Respiratory or Breathing Exercise therapy is thought to improve symptom control in asthma. Various breathing techniques can be used, such as the Buteyko technique and yoga.

Treat Asthma using Breath Exercises

There has been a lot of scientific evidence showing the positive role of nonpharmacological management in various diseases, including improving quality of life without drug intervention. This nonpharmacological management is also applied to asthma. Asthma is a chronic inflammatory disease of the airway characterized by wheezing, shortness of breath, cough, and heaviness in the chest.

In the course of their illness, asthma patients may experience unpredictable exacerbations episodes and reduce the quality of life. Some people with asthma also have a more severe spectrum of disease, despite good adherence to therapy. It causes asthma therapy's complexity, and nonpharmacological management, such as breathing exercise, is expected to increase patient outcomes.

Efficacy of Breathing Exercise Therapy in Asthma

Various breathing therapy types can be used to manage asthma, such as the Buteyko technique and yoga breathing techniques. However, studies examining the efficacy of these breathing techniques are still minimal.

3 Breathing Exercises therapy in asthma:
  1. Therapy that aims to manipulate breathing patterns
  2. Therapy increases the strength or stamina of the respiratory muscles.
  3. Treatment aimed at increasing chest cavity flexibility and improving posture
Santino et al. reported that respiratory therapy generally focuses on tidal volume, increases relaxation, motivates patients to do independent exercises at home, modifies breathing patterns with nasal breathing, holds breath, and uses abdominal breathing.

a. Yoga

One type of respiratory therapy that can be used in asthma management is Yoga exercises. Examples of yoga breathing techniques that can be used by asthma sufferers are:
  1. pranayama (deep breathing exercises),
  2. Kapalabhati (breathing patterns),
  3. Bhastrika (rapid and deep breathing using the abdominal muscles),
  4. ujjayi (pranayama with a more intense voice),
  5. meditation,
  6. and Shavasana (relaxation therapy).

A study published in 2017 tried to analyze respiratory therapy's efficacy using the Pranayama yoga movement added to standard asthma therapy. The patient's quality of life was measured using the St. score. George's Respiratory Questionnaire (SGRQ). The study included 60 stable asthma patients who had received standard medical therapy for at least three months. The investigators concluded that respiratory therapy significantly improved the SGRQ score. However, this study did not analyze pulmonary function changes on spirometry, such as Forced Expiratory Volume in 1s, Forced Vital Capacity, or Peak Expiratory Flow Rate.

Another study by Sodhi et al. involved 120 mild asthma patients randomized to yoga breathing therapy and a control group. They measured the respiratory function at baseline, four, and eight weeks. The analysis showed a trend of the significant improvement in the group undergoing yoga breathing therapy than controls.
A similar result was reported by another clinical trial involving 60 patients with mild to moderate asthma. Respiratory or breathing exercise therapy is reported to significantly improve lung function and is useful as an adjuvant treatment for asthma.

b. Buteyko

The Buteyko respiratory therapy was developed by Konstantin Buteyko based on the understanding that hyperventilation is based on bronchospasm in asthma, although this is not recognized pathogenesis of asthma. This is due to hypocapnia, which occurs during hyperventilation. In the Buteyko method, the principle used is to modify the breathing pattern to shallow breathing, reduce the respiratory rate interspersed with the controlled cessation of breathing, and encourage nasal breathing.

A systematic review conducted by Burgess et al. reported that respiratory therapy with the Buteyko method could improve people's quality of life with asthma and reduce the need for 2-agonists such as salbutamol. However, Burgess et al. also reported that the Buteyko method did not improve lung function. They measured it by:
  • peak expiratory flow rate,
  • forced vital capacity or forced expiratory volume in 1s (FEV1).

The benefits of using the Buteyko technique are still controversial. Consider that studies that report hyperventilation and hypocapnia are not the basis for asthma. Also, there was no evidence of changes in carbon dioxide levels with Buteyko therapy.

Recent Review Results Regarding the Efficacy of Breathing Exercises Therapy in Asthma

In March 2020, Santino et al. published a systematic review of respiratory therapy's asthma efficacy in the Cochrane Database of Systematic Reviews. This review is an update from a previous review published in 2013.

In this systematic review, nine new studies (a total of 1910 participants), bringing the total analyzed studies to 22 studies with a total sample of 2880 people. Of the total, 14 studies used yoga breathing therapy, four studies used breathing retraining, 1 study used the Buteyko method, 1 study used the Buteyko and Pranayama methods, 1 used the Papworth method, and 1 used the diaphragmatic breathing method.

The analysis showed that respiratory therapy improved the patient's quality of life three months after starting therapy. Respiratory therapy has not been found to help reduce asthma symptoms. However, it was found to reduce hyperventilation symptoms 4-6 months after beginning treatment. FEV1 was found to be increased in the group of patients undergoing breathing exercises. It should be noted that the quality of scientific evidence reviewed ranged from low to moderate. Studies with larger samples and better methodology are still needed before concluding.

Many previous studies have indicated the benefits of breathing therapy in the management of asthma. Respiratory therapy can be performed using a variety of methods, such as yoga and the Buteyko method.

Although scientific evidence regarding respiratory therapy's efficacy is still limited, currently available scientific evidence suggests the potential of respiratory therapy as an adjuvant in mild-moderate asthma therapy. Respiratory therapy is reported to improve the patient's quality of life, reduce hyperventilation symptoms, and increase the value of forced expiratory volume in 1s (FEV1) on spirometry. It should be noted that studies with larger sample sizes and better methodology are still needed before conclude the definitive.