We recently came across this article on Breathe, The Respiratory Professional’s Source for Continuing Medical Education, which summarises the evidence of the role of breathing control approaches in asthma and provides information on the content of evidence-based breathing exercise programmes.
The article initially states the three broad groups of breathing exercises for asthma:
1. Exercises aimed at manipulating the pattern of breathing (breathing retraining)
2. Exercises aimed at increasing the strength and/or endurance of the respiratory muscles (respiratory muscle training) e.g. POWERbreathe
3. Exercises aimed at increasing the flexibility of the thoracic cage and improving posture (musculoskeletal training)
This particular article focuses on breathing retraining techniques, which, after years of neglect, has recently seen a resurgence. A typical first breathing training session they suggest contains teaching the use of the abdomen (as opposed to upper chest breathing) and offers advice on the use of the lower thoracic and abdominal expansion rather than upper chest expansion. Breathing Control they define as “breathing at normal rate and depth initially, but using only lower thoracic and abdominal compartment expansion (also known as diaphragmatic breathing)”. POWERbreathe Inspiratory Muscle Training (IMT) teaches people to use their diaphragm (the main inspiratory muscle) for deep breathing, strengthening it and making it more resistant to fatigue.
The authors go on to suggest that the main components at the core of the breathing training packages that may be modified are, rate of breathing (number of breaths per minute), depth of breathing (volume of air inspired per breath), airflow velocity (flow rate), timing (inspiratory/expiratory phase, duration, ratio and pauses), rhythm of breathing (within-individual variability of rate, volume and timing) and primary region of movement (upper thoracic expansion, lower thoracic expansion, abdominal expansion). The POWERbreathe K2 IMT device offers a Single Breathe Test that measures inspiratory muscle strength, peak inspiratory flow rate and inhaled volume in a single breath.
The article informs us that there’s now “a convincing body of evidence that breathing training for people with asthma is effective in improving patient-reported endpoints, such as symptoms, health status and psychological well-being, and may be effective in reducing rescue bronchodilator medication usage.”
In addition to this, we’re able to show that in randomised controlled trials on mild/moderate asthmatics, POWERbreathe IMT:
- Increased inspiratory muscle strength by a mean of 11% in just 3 weeks1.
- Has been shown to relieve the symptoms of asthma by improving lung function, resulting in reduction of medication and a fall in hospitalisations2.
Also, after as little as 3 weeks’ POWERbreathe IMT1, asthma patients experienced a reduction in dyspnoea (difficult or laboured breathing; shortness of breath) as well as improvements in quality of life.
And in laboratory studies and randomised controlled trials, IMT was shown to generate:
- A reduction in the consumption of asthma medication of up to 79%2
- A reduction of ß2-agonists consumption by up to 79%2
- An improvement in asthma symptoms by up to 75% in 3 weeks1
Read more about POWERbreathe for Asthma or have a look at the models most suited to people with asthma (please consult your health care provider before beginning any health related program), in addition to the book from the Bradcliff Breathing Method for managing your asthma, ‘Dynamic Breathing’:
- POWERbreathe Medic – on prescription in UK
- POWERbreathe Classic Level 1 (LR)
- POWERbreathe Plus Level 1 (LR)
- POWERbreathe K2
The article goes on to say that the latest Global Initiative for Asthma (GINA) iteration states that “breathing exercises may be a useful supplement to medications” and that the recently updated non-pharmacological management section of the British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) UK Asthma Guideline gives grade-A recommendation to the statement ‘Breathing exercise programmes (including physiotherapist-taught methods) can be offered to people with asthma as an adjuvant to pharmacological treatment to improve quality of life and to reduce symptoms’, based on evidence graded as 1++. This should now be a standard part of the range of treatments offered to patients.”