title: Breathing exercises for asthma: a randomised controlled trial.
abstract: BACKGROUND
  The effect of breathing modification techniques on asthma symptoms and objective disease control is uncertain.
  
  
  METHODS
  A prospective, parallel group, single-blind, randomised controlled trial comparing breathing training with asthma education (to control for non-specific effects of clinician attention) was performed. Subjects with asthma with impaired health status managed in primary care were randomised to receive three sessions of either physiotherapist-supervised breathing training (n = 94) or asthma nurse-delivered asthma education (n = 89). The main outcome was Asthma Quality of Life Questionnaire (AQLQ) score, with secondary outcomes including spirometry, bronchial hyper-responsiveness, exhaled nitric oxide, induced sputum eosinophil count and Asthma Control Questionnaire (ACQ), Hospital Anxiety and Depression (HAD) and hyperventilation (Nijmegen) questionnaire scores.
  
  
  RESULTS
  One month after the intervention there were similar improvements in AQLQ scores from baseline in both groups but at 6 months there was a significant between-group difference favouring breathing training (0.38 units, 95% CI 0.08 to 0.68). At the 6-month assessment there were significant between-group differences favouring breathing training in HAD anxiety (1.1, 95% CI 0.2 to 1.9), HAD depression (0.8, 95% CI 0.1 to 1.4) and Nijmegen (3.2, 95% CI 1.0 to 5.4) scores, with trends to improved ACQ (0.2, 95% CI 0.0 to 0.4). No significant between-group differences were seen at 1 month. Breathing training was not associated with significant changes in airways physiology, inflammation or hyper-responsiveness.
  
  
  CONCLUSIONS
  Breathing training resulted in improvements in asthma-specific health status and other patient-centred measures but not in asthma pathophysiology. Such exercises may help patients whose quality of life is impaired by asthma, but they are unlikely to reduce the need for anti-inflammatory medication.
authors.affiliation: Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen, UK. mikethomas@doctors.org.uk
authors.forename: M
authors.initials: M
authors.lastname: Thomas
authors.forename: R K
authors.initials: RK
authors.lastname: McKinley
authors.forename: S
authors.initials: S
authors.lastname: Mellor
authors.forename: G
authors.initials: G
authors.lastname: Watkin
authors.forename: E
authors.initials: E
authors.lastname: Holloway
authors.forename: J
authors.initials: J
authors.lastname: Scullion
authors.forename: D E
authors.initials: DE
authors.lastname: Shaw
authors.forename: A
authors.initials: A
authors.lastname: Wardlaw
authors.forename: D
authors.initials: D
authors.lastname: Price
authors.forename: I
authors.initials: I
authors.lastname: Pavord
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000628:therapy*; D001945:Breathing Exercises; D016085:Bronchoconstrictor Agents; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D006985:Hyperventilation / Q000209:etiology; D008297:Male; D016210:Methacholine Chloride; D008875:Middle Aged; D009569:Nitric Oxide / Q000032:analysis; D011788:Quality of Life; D016037:Single-Blind Method; D013183:Sputum / Q000166:cytology; D016896:Treatment Outcome
chemical_list: D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride; D009569:Nitric Oxide