Buteyko.ie

Breathing therapies and bronchodilator use in
asthma
Thoraxdoi:10.1136/thx.2005.057422 Updated information and services can be found at: References
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Breathing therapies and bronchodilator PROBLEMS OF TRIAL DESIGN Designing any convincing yet inert pla-cebo intervention for breathing therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
other breathing manoeuvres, relaxation,education, videos, and sham training Breathing modification techniques may have a useful role in the nearly all of these. We currently haveminimal understanding of the physiolo-gical or psychological effects of any of the Treatments involving the manipula- breathing’’ exercises focusing on pos- respiratory manoeuvresused in clinical instructed to practise the exercises twice siotherapists and other practitioners in a tion of breathing pattern, and ‘‘breathing variety of clinical settings1 yet, despite control’’ will also incorporate relaxation logistic difficulties exist in the design technique via a video. Unfortunately, this trolled clinical trials required to provide results in a rather simplistic approach to a fairly complex intervention, as to teach any form of exercise effectively requires formity with the prescribed exercise.
both groups over the baseline period.
researchers to any intervention received, of back-titration of inhaled corticoster- it is frequently clinically acceptable to dose that was similar in both groups.
and ‘‘nasal breathing‘‘—a package that action between patient and practitioner.
pared with a control involving ‘‘non- specific upper body exercises’’. However, included ‘‘controlled inspiratory-expira- tory cycles’’ during arm exercises as well as ‘‘control of breathing’’ and ‘‘relaxa- tion’’. This means that both arms of the bronchodilator use. Previous trials invol- interventions are not described in suffi- tion. Terms like ‘‘control of breathing’’ subjects completed the 30 week study.
be ‘‘active’’ by mimicking the hypoven- routines provided a non-specific deferral have been inert. It is therefore possible of upper chest exercises and ‘‘control of the effectiveness of breathing therapies, effective therapies, rather than indicat- ing a lack of effect in the ‘‘active’’ those with pre-existing cardiac disease.26 There is therefore a good case to be made for any intervention, particularly a non- 1 Prasad NH, Webber BA, Pryor JA, et al.
Physiotherapy for respiratory and cardiacproblems: adults and paediatrics. Edinburgh: ing pattern is in some way abnormal.
2 Slader CA, Reddel HK, Spencer LM, et al. Double Direct evidence for clinically significant blind randomised controlled trial of two different breathing techniques in the management of use a result of the breathing exercises in the two arms of the study or was it due to 3 Hawkins G, McMahon AD, Twaddle S, et al.
studies have indicated that patients with Stepping down inhaled corticosteroids in asthma: jects recruited to this study were clinically 4 Thomas M, McKinley RK, Freeman E, et al.
odilator use at baseline (3 puffs per day) Breathing retraining for dysfunctional breathing in so ‘‘regression to the mean’’ and trial asthma- a randomised controlled trial. Thorax 5 Bowler SD, Green A, Mitchell CA. Butekyo breathing techniques in asthma: a blinded 6 Opat AJ, Cohen MM, Bailey MJ, et al.
A clinical trial of the Buteyko breathing technique and continued to improve over the initial prevalence of ‘‘dysfunctional breathing’’ 7 Cooper S, Oborne J, Nelson S, et al. The effect of this could be a full explanation. Subjects pranayama) in asthma: a randomised controlled retraining targeting such patients showed 8 Bruton A, Clark R. A pilot study measuring mixed venous carbon dioxide levels in students with and rescue medication, so it is possible that without a diagnosis of asthma. Physiotherapy quality of life in over half the subjects.4 9 Pryor JA, Pryor JA. Physiotherapy for respiratory and cardiac problems. Edinburgh: Churchill 10 Hark WT, Thompson WM, McLaughlin TE, et al.
into a practical possibility.17 This should Spontaneous sigh rates during sedentary activity: specific effect of the exercises. If this were watching television vs reading. Ann Allergy 11 Stalmatski A. Freedom from asthma: Butekyo’s enable us to identify those with dysfunc- revolutionary treatment. London: Kyle Cathie Ltd, tional breathing. Future trials of breath- 12 Osborne CA, O’Connor BJ, Lewis A, et al.
Hyperventilation and asymptomatic chronic breathing exercise (even if this is physio- 13 van den Elshout FJ, van Herwaarden CL, logically inert) may be valuable. Further hypocapnia on respiratory resistance in normal bility and generalisability of these find- and asthmatic subjects. Thorax 1991;46:28–32.
14 Askanazi J, Silverberg PA, Foster RJ, et al. Effects ings, which potentially have considerable of respiratory apparatus on breathing pattern.
15 Martinez-Moragon E, Perpina M, Belloch A, et al.
Prevalence of hyperventilation syndrome in patients treated for asthma in a pulmonology An observed reduction in b2 agonist use of clinic. Arch Bronconeumol 2005;41:267–71.
almost 90% is of interest, particularly at a 16 Thomas M, McKinley RK, Freeman E, et al.
time when the safety profile of b agonists in patients treated for asthma in primary has once again come under the spotlight.18 that high levels of use of short acting b 17 Wilhelm FH, Roth W, Sackner MA. The LifeShirt.
measurement of respiratory and cardiac function.
18 Nelson HS. Is there a problem with inhaled long- acting b-adrenergic agonists? J Allergy Clin 19 Spitzer WO, Suissa S, Ernst P, et al. The use of beta-agonists and the risk of death and near asthma.20 There is evidence that frequent . . . . . . . . . . . . . . . . . . . . . .
20 Blais L, Ernst P, Suissa S. Confounding by results in some loss of bronchodilation21–23 21 Cockcroft D, McParland CP, Britto SA, et al.
M Thomas, Department of General Practice, receptor.25 In addition, discontinuation of 22 Inman MD, O’Byrne P. The effect of regular Cottage, Oakridge, Stroud, Gloucestershire bronchoconstriction. Am J Respir Crit Care Med 23 Vathenen AS, Knox AJ, Higgins BG, et al.
Rebound increase in bronchial responsiveness after treatment with inhaled terbutaline. Lancet 26 Suissa S, Hemmelgard B, Blais L, et al.
24 Bhagat R, Swystun VA, Cockcroft DW.
25 Israel E, Drazen JM, Liggett SB, et al. The effect of Bronchodilators and acute cardiac death.
Am J Respir Crit Care Med 1996;154:1598–602.
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positive antibody titre. Specifically, theinvestigation in Munich by Kappler et al9 simply used the manufacturer’s recom-mended threshold (.1:500) with conco- mitant quality control mechanisms. Incontrast, the investigation in Utrecht byTramper-Stranders et al10 applied lower titres to discriminate PA antibody positiv-ity after creating receiver-operator curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(ROC) to identify the titre cut off value Contrasting messages on the diagnostic value of Pseudomonas that maximised sensitivity while preser-ving specificity. The ROC technique was developed originally in the 1940s toimprove operator vigilance for radar based The two interesting but contrasting respiratory infections. They also detection of incoming aeroplanes11 and applied12 successfully to ‘‘signal detect- ability and medical decision-making’’ in sis (CF) published in this issue of Thorax the 1970s. It is a valuable method butdepends on having a reliable ‘‘gold standard’’ marker—for example, an actu- tant as very young patients are routinely culture associated with lower respiratory diagnosed through newborn screening.
titres and potential for early identifica- requirement is a particular challenge with are typically free of Pseudomonas aerugi- children. In fact, the ‘‘gold standard’’ is usually valid assumption that sensitivity is a function of the test and not prevalence cator exists—that is, oropharyngeal cul- significant steps forward, although their also partially explain the discrepancy in 3 months in a prospective assessment.
(table 1): (A) a cross sectional evaluation biological results, and (B) a prospective Rosenfeld et al3 stated that ‘‘limitations in 4–14 year old children. Although the of specificity to the site of P aeruginosa of obtaining respiratory secretions neces- infection (i.e. upper or lower airway)’’.
clearly in table 1 in the paper by Kappler et yngeal swabs were used for 107 patients.
Tramper-Stranders et al10 state that ‘‘the sensitivity and positive predictive value of and 83%’’, which reflects the results of a of ‘‘precipitating antibodies’’ (precipi- tins) against a pool of sonicated extracts Stranders et al.13 Table 1 in the paper by available ELISA test system, but different

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