AsthmaCare UK - Clinical Trials of the Buteyko breathing re-training method

Discussion in medical literature has highlighted the existence of dysfunctional or abnormal breathing patterns in people with asthma. The Australian Doctor (11 May 2001), in an article entitled "Study explains success of Buteyko", quoted research published in the British Medical Journal (May 2001) establishing a strong link between asthma and "a complex of abnormal breathing symptoms suggestive of hyperventilation syndrome or dysfunctional breathing". The researchers recommended that, "if dysfunctional breathing is as common as our data show, facilities for breathing retraining need to be available as part of the overall management of asthmatic patients".

1. Buteyko breathing techniques in asthma: a blinded randomised trial Simon D Bowler, Amanda Green and Charles A Mitchell Medical Journal of Australia 1998; 169:575-578 and
2. Buteyko Breathing Technique for asthma: an effective intervention Patrick McHugh, Fergus Aitcheson, Bruce Duncan, Frank Houghton Journal of the New Zealand Medical Association, 12-December-2003, Vol 116 No 1187

An outline of the trials -

Mater Hospital Trial 1995

A therapy is accepted as having therapeutic value when it is proven and verified by independent trials. This section of the website provides a brief summary of the first trials into Buteyko Breathing in the Western world, which were conducted at the Mater Hospital, Brisbane, Australia in 1995 and the Gisborne Hospital, New Zealand in 1998.

Summary of blind randomised trial at the Mater Hospital, Brisbane, 1995.

Duration: January to April 1995

Trial sample: 39 people

The purpose of the trial was to evaluate the therapeutic benefits of the Buteyko Breathing Method as a treatment for asthma. The trial was funded by a grant from the Australian Association of Asthma Foundations and conducted by Professor Charles Mitchell. Following publicity by the asthma foundation, one-hundred-and-seventy subjects were interviewed and screened. The forty-two subjects who met the requirements were monitored for a period of four weeks prior to the trial to determine their peak flow readings, medication use and asthma stability. During this period, three subjects were excluded because they did not require sufficient short-acting reliever medication.

Thirty-nine subjects participated in the trial; nineteen were allocated to the Buteyko group and twenty to the control group. Participants were allocated to either group by random selection. There were no significant medication use or airway obstruction differences between either group.

Background

The trial was blind, meaning that none of the participants involved was aware of what therapy he or she was being taught; no mention of Buteyko was made during the training on which the trial results were based.

Buteyko Breathing was taught in accordance with normal Buteyko procedures. The Buteyko practitioner made follow-up calls to each patient as needed, and some participants were given follow-up instruction.

The control group was taught conventional abdominal breathing exercises and relaxation techniques by a physiotherapist. The practitioner in the control group made one call to each participant.

Each participant was instructed to use his or her short-acting reliever medication only as needed. In the event that the requirement for short-acting reliever was reduced to one dose or less per day, participants were instructed to reduce their steroid intake.

All participants completed an individual diary of progress including medication intake and symptoms. Each participant completed quality-of-life questionnaires twice: once when the trial started and again three months later as a comparison measure. The quality-of-life measurement took four indicators into account including mood, breathing, social interaction and concern for others.

Trial Results

Exacerbation of symptoms

During the three months of the study, three subjects from each group were admitted to hospital. In addition, six subjects from the Buteyko Method group and seven subjects from the control group received short courses of oral steroids. An approximate number of severe chronic asthmatics were involved in both groups.

Conclusions

The Buteyko Breathing group experienced a significant reduction in the need for reliever medication and steroids, along with a greater improvement in quality of life.

The control group showed little change in medication and quality of life despite being taught the conventional breathing exercises that continue to be the mainstay of treatment in hospitals and clinics. It is interesting to note that half the control group was later taught Buteyko Breathing and the results from this group were consistent with earlier findings, according to Tess Graham, the Buteyko practitioner involved in the trials.

In order to measure only changes to lung function brought about by Buteyko breathing, preventer medication would be required to remain constant. A reduction of preventer medication generally would lead to a decrease of lung function for any asthmatic. During this trial, the Buteyko group were able to reduce their need for preventer medication and yet there was no deterioration in lung function. In twelve weeks, patients could produce the same lung function scores as before the trial but with less than half the need for medication.

A headline from an article published in Australian Doctor read "Doctors gasp at Buteyko success". Dr Simon Bowler, a respiratory physician at Mater Hospital in Brisbane was quoted as saying "we were surprised at the results, as we didn't expect any significant changes."

Final note

When the trial started, the average volume per minute in the Buteyko group was 14 litres and 14.1 litres in the control group. After three months, the average volume per minute was reduced to 9.6 litres in the Buteyko group and 13.3 litres in the control group.

There was shown to be a direct correlation between the reduction in use of short-acting reliever and volume per minute of breathing. Those who reduced their breathing volume the most were able to reduce their symptoms and therefore their medication the most. In addition, no contra-indications or dangers were cited throughout the trials or during the reviews afterwards.

Buteyko's theory is that because hyperventilation causes asthma, a reduction in overbreathing results in a reduction of asthma severity and therefore the need for medication. This was indeed proven by the trials.

References:

1. MJA 1998; 169: 575-578. Simon D Bowler, Amanda Green and Charles A Mitchell
2. The Buteyko Manual for Asthma by James Hooper
3. Australian Doctor 7 April 1995.

Gisborne Hospital Trial 2000

The results of a six month clinical trial assessing the impact of the Buteyko Method on medication use in asthma, and undertaken at the Gisborne Hospital, New Zealand, were published in the New Zealand Medical Journal, Volume 116 in December 2003. This study was conducted by Patrick McHugh, Fergus Aitcheson, Bruce Duncan and Frank Houghton, under the title Buteyko Breathing Technique for asthma: an effective intervention.

38 asthmatics aged between 18 and 70 took part in the trial and were split into two groups. One group was taught the Buteyko Method while the second group was given conventional asthma education and relaxation techniques. Investigator contact between the two groups was equal.

Gisborne Buteyko Trial - percentage mean reductions in B2 agonist use

* There was no significant difference in mean B2 agonist use between BBT and control groups at the start of the trial

The full text of the Gisborne Hospital trial can be downloaded by clicking on the link below: HTML version: http://www.nzma.org.nz/journal/116-1187/710/

PDF version
(Acrobat reader required): http://www.nzma.org.nz/journal/116-1187/710/content.pdf

Some important observations from the Gisborne trial:

• The study broadly replicates the findings of Bowler et al. The Buteyko Breathing Technique (BBT) as taught by a member of BIBH was observed to produce a large clinically significant reduction in B2 agonist and inhaled steroid use without negative impact on measures of lung function and with no apparent adverse effects.
• The study by Bowler et al demonstrated inhaled steroid reduction of 49% for the BBT group and 0% for the control group at three months. The current study exhibited inhaled steroid reduction of 50% in the BBT group and a 1% increase for the control group at six months.
• With regards B2 agonist use, Bowler et al demonstrated a 95% reduction in the BBT group and a 7% reduction in the control group at three months. The Gisborne study showed a reduction of 85% in the BBT group and a reduction of 37% in the control group at six months. The magnitude of effect in both studies was remarkably similar.
• At six weeks, both groups showed significant reduction in B2 agonist usage from baseline. This reduction was sustained at six months in the BBT group but not as significantly in the control group. The initial reduction in B2 agonist use in the control group is attributed to relaxation techniques that were taught as part of the conventional asthma education they received.
• The Gisborne trial was designed to address any inequality in investigator contact, which was criticised in commentary on the Brisbane trial. In the current trial post-intervention phone contact in both BBT and control group by the tutor was minimal and equal. The similarity in results between the two trials suggests that factors other than contact bias were operating to produce the observed results.