Buteyko for Asthma

The following information is extracted from a recent clinical article Alan wrote which was published in Nursing in General Practice (the journal of the Irish Practice Nurses Association).

Asthma is a very common condition seen in primary care in Ireland. Indeed, the following headline dated 11 November 2013 appeared on the Asthma Society of Ireland website “Ireland is Top in Europe for High Asthma Rates.” Also in 2013, the European Respiratory Society noted that Ireland has a comparatively high adult mortality rate for asthma, and is at the top of the European table after Serbia, Albania, Azerbaijan, Uzbekistan and Kyrgyzstan. The situation is equally worrying for childhood asthma, with Ireland listed in the countries with the most cases of childhood wheezing and asthma.

High rates of uncontrolled asthma

According to a presentation given to the Joint Oireachtas Committee on Health and Children by the Asthma Society of Ireland on 7 February 2013:

• 60% of asthma sufferers (in Ireland) do not have their asthma under control
• 62 people died from asthma in 2011. Tragically, a large number of these deaths were preventable because asthma is a controllable disease with the right treatment and management.

The 60% cited in the first point above, is based on the HARP (Helping Asthma in Real Patients) study which found that across a number of participating GP surgeries, up to 60% of patients failed to meet international criteria for asthma control. Also, again according to the Asthma Society of Ireland, recent research has found that “more than half of Irish people with asthma are awakened at night by asthma symptoms, and nearly three-quarters of sufferers experience some limitation in their normal activities due to asthma. Worryingly, almost eight in 10 children with asthma did not have their illness under control”.

Asthma control and management guidelines

Informed self-management and adherence to prescribed treatment play a key role in the control of severe asthma. Patients and doctors/nurses need to work in partnership to achieve optimal control. Guidelines for the management of asthma vary somewhat from country to country. However, most guidelines highlight effective control of asthma as the most important goal, as a way to ensure that the asthma patient is able to lead a normal and physically active life. Essentially, this means the objectives for the patient are: (a) to be completely free of any symptoms e.g. cough, wheeze, breathlessness, (b) to attend work or school regularly and to participate fully in all activities, including sport, (c) to have restful sleep, free from night-time cough and/or wheeze, (d) to minimise the number of asthma attacks, and (e) to avoid hospital admissions.

Medication is the mainstay of asthma treatment. However, internationally there is growing interest in non-pharmacological ways of controlling asthma, and in particular, the Buteyko breathing technique (BBT).

Improving asthma control with the Buteyko breathing technique

According to Bruton and Thomas (2011), many patients have concerns about taking regular medication, particularly inhaled corticosteroids. In an article published in Nursing Practice, Hambleton (2013), a respiratory nurse specialist, notes that integrating the Buteyko technique into respiratory care can promote patient autonomy and reduce the need for drugs.

She states:

“Buteyko breathing technique (BBT) can be used to improve asthma control and is included in the BTS (British Thoracic Society) guidelines. It hands back control to the patient and can reduce the amount of drugs they are required to take.”

“Initially only one consultant sent me referrals for BBT. However, as I began to demonstrate the benefits for patients and successful use of the technique, other consultants have now engaged with the service.”

In an article published in Practice Nursing, Godfrey (2010) notes that the Buteyko breathing technique is being increasingly used in the UK’s National Health Service in the treatment of asthma. She also notes that research has demonstrated the Buteyko technique to be a safe technique that it is suitable for the majority of the population, including children (from age 4).

Background to the Buteyko method/technique

The Buteyko Method was developed in the 1950′s by a Russian medical doctor called Professor Konstantin Buteyko. Buteyko’s extensive research led him to conclude that many chronic diseases, including asthma, could be scientifically explained, in large part, as being a consequence of hyperventilation (over breathing). The goal of Buteyko breathing retraining is to reverse chronic hyperventilation and restore a healthy breathing pattern.

Buteyko postulated that if he could retrain patients who hyperventilate, so that their breathing pattern reverted towards the norm, then he could reverse diseases such as asthma. After years of experimentation, he developed the ‘Buteyko Method’ to normalize breathing.

The fundamental principle of the Buteyko theory is that chronic hyperventilation causes a loss of carbon dioxide (CO2) in the lungs and in the blood. A deficit of CO2 disturbs the body’s acid-alkaline balance, causing bronchoconstriction, constriction of blood vessels and smooth muscle, and poor tissue oxygenation. This is related to the Bohr Effect i.e. haemoglobin’s oxygen binding affinity is inversely related both to acidity and to the concentration of CO2. Professor Buteyko believed that reducing breathing volume and using breath-holding techniques, raised CO2 levels and reversed bronchoconstriction, although this has not been conclusively demonstrated in published research. However, Courtney (2008) has noted that there are many other possible reasons why the Buteyko Method works.  These reasons could include: change in symptom perception, improved sense of control, improved biomechanics of breathing, beneficial effects of low volume breathing, altered nitric oxide levels, and resetting of respiratory rhythm generation by breath-holding techniques.

Mounting evidence for effectiveness

The first clinical trial outside of Russia, on the Buteyko method and asthma, was published in the Medical Journal of Australia. The trial results showed that after 12 weeks, participants who learned and practised Buteyko breathing techniques had an average 96 per cent reduction in reliever medication, an average 49% reduction in preventer medication, and an average reduction in asthma symptoms of 71%. The people in the control group showed no significant changes in these parameters.

Following this, the results of another study were published in the New Zealand Medical Journal. This trial was conducted on subjects with asthma, aged 18 to 70, over a 6 month period. The Buteyko group exhibited reductions of 85% in reliever medications and 50% in preventer medications. The study concluded that the Buteyko Method is a safe and efficacious asthma management technique.

A trial conducted in Glasgow had its results published in the journal Thorax. This trial was designed for 600 adults with asthma. 384 (64%) of the initial participants completed the trial. The results for the Buteyko group showed average reductions of over 90% for reliever medications, preventer medications and asthma symptoms after 6 months, which were maintained at 12 months.

A Canadian trial investigated the use of the Buteyko technique as an adjunct to the conventional treatment for asthma. The results of this trial were published in the journal Respiratory Medicine. In the trial, 129 people with asthma that were being treated with inhaled steroids; were split into 2 groups. One group was taught the Buteyko breathing method and the control group was taught breathing and relaxation techniques by a respiratory physiotherapist. After 6 months there was a very significant decrease in the use of inhaled steroids in the Buteyko group. On average, members of this group had reduced their use of daily inhaled steroids by close to 40%, with 14 out of 46 people (25%) stopping steroid treatment completely. By contract, members of the control group had, on average, only reduced their medication by 7%.

In 2008, the British Thoracic Society, in their ‘Guideline on the Management of Asthma’, upgraded the Buteyko Breathing technique in recognition of the fact that there are high quality clinical trials supporting the effectiveness of the method in reducing asthma symptoms and bronchodilator use.

In 2012, the Agency for Healthcare Research and Quality in the United States published a comprehensive review of 22 studies which examined evidence for whether breathing exercises and retraining techniques lead to improvements in asthma control. The review found that the Buteyko method achieves “medium to large improvements in asthma symptoms and reductions in reliever medications.”

No conflict with conventional asthma management

The Buteyko breathing technique does not conflict with conventional asthma management. It is a ‘complementary’ behavioural technique. Initially, the benefits of treatment manifest in a reduction in symptoms and a reduction in the requirement for bronchodilators. Any reduction in medication is handled by the patient’s doctor, as soon as symptoms diminish. Buteyko practitioners make it clear to clients that under no circumstances should they change or reduce their prescribed medication without first consulting their doctor.

BUTEYKO AND OTHER CONDITIONS