Breathing Retraining in Asthma Management–I told you so!

Many asthma patients or patients who can’t breathe are found to have problems with their breathing technique.  In medical terms, I use Vocal Cord Dysfunction, Spasmodic Dysphonia, Irritable Larnyx Syndrome just to name a few.  Some health care providers, including doctors, aren’t always familiar with the concept that vocal cord problems can cause difficulty breathing, but this 40+ page review should convince you otherwise. This is an informative video about problems that affect many asthma patients & isn’t directly related to the lungs at all–

Now I’m not condoning the use of “breathing exercises” to treat asthma, but remember that up to 40% of asthma patients have problems with their vocal cords.  What does this translate to:

  •  Underdiagnosis of vocal cord problems
  • Lack of follow-up when inhalers don’t completely resolve asthma symptoms

 Thanks to Dr Burgess & colleagues, I am beginning to see extensive medical reviews on breathing exercises for asthma that will most likely apply to vocal cord problems as well.  Burgess, et al.  Published in Expert Rev Resp Med. 2011;5(6):789-807)

In asthma management, complementary and alternative medicine is enjoying a growing popularity worldwide. This review synthesizes the literature on complementary and alternative medicine techniques that utilize breathing retraining as their primary component and compares evidence from controlled trials with before-and-after trials. Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library electronic databases were searched.  Breathing retraining, a popular form of complementary and alternative medicine (CAM), is the subject of this review.  You can read the entire article if you would like–don’t count on staying awake for the entire article! 

What do breathing modification techniques do for asthma:

  • Demonstrate a significant decrease in β2-agonist use
  • Improvement in quality of life
  • Decrease in inhaled corticosteroid use
  •  No between-group differences in forced expiratory volume  (FEV1) or provocation dose needed to cause a 20% fall in FEV1 for methacholine  (PD20)

 It is reasonable for clinicians to offer qualified support to patients with asthma undertaking these breathing retraining techniques.

What are these techniques?

  • Diaphragmatic breathing
  • Inspiratory/expiratory muscle trainer–see this very good video: 
  • The Buteyko technique
  • There was some evidence that beneficial effects declined with time if breathing techniques were not maintained.

Weiner et al., in three separate controlled trials, found that specific inspiratory muscle training using either an externally weighted device or a purpose-designed threshold inspiratory muscle trainer (HealthScan; NJ, USA) compared with ‘sham’ muscle training significantly increased inspiratory muscle strength as measured by maximal inspiratory mouth pressure at residual volume (PImax at residual volume). Whew what a mouthful!

The most recent of these studies that compared female to male asthmatics found that using the same training method to allow females to attain a PImax equal to that of males resulted in a significant and highly correlated decrease in both dyspnea score and medication use in the active intervention group only.  

Here’s a video on some very simple breathing exercises one can do for VCD:

VCD training

I am now beginning to use “The Breather” for both inspiratory/expiratory muscle training in patients with “Irritable Larnyx” syndrome who also have asthma.  Early success only means it warrants further examination of this technique by well-designed clinical studies–any volunteers? 

These techniques will not replace asthma medication or a carefully designed asthma plan, but their use should not be dismissed out of hand, especially in patients with throat problems along with their asthma.  Further well-designed trials of these techniques are needed to properly evaluate their place in asthma management.

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