Buteyko breathing technique for patients with asthma?

The Buteyko techniques (known in Russia as ‘Voluntary Elimination of Deep Breathing’) are treatments to control respiration developed by the Russian Konstantin Buteyko (1923–2003). Inspired by the methods of respiratory control in yoga, the original Buteyko technique was specifically aimed at easing the symptoms of respiratory conditions, particularly asthma. Konstantin Buteyko postulated that there is a connection between hyperventilation and asthma and that it should be possible to reduce asthma symptoms by deliberate breath control.

The Eucapnic Buteyko method is an adaptation of Buteyko’s original technique which was first introduced in Australia and is now used worldwide. It includes the same focus on ventilation control, but the approach has been re-designed with the aim of achieving better patient-compliance. Both treatments and further variations depend crucially on the cooperation of the patient who has to attend long sessions of learning the technique and must follow the somewhat tedious programme rigorously.

A Cochrane review of Buteyko and similar breathing techniques concluded that “there is no credible evidence regarding the effectiveness of breathing exercises for the clinical symptoms of dysfunctional breathing/hyperventilation syndrome. It is currently unknown whether these interventions offer any added value in this patient group or whether specific types of breathing exercise demonstrate superiority over others.”

Now, a new study adds to this knowledge. This randomized clinical trial included two groups (n = 30 each) of patients with asthma. They received either:

• Buteyko breathing technique (BBT) together with usual therapy (UT)
• or UT alone over a period of 3 months.

The primary outcome comprised the voluntary control pause (CP) after 3 months, secondary outcomes an additional breathhold parameter, forced expiratory volume in 1 s (FEV₁), capnovolumetry, exhaled nitric oxide (FeNO), Asthma Control Questionnaire (ACQ) and Nijmegen Questionnaire (NQ), and the use of medication (β₂-agonists; inhaled corticosteroids, ICS).

CP showed significant time-by-group interaction [F(1,58.09) = 28.70, p < 0.001] as well as main effects for study group [F(1,58.27) = 5.91, p = 0.018] and time [F(1,58.36) = 17.67, p < 0.001]. ACQ and NQ scores were significantly (p < 0.05 each) improved with BBT. This was associated with reductions in the use of β₂-agonists and ICS (p < 0.05 each) by about 20% each. None of these effects occurred in the UT group. While FEV₁ and the slopes of the capnovolumetric expiratory phases 2 and 3 did not significantly change, the capnovolumetric threshold volume at tidal breathing increased (p < 0.05) with BBT by about 10 mL or 10%, compared to baseline, suggesting a larger volume of the central airways. No significant changes were seen for FeNO.

The authors concluded that BBT was clinically effective, as indicated by the fact that the improvement in symptom scores and the small increase in bronchial volume occurred despite the significant reduction of respiratory pharmacotherapy. As the self-controlled Buteyko breathing therapy was well-accepted by the participants, it could be considered as supporting tool in asthma therapy being worth of wider attention in clinical practice.

I disagree with this conclusion and think it ought to be changed to:

BBT or a placebo effect was clinically effective.

The reason is that, as many readers have heard me say before, the infamous A+B versus B design does not control for placebo effects and thus is guaranteed to produce a positive result.

The research was conducted by an international team evidently led by the relatively new ARCIM Institute which claims on its website:

The acronym ARCIM stands for Academic Research in Complementary and Integrative Medicine.