Self-taught breath retraining proved to be an effective, readily available and cost efficient strategy for improving quality of life among patients with asthma in a randomized trial.
The training involved video instruction designed to teach patients breathing exercises such as diaphragmatic breathing, nasal breathing, slow breathing, controlled breath holds, and relaxation techniques.
Quality-of-life improvements among video-trained adult asthma patients were equivalent to those of patients participating in three face-to-face, 30- to 40-minute sessions with a physiotherapist.
Neither breath-training intervention was associated with improvements in lung function or airway inflammation, but both were associated with measurable improvements in quality-of-life, wrote Anne Bruton, PhD, of Southampton University in England, and colleagues in Lancet Respiratory Medicine.
“To our knowledge we report the largest trial of breathing retraining in asthma to date,” Bruton and colleagues wrote. “We confirmed improvements in quality-of-life scores over usual care previously reported in smaller studies for face-to-face physiotherapist-taught programs, and additionally showed that the (video) program results in equivalent clinically relevant benefits more conveniently and less expensively.”
More than 650 patients from 34 general practices in Great Britain were enrolled. All were age 16-70, had been prescribed at least one asthma medication during the previous year, and had Asthma Quality-of-Life Questionnaire (AQLQ) scores less than 5.5.
The researchers developed a self-guided intervention, which was delivered as a DVD plus a printed booklet. Participants were randomized 2:1:2 to the self-training, therapist-delivered training, or standard care for 12 months.
The main study outcome was AQLQ score in the intention-to-treat population at 12 month: participants completed quality-of-life questionnaires at the start of the trial and after 3, 6, and 12 months. The trial was also 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.
Among the main findings for AQLQ scores at 12 months:
- Significantly higher in the self-training group (mean 5.40, SD 1.14) compared to usual care (5.12, SD 1.17; adjusted mean difference 0.28, 95% CI 0.11 to 0.44)
- Higher in the face-to-face group (5.33, SD 1.06) than usual care (adjusted mean difference 0.24, 95% CI 0.04 to 0.44)
- Similar in the self-training and face-to-face groups (adjusted mean difference 0.04, 95% CI -0.16 to 0.24)
No differences were seen between the randomization groups in FEV1 or fraction of exhaled nitric oxide.
Adverse event rates were similar in all three study arms, suggesting that breath retraining was not associated with additional side effects.
Bruton and colleagues have made the content of the DVD and supporting booklet freely available online through their Breathestudy website.
They noted that the low cost and easy access for an internet-based intervention, along with the absence of adverse effects, “indicate that this evidence-based non-pharmacological intervention can now be offered to people with asthma with persisting quality-of-life impairment despite current asthma medications.”
But they added that it is important to stress to patients that the intervention is to be used along with, and not instead of, their currently prescribed medications.
In an accompanying editorial, John D. Balkey, PhD, of Royal Liverpool Hospital in England, highlighted the number needed to treat — eight patients — to achieve a clinically important difference in AQLQ. This is superior to that reported for medications commonly added to inhaled corticosteroids.
“Unlike add-on therapies, however, breathing retraining was not associated with any change in other symptom measures, such as airflow obstruction or inflammation. As the authors point out, breathing retraining is an adjunct to appropriate pharmacotherapy and not a replacement,” Balkey wrote.
The editorial writer added that further research is needed to confirm the generalizability of the findings.
The research was funded by the U.K. National Institute of Health Research.
F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner