Breathing exercises for adults with asthma

Importance of this review

Asthma is a chronic airway inflammatory disorder of the lungs affecting up to 18% of the population worldwide. Clinical scenario is characterized by recurrent episodes of wheeze, cough, breathlessness, chest tightness, and exacerbations, typically triggered or worsened by several factors, such as viral infections, allergens, smoke, stress, and drugs.

In some cases, patients affected by asthma may need emergency care including hospital admission, and about 180,000 people annually die from it. Moreover, this disabling condition affects quality of life, causing a high number of missed work days and healthcare costs, along with premature death.

To date, no definitive cure for asthma is known. Among non-pharmacological interventions, breathing exercises, physical activity, and preventive strategies like cessation of smoking, avoidance of allergens exposure (occupational, environmental and/or indoor), and weight reduction are proposed.

Breathing training is a multi-component intervention targeting the biochemical, biomechanical, or psychophysiological dimensions of dysfunctional breathing pattern, modifying tidal volume and encouraging relaxation, nasal-airway, breath-holding, ribcage strengthening, and abdominal breathing.

This review talks about

In this update of a review last published in 2013, authors aim to summarise and assess the latest evidence from randomised controlled trials about the efficacy of breathing exercises as treatment for adults with asthma.

Studies included were 

Twenty-two randomised controlled trials published prior to 4 April 2019 involving 2,880 adult participants (more than 18 years of age) with mild to moderate asthma. Out of these, fourteen studies focused on yoga and four involved breathing retraining – one using the Buteyko method, one the Buteyko and pranayama, one the Papworth method, and one focused on deep diaphragmatic breathing.

This review is important for

Individuals with asthma, their caregivers or family, professionals working with asthma patients, general physicians, asthma intervention researchers, and policymakers

Key results of this review

Results showed that breathing exercises improve quality of life compared to inactive control after three and six months and, among asthma symptoms, breathing exercises improved hyperventilation symptoms and lung function (in terms of FEV1), with an overall moderate- to low-level evidence.

Authors’ conclusions

Breathing exercises probably improve quality of life and reduce hyperventilation symptoms and may make no difference in reducing asthma symptoms in terms of lung function. Due to some methodological differences among included studies, the quality of evidence for the measured outcomes ranged from moderate- to very low-certainty according to GRADE criteria. No studies reported data about inpatient hospitalisation episodes, days off work, and participants' subjective evaluation of the intervention.

Future aspects based on this review

Further studies are required including full descriptions of treatment mechanisms and outcome measurements focused on asthma symptoms and cognitive and emotional factors related to biochemical, biomechanical, and psychophysiological dimensions of asthma dysfunctional breathing.

Commented by Sunita Gudwani