 5·40, SD 1·14) than in the usual care group (5·12, SD 1·17; adjusted mean difference 0·28, 95% CI 0·11 to 0·44), and in the face-to-face group (5·33, SD 1·06) than in the usual care group (adjusted mean difference 0·24, 95% CI 0·04 to 0·44); AQLQ scores were similar between the DVDB group and the face-to-face group (0·04, 95% CI −0·16 to 0·24). There were no significant differences between the randomisation groups in FEV1 or fraction of exhaled nitric oxide. 744 adverse events occurred in 272 patients: 101 (39%) of 261 patients in the DVDB group, 55 (42%) of 132 patients in the face-to-face group, and 132 (50%) of 262 in the usual care group, with patients reporting one or more event. 11 (4%) patients in the DVDB group, four (3%) patients in the face-to-face group, and 20 (8%) patients in the usual care group had a serious adverse event.InterpretationBreathing retraining programmes improve quality of ...

Assessing the impact of breathing retraining on asthma symptoms and dysfunctional breathing in children

“…A randomized controlled trial in 94 adults with asthma demonstrated an equal response to breathing retaining in participants with a baseline NQ score of less than 23 (suggesting no DB symptoms) and more than or equal to 23 (suggesting DB symptoms). 34 In this service evaluation, DB symptoms (NQ scores) significantly improved in children with both a baseline score of less than 23 and more than or equal to 23; however, participants with a baseline score of more than or equal to 23 had a significantly greater response. These data suggest that although a baseline NQ score more than or equal to 23 strongly correlated with DB, it was not sensitive enough to identify children who would benefit from breathing retraining, therefore, the NQ questionnaire should not be used in isolation in clinical practice.…”

“…A randomized controlled trial in 94 adults with asthma demonstrated an equal response to breathing retaining in participants with a baseline NQ score of less than 23 (suggesting no DB symptoms) and more than or equal to 23 (suggesting DB symptoms) . In this service evaluation, DB symptoms (NQ scores) significantly improved in children with both a baseline score of less than 23 and more than or equal to 23; however, participants with a baseline score of more than or equal to 23 had a significantly greater response.…”

Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (POTS): The impact of a physiotherapy intervention

“…Patients were then guided thorough the breathing control exercise which involved breathing with an inspiratory time of two seconds, an expiratory time of two seconds and a post expiratory pause of one second (i.e. total respiratory cycle time = 5 seconds, with the aim of achieving a resting respiratory rate of 12 breaths per minute) (Thomas et al, 2003;Bruton et al, 2018;Bott et al, 2009). If when teaching breathing control, patients were unable to reduce excessive upper chest movements, they were instructed to place both hands behind their head to help fix the upper chest and reduce upper chest motion.…”

“…Patients were instructed that the aim of the breathing exercise was to slowly and progressively increase tolerance of the imposed breathing pattern and rate. All patients were advised to undertake breathing control exercise for 15 minutes twice daily (Bruton et al, 2018;Cooper et al, 2003).…”

Physiotherapy breathing retraining for asthma and quality of life

“…A randomised controlled trial has assessed the effect on quality of life of digital self-guided breathing retraining exercises for people with asthma 1. The trial included 655 patients aged 16-70 years recruited from 34 UK general practices.…”