The Buteyko breathing technique has been shown to help people control asthma symptoms and could be incorporated into asthma reviews by practice nurses
The Buteyko breathing technique is recommended in national guidance for control of asthma symptoms. This article explores the evidence base for the technique, outlines its main principles and includes two cases studies.
Citation: Austin G (2013) Buteyko technique use to control asthma symptoms. Nursing Times; 109: 16: 16-17.
Author: Gillian Austin is clinical specialist physiotherapist, pulmonary rehabilitation/respiratory physiotherapy, Hertfordshire Community Trust.
- This article has been double-blind peer reviewed
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The Buteyko Breathing Technique (BBT) is a system of breathing exercises and holistic advice that lower patients’ minute volume by reducing both respiratory rate and depth. In simple terms, this means learning to “breathe less”.
The BBT is designed to re-educate patients’ breathing patterns and reduce the symptoms of asthma and other breathing disorders (Brindley and Oliver, 2008). Hyperventilation and/or dysfunctional breathing can aggravate symptoms and adversely affect control of asthma (Thomas et al, 2009; Holloway and West, 2007). Patients are taught to normalise their breathing pattern at rest, and to control their breathing and limit hyperventilation when breathlessness occurs due to exertion, contact with asthma triggers or at the onset of an asthma attack.
Development of the technique
Professor Konstantin Buteyko, the Russian physician (1923-2003) who developed the technique, believed that people with breathing disorders were hyperventilating, leading to hypocapnia - abnormally low levels of carbon dioxide (CO2). This causes bronchoconstriction and numerous other systemic changes, directly and indirectly, due to the resulting respiratory alkalosis (Bruton and Holgate, 2005; Foster et al, 2001; Lum, 1978). Buteyko believed shallow breathing and breath-holding techniques, which are components of the BBT, raised CO2 levels and reversed bronchoconstriction, although this has not been conclusively demonstrated in published research.
The BBT spread to Australia and New Zealand in the 1990s, where the first randomised controlled trial was carried out (Bowler et al, 1998). Five RCTs (Cowie et al, 2008; Cooper et al, 2003; McHugh et al, 2003; Opat et al, 2000; Bowler et al, 1998) found it could benefit people with symptomatic asthma by improving quality of life and symptom control, as well as enabling them to reduce dependence on inhaled bronchodilators. However, no study has shown that the BBT can alter lung function or airway hyper-responsiveness, which suggests that it does not affect the underlying disease process of asthma.
The BBT is included in the British Thoracic Society and Scottish Intercollegiate Guideline Network (2008) guideline for asthma, which recommends it may be considered to help with asthma symptom control. Physiotherapists and other clinicians have seen the benefits of breathing control techniques in clinical settings for many years (Holloway and West, 2007; Hough, 2001), particularly in patients who, despite large quantities of inhaled and oral steroid medication, have difficulty in asthma control due to concomitant hyperventilation and breathing pattern disorders.
Although BBT appears to have potential benefits in asthma, it is still not widely available on the NHS, and most patients wishing to learn it do so privately (Shaw et al, 2006). More recently, though, it is beginning to be used in NHS practice by respiratory nurses and physiotherapists who have completed a short intensive course run by the Buteyko Breathing Association.
Indications for use
The BBT is commonly delivered as a five-week programme to people experiencing asthma symptoms despite pharmacological treatment. It is particularly useful to those who are unable to achieve good asthma control at step 2 of the asthma BTS guidelines. It is at this stage that dysfunctional breathing should be considered, particularly if spirometry is normal.
Asthma symptoms commonly trigger a cycle of mouth breathing, hyperventilation and breathlessness. This pattern of “over-breathing” can dry out the delicate mucous membranes of the lungs, leading to irritation, coughing and further inflammation. The BBT aims to reverse this vicious cycle and re-educate patients with asthma on their breathing technique.
The research base centres around asthma, but anecdotally the BBT has been shown to benefit those with other breathing disorders, including those with chronic obstructive pulmonary disease. Many physiotherapists are using it in pulmonary rehabilitation and encouraging patients with COPD to breathe through their nose. Patients are advised to stop or slow down while exercising to allow them to regulate their breathing. Nose breathing makes it virtually impossible to hyperventilate, so patients are able to maintain better control of their breathing during exercise. This can help to reduce feelings of breathlessness, help with pacing the intensity of the exercise, reduce panic and boost confidence.
BBT within asthma reviews
Ideally patients should receive a five-week Buteyko programme delivered by a trained practitioner; however, some of the principles can be incorporated into asthma reviews delivered by practice nurses:
- Observe whether the patient breathes through the nose or the mouth; those who appear to be breathing through the nose should be asked to climb a couple of flights of stairs to see whether they still breathe with the mouth closed;
- Breathing through the nose makes it difficult to overbreathe so can help to prevent hyperventilation and panic. Nose breathing takes practice and this needs to be reinforced to patients;
- Patients whose breathing is audible are likely to be hyperventilating and should be advised breathing should be quiet.
- Explain that a dry cough is often exacerbated by mouth breathing and, although it may feel helpful, repeated coughing can lead to upper airway irritation, which can lead to further coughing;
- Explain how poor posture can change breathing; sitting slumped at a computer squashes the abdominal organs, which leads to breathing with the upper chest and through an open mouth.
Box 1. Case study 1
Ian Jenkins (not his real name), aged 54, was diagnosed with asthma aged 14. He was taking a combination inhaler (fluticasone and salmeterol 250mcg/2 puffs twice a day) as well as a short-acting bronchodilator (salbutamol 100mcg/4-6 puffs a day). His vital signs at first assessment were heart rate 65bpm, oxygen saturation (SpO2) 96% and blood pressure 138/78.His asthma control questionnaire score was 1.5, which suggests uncontrolled asthma. His Nijmegen hyperventilation questionnaire (van Dixhoorn and Duivenvoorden, 1985) score, was 18/64 – a score over 23 suggests hyperventilation.Mr Jenkins received five sessions of BBT over five weeks, which included breathing exercises with periods of relaxed and reduced breathing. After three weeks, he reduced his use of the salbutamol inhaler but still carried it with him. Before BBT training, he had been using more than two canisters of salbutamol per month. Afterwards, he used less than one per month. After the programme, Mr Jenkins’ Nijmegen score was 14/64, and his asthma control questionnaire score was 0.66, a value for controlled asthma.
Box 2. Case study 2
Rachel Parker (not her real name), aged 12, was diagnosed with asthma before the age of two years. She often had chest infections, and was hospitalised for asthma at ages two and 10. A cough kept her awake at night; she was wheezy in the morning. She produced sticky sputum and found exercise difficult. She had discomfort in the tracheal/sternal area. She was using more than six puffs of salbutamol/day as well as 400mcg of the inhaled steroid beclometasone. After a week of a children’s Buteyko programme, Rachel said the nose-clearing exercises helped her to breathe through her nose and the Stop Cough technique was helpful. She was now breathing easily through her nose. By week 3, Rachel was no longer taking salbutamol apart from before exercise; she continued to take her inhaled steroid as prescribed. Her fourth, final session included advice on breathing during exercise. She was no longer coughing, was sleeping through the night, and the generalised chest pain had disappeared.
- The Buteyko technique encourages patients to breathe less
- The aim is to re-educate patients’ breathing patterns using a series of breathing exercises
- Buteyko can improve asthma symptom control and quality of life
- The technique can be used in conjunction with conventional medicine
- It can be used for both adults and children
Bowler S et al (1998) Buteyko breathing techniques in asthma: a blinded randomised controlled trial. Medical Journal of Australia; 169; 575-578.
Brindley J, Oliver J (2008) Breathing for Asthma - a Training Manual. Buteyko Breathing Association.
British Thoracic Society and Scottish Intercollegiate Guideline Network (2008) British guideline on the management of asthma. Thorax; 63 (suppl): iv1-iv121.
Bruton A, Holgate S (2005) Hypocapnia and asthma: a mechanism for breathing retraining. Chest; 127: 5, 1808-1811.
Cooper S et al (2003) Effect of two breathing exercises (Buteyko and Pranayama) in asthma: a randomised controlled trial. Thorax; 58: 674-679.
Cowie R et al (2008) A randomised controlled trial of the buteyko technique as an adjunct to conventional management of asthma. Respiratory Medicine; 102, 726-732.
Foster G et al (2001) Respiratory alkalosis. Respiratory Care; 46: 4, 384-391.
Holloway E, West R (2007) Integrated breathing and relaxation training (the Papworth method) for adults with asthma in primary care: a randomised controlled trial. Thorax; 62: 12, 1039-1042.
Hough A (2001) Physiotherapy in Respiratory Care. Cheltenham: Nelson Thornes.
Lum L (1978) Respiratory alkalosis and hypocarbia. Chest, Heart and Stroke Journal; 3: 4, 31-34.
McHugh P et al (2003) Buteyko breathing technique for asthma: an effective intervention. New Zealand Medical Journal; 116: 1187, U710.
Opat A et al (2000) A clinical trial of the Buteyko breathing technique in asthma as taught by a video. Journal of Asthma; 37: 7, 557-564.
Shaw A et al (2006) Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study. BMC Health Services Research; 6: 76.
Thomas M et al (2009) Breathing exercises for asthma: a randomised controlled trial. Thorax; 64: 55-61.
van Dixhoorn J, Duivenvoorden H (1985) Efficacy of Nijmegen questionnaire in recognition of the hyperventilation syndrome. Journal of Psychosomatic Research; 29: 2, 199-206.