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Slide 1 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma
Slide 2 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma?
Slide 3 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control
Slide 4 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises
Slide 5 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies
Slide 6 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma.
Slide 7 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration
Slide 8 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation
Slide 9 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated.
Slide 10 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.”
Slide 11 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results
Slide 12 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ)
Slide 13 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ) Reliever Use
Slide 14 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ) Reliever Use Week 12 Week 14 Week 16 Week 22 Week 28 0 0.5 1 1.5 2 2.5 1 Week 6 Week 30 Group A Group B Median Daily Reliever Use
Slide 15 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ) Reliever Use Week 12 Week 14 Week 16 Week 22 Week 28 0 0.5 1 1.5 2 2.5 1 Week 6 Week 30 Group A Group B Median Daily Reliever Use Airway Hyperresponsiveness to Mannitol
Slide 16 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ) Reliever Use Week 12 Week 14 Week 16 Week 22 Week 28 0 0.5 1 1.5 2 2.5 1 Week 6 Week 30 Group A Group B Median Daily Reliever Use Airway Hyperresponsiveness to Mannitol Results Summary Primary: Quality of life NO CHANGE Daily symptom score IMPROVEMENT - B Secondary: FEV1 NO CHANGE AHR (mannitol) NO CHANGE Reliever use 86% REDUCTION ICS dose 50% REDUCTION ACQ (Juniper) NO CHANGE Patient global assessments NO CHANGE Physician global assessments IMPROVEMENT - B Route of breathing TREND TO NASAL - A End-tidal CO2 NO CHANGE Airways resistance (FOT) NO CHANGE
Slide 17 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ) Reliever Use Week 12 Week 14 Week 16 Week 22 Week 28 0 0.5 1 1.5 2 2.5 1 Week 6 Week 30 Group A Group B Median Daily Reliever Use Airway Hyperresponsiveness to Mannitol Results Summary Primary: Quality of life NO CHANGE Daily symptom score IMPROVEMENT - B Secondary: FEV1 NO CHANGE AHR (mannitol) NO CHANGE Reliever use 86% REDUCTION ICS dose 50% REDUCTION ACQ (Juniper) NO CHANGE Patient global assessments NO CHANGE Physician global assessments IMPROVEMENT - B Route of breathing TREND TO NASAL - A End-tidal CO2 NO CHANGE Airways resistance (FOT) NO CHANGE Comparison with Previous Studies Similar: Improvement in patient centred outcomes Marked reduction in reliever use No consistent changes in physiological measures Lung function Airway responsiveness End tidal CO2
Slide 18 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ) Reliever Use Week 12 Week 14 Week 16 Week 22 Week 28 0 0.5 1 1.5 2 2.5 1 Week 6 Week 30 Group A Group B Median Daily Reliever Use Airway Hyperresponsiveness to Mannitol Results Summary Primary: Quality of life NO CHANGE Daily symptom score IMPROVEMENT - B Secondary: FEV1 NO CHANGE AHR (mannitol) NO CHANGE Reliever use 86% REDUCTION ICS dose 50% REDUCTION ACQ (Juniper) NO CHANGE Patient global assessments NO CHANGE Physician global assessments IMPROVEMENT - B Route of breathing TREND TO NASAL - A End-tidal CO2 NO CHANGE Airways resistance (FOT) NO CHANGE Comparison with Previous Studies Similar: Improvement in patient centred outcomes Marked reduction in reliever use No consistent changes in physiological measures Lung function Airway responsiveness End tidal CO2 However…why different results to previous studies? In this study : NO consistent differences between the two groups Double blinding of subjects and investigators Closely matched control intervention in this study Identical advice given to both groups in this study regarding as needed reliever use In Previous studies : Dissimilar comparison interventions in the control arms: Asthma education Physiotherapy Relaxation No matched reliever substitute
Slide 19 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ) Reliever Use Week 12 Week 14 Week 16 Week 22 Week 28 0 0.5 1 1.5 2 2.5 1 Week 6 Week 30 Group A Group B Median Daily Reliever Use Airway Hyperresponsiveness to Mannitol Results Summary Primary: Quality of life NO CHANGE Daily symptom score IMPROVEMENT - B Secondary: FEV1 NO CHANGE AHR (mannitol) NO CHANGE Reliever use 86% REDUCTION ICS dose 50% REDUCTION ACQ (Juniper) NO CHANGE Patient global assessments NO CHANGE Physician global assessments IMPROVEMENT - B Route of breathing TREND TO NASAL - A End-tidal CO2 NO CHANGE Airways resistance (FOT) NO CHANGE Comparison with Previous Studies Similar: Improvement in patient centred outcomes Marked reduction in reliever use No consistent changes in physiological measures Lung function Airway responsiveness End tidal CO2 However…why different results to previous studies? In this study : NO consistent differences between the two groups Double blinding of subjects and investigators Closely matched control intervention in this study Identical advice given to both groups in this study regarding as needed reliever use In Previous studies : Dissimilar comparison interventions in the control arms: Asthma education Physiotherapy Relaxation No matched reliever substitute In terms of our results…. All process elements were matched including suggestions of relaxation Direct comparison of the specific elements i.e. the actual exercises were the only difference between the two study groups Previous “weaker” controls may have led to an overestimation of the effect of the exercises
Slide 20 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ) Reliever Use Week 12 Week 14 Week 16 Week 22 Week 28 0 0.5 1 1.5 2 2.5 1 Week 6 Week 30 Group A Group B Median Daily Reliever Use Airway Hyperresponsiveness to Mannitol Results Summary Primary: Quality of life NO CHANGE Daily symptom score IMPROVEMENT - B Secondary: FEV1 NO CHANGE AHR (mannitol) NO CHANGE Reliever use 86% REDUCTION ICS dose 50% REDUCTION ACQ (Juniper) NO CHANGE Patient global assessments NO CHANGE Physician global assessments IMPROVEMENT - B Route of breathing TREND TO NASAL - A End-tidal CO2 NO CHANGE Airways resistance (FOT) NO CHANGE Comparison with Previous Studies Similar: Improvement in patient centred outcomes Marked reduction in reliever use No consistent changes in physiological measures Lung function Airway responsiveness End tidal CO2 However…why different results to previous studies? In this study : NO consistent differences between the two groups Double blinding of subjects and investigators Closely matched control intervention in this study Identical advice given to both groups in this study regarding as needed reliever use In Previous studies : Dissimilar comparison interventions in the control arms: Asthma education Physiotherapy Relaxation No matched reliever substitute In terms of our results…. All process elements were matched including suggestions of relaxation Direct comparison of the specific elements i.e. the actual exercises were the only difference between the two study groups Previous “weaker” controls may have led to an overestimation of the effect of the exercises Patient perception of benefit Changes in Asthma How is your asthma now, compared with before you started the breathing exercises? Much worse Much better Less asthma and constriction of breathing MF-A I’m not woken throughout the night because of my asthma JH-B …about the same, but medication has been successfully halved TS-A
Slide 21 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ) Reliever Use Week 12 Week 14 Week 16 Week 22 Week 28 0 0.5 1 1.5 2 2.5 1 Week 6 Week 30 Group A Group B Median Daily Reliever Use Airway Hyperresponsiveness to Mannitol Results Summary Primary: Quality of life NO CHANGE Daily symptom score IMPROVEMENT - B Secondary: FEV1 NO CHANGE AHR (mannitol) NO CHANGE Reliever use 86% REDUCTION ICS dose 50% REDUCTION ACQ (Juniper) NO CHANGE Patient global assessments NO CHANGE Physician global assessments IMPROVEMENT - B Route of breathing TREND TO NASAL - A End-tidal CO2 NO CHANGE Airways resistance (FOT) NO CHANGE Comparison with Previous Studies Similar: Improvement in patient centred outcomes Marked reduction in reliever use No consistent changes in physiological measures Lung function Airway responsiveness End tidal CO2 However…why different results to previous studies? In this study : NO consistent differences between the two groups Double blinding of subjects and investigators Closely matched control intervention in this study Identical advice given to both groups in this study regarding as needed reliever use In Previous studies : Dissimilar comparison interventions in the control arms: Asthma education Physiotherapy Relaxation No matched reliever substitute In terms of our results…. All process elements were matched including suggestions of relaxation Direct comparison of the specific elements i.e. the actual exercises were the only difference between the two study groups Previous “weaker” controls may have led to an overestimation of the effect of the exercises Patient perception of benefit Changes in Asthma How is your asthma now, compared with before you started the breathing exercises? Much worse Much better Less asthma and constriction of breathing MF-A I’m not woken throughout the night because of my asthma JH-B …about the same, but medication has been successfully halved TS-A Patient perception of benefit Utility of the Breathing Exercises I tried them a couple of times and didn’t get the same benefit as a puff of Ventolin. This put me off trying them again. KL-B I had a lack of confidence in the efficacy of the routine [initially] SR-A …as the study continued I have been able to ‘breathe’ myself out of many situations AD-A
Slide 22 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ) Reliever Use Week 12 Week 14 Week 16 Week 22 Week 28 0 0.5 1 1.5 2 2.5 1 Week 6 Week 30 Group A Group B Median Daily Reliever Use Airway Hyperresponsiveness to Mannitol Results Summary Primary: Quality of life NO CHANGE Daily symptom score IMPROVEMENT - B Secondary: FEV1 NO CHANGE AHR (mannitol) NO CHANGE Reliever use 86% REDUCTION ICS dose 50% REDUCTION ACQ (Juniper) NO CHANGE Patient global assessments NO CHANGE Physician global assessments IMPROVEMENT - B Route of breathing TREND TO NASAL - A End-tidal CO2 NO CHANGE Airways resistance (FOT) NO CHANGE Comparison with Previous Studies Similar: Improvement in patient centred outcomes Marked reduction in reliever use No consistent changes in physiological measures Lung function Airway responsiveness End tidal CO2 However…why different results to previous studies? In this study : NO consistent differences between the two groups Double blinding of subjects and investigators Closely matched control intervention in this study Identical advice given to both groups in this study regarding as needed reliever use In Previous studies : Dissimilar comparison interventions in the control arms: Asthma education Physiotherapy Relaxation No matched reliever substitute In terms of our results…. All process elements were matched including suggestions of relaxation Direct comparison of the specific elements i.e. the actual exercises were the only difference between the two study groups Previous “weaker” controls may have led to an overestimation of the effect of the exercises Patient perception of benefit Changes in Asthma How is your asthma now, compared with before you started the breathing exercises? Much worse Much better Less asthma and constriction of breathing MF-A I’m not woken throughout the night because of my asthma JH-B …about the same, but medication has been successfully halved TS-A Patient perception of benefit Utility of the Breathing Exercises I tried them a couple of times and didn’t get the same benefit as a puff of Ventolin. This put me off trying them again. KL-B I had a lack of confidence in the efficacy of the routine [initially] SR-A …as the study continued I have been able to ‘breathe’ myself out of many situations AD-A Not very useful. Symptoms mean shortness of breath, so deep, relaxed breathing is very difficult…. AL-A …the symptom control exercises helped me to take time out to relax and distress [sic] instead of always taking my Ventolin SB-B Extremely useful, even if it wasn’t enough, it gave me the space to wait before medicating without that desperate panicky feeling. GP-B Patient perception of benefit Utility of the Breathing Exercises
Slide 23 - Breathing techniques for asthma CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Bosnic-Anticevich, FK Thien, CR Jenkins CRC for Asthma A cure for asthma? Breathing Techniques Background Some physiologic rationale to consider breathing techniques as possibly effective for asthma Dysfunctional breathing affects 30% asthma patients Several studies to date show improved symptoms and QoL, and reduced reliever use Cochrane review (August 2002) suggested no reliable conclusions could be drawn from 42 papers (7 RCT’s) A proven low risk, low cost intervention would appeal to patients and to clinicians if it offered improved asthma control Problems with breathing techniques studies Varying techniques of breathing retraining Varying length and frequency of treatment. Widely differing interventions Significant differences between control and intervention Small studies unable to provide a reliable estimate of the efficacy of breathing exercises CRC for Asthma 7 year funding Industry and Academic partnerships Federal government funding added Must be multicentre, collaborative research CRC for partners Project 7 : Targeting treatment Opportunity to assess non-drug therapies CRC Project Title A randomised controlled trial of the effect of breathing techniques on symptoms, AHR, QOL and dose of ICS in subjects with symptomatic asthma. Study Design Week * = ICS down titration Group A Video Based on the main components of previously tested breathing techniques: Nasal route of breathing (“gentle breathing”) Hypoventilation (“awareness of reduced breath”) Breath hold at FRC (“breath check”) Panoramic scenery and background music during periods of hypoventilation Group B Video Exercises designed by CT physios at RPAH Components (repeated in sets): Shoulder rotation Forward curl Arm raise + focussing on good posture and relaxation (“control of breathing”) No evidence for clinical impact of these exercises on asthma Route of breathing not specified, but mixed oral and nasal route of breathing demonstrated. Instruction About Reliever “If you feel your asthma symptoms starting, before you take your symptom reliever, pause, and do your breathing exercises. You should feel as though your symptoms start to resolve within a few minutes. If you are still experiencing symptoms, don’t panic. Relax, and try your exercises again. If your symptoms still don’t improve, use your symptom reliever.” Results Quality of Life (AQLQ) Reliever Use Week 12 Week 14 Week 16 Week 22 Week 28 0 0.5 1 1.5 2 2.5 1 Week 6 Week 30 Group A Group B Median Daily Reliever Use Airway Hyperresponsiveness to Mannitol Results Summary Primary: Quality of life NO CHANGE Daily symptom score IMPROVEMENT - B Secondary: FEV1 NO CHANGE AHR (mannitol) NO CHANGE Reliever use 86% REDUCTION ICS dose 50% REDUCTION ACQ (Juniper) NO CHANGE Patient global assessments NO CHANGE Physician global assessments IMPROVEMENT - B Route of breathing TREND TO NASAL - A End-tidal CO2 NO CHANGE Airways resistance (FOT) NO CHANGE Comparison with Previous Studies Similar: Improvement in patient centred outcomes Marked reduction in reliever use No consistent changes in physiological measures Lung function Airway responsiveness End tidal CO2 However…why different results to previous studies? In this study : NO consistent differences between the two groups Double blinding of subjects and investigators Closely matched control intervention in this study Identical advice given to both groups in this study regarding as needed reliever use In Previous studies : Dissimilar comparison interventions in the control arms: Asthma education Physiotherapy Relaxation No matched reliever substitute In terms of our results…. All process elements were matched including suggestions of relaxation Direct comparison of the specific elements i.e. the actual exercises were the only difference between the two study groups Previous “weaker” controls may have led to an overestimation of the effect of the exercises Patient perception of benefit Changes in Asthma How is your asthma now, compared with before you started the breathing exercises? Much worse Much better Less asthma and constriction of breathing MF-A I’m not woken throughout the night because of my asthma JH-B …about the same, but medication has been successfully halved TS-A Patient perception of benefit Utility of the Breathing Exercises I tried them a couple of times and didn’t get the same benefit as a puff of Ventolin. This put me off trying them again. KL-B I had a lack of confidence in the efficacy of the routine [initially] SR-A …as the study continued I have been able to ‘breathe’ myself out of many situations AD-A Not very useful. Symptoms mean shortness of breath, so deep, relaxed breathing is very difficult…. AL-A …the symptom control exercises helped me to take time out to relax and distress [sic] instead of always taking my Ventolin SB-B Extremely useful, even if it wasn’t enough, it gave me the space to wait before medicating without that desperate panicky feeling. GP-B Patient perception of benefit Utility of the Breathing Exercises The Bottom Line Breathing techniques taught by video may be useful in the management of patients with mild asthma symptoms who use reliever frequently.
 

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