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Breathing exercises help asthma patients ‘improve quality of life’

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Asthma patients who continue to have problems, despite receiving standard treatment, experience an improved quality of life when they are taught breathing exercises, according to UK researchers.

They also found that the benefits of the exercises were similar, whether they were taught in person by a physiotherapist in face-to-face sessions, or delivered digitally for use in the patient’s own home.

“We hope that our results will offer an effective addition to usual treatment”

Mike Thomas

The self-taught training included a video and booklet, and had similar results to face-to-face training in boosting quality of life by improving symptoms, mood, and ability to conduct day-to-day activities.

The self-taught training was also cheaper and less resource-intensive than physiotherapist training, noted the researchers in the journal The Lancet Respiratory Medicine.

The Breathe Study, led by the University of Southampton and funded by the National Institute for Health Research, represents the largest randomised controlled trial so far to test such training.

The trial included 655 people with asthma aged 16-70 years from 34 centres across the UK who had used a drug treatment and had impaired quality of life. Participants were randomly allocated to receive self-taught training, physiotherapist training, or usual care.

The self-taught training comprised breathing exercises – diaphragmatic breathing, nasal breathing, slow breathing, controlled breath holds, and relaxation techniques. It also involved information on how the techniques worked to improve symptoms and a daily planner and progress chart.

“Remotely delivered breathing retraining is a key component toward incremental improvement”

John Blakey

In contrast, the physiotherapy group were seen by a respiratory physiotherapist for three one-to-one sessions that lasted 30-40 minutes. They were taught the same breathing techniques as the self-taught group. Meanwhile, the usual care group received no additional treatment.

Participants completed quality of life questionnaires at the start of the trial and after three, six and 12 months, and some were also interviewed. Additionally, lung function was measured throughout the trial.

One year after the beginning of the trial, participants in both training groups showed improved quality of life, compared to those given usual care. Quality of life was similar in both training groups.

The intervention groups also showed slightly reduced levels of depression compared to the usual care group, but the breathing retraining had no effect on anxiety.

In addition, none of the participants in any groups showed improvements in their lung function, or reduced inflammation of their airways.

“It demonstrates how important technology can be in transforming healthcare”

Samantha Walker

Participants rated both forms of training positively, and felt they had better control over their breathing, less need for rescue medication, felt more relaxed and had a better quality of life.

There were similar rates of adverse events in the three groups, suggesting that the breathing retraining caused no additional adverse events or side effects, noted the researchers.

Meanwhile, a separate cost-effectiveness study suggested that both types of breathing retraining were more effective than usual care. The cost of both interventions per patient were £2.85 for self-taught training, and £83.45 for physiotherapist breathing retraining.

The study authors acknowledged some limitations, including that the participants were generally older, so more research was needed to see if breathing retraining was effective in younger groups.

University of Southampton

Breathing exercises help asthma patients ‘improve quality of life’

Mike Thomas

Senior study author Professor Mike Thomas said: “Our findings suggest that a self-help breathing intervention can be offered conveniently and cost-effectively alongside usual drug treatments to people with asthma whose quality of life is impaired by their disease, despite treatment.

“In the UK, over five million people have asthma and although drug treatments can improve symptoms, many people live with persistent symptoms that impair their quality of life,” he said.

“With these patients often expressing interest in other medication-free ways to manage their symptoms, we hope that our results will offer an effective addition to usual treatment,” he noted.

Writing in a linked comment in the same journal, Dr John Blakey, from the Royal Liverpool Hospital, said: “Further work will be required to fully explore the generalisability of the findings.

“Asthma outcomes have remained poor over recent years, with low expectations around control from patients and health-care providers,” he said.

“Remotely delivered breathing retraining is a key component toward incremental improvement, and a necessary adjunct to improved use of more tailored medical treatments,” he added.

Asthma UK

Breathing exercises help asthma patients ‘improve quality of life’

Samantha Walker

Dr Samantha Walker, director of research and policy at the charity Asthma UK, described the study findings as “exciting”. “It demonstrates how important technology can be in transforming healthcare and potentially the lives of the 5.4 million people in the UK with asthma,” she said.

She added: “We’re urging researchers and innovators to work together to develop ways to help people with asthma through digital means, whether that is through video, SMART inhalers that can monitor the effectiveness of treatment, or apps to help patients manage their symptoms.”

The researchers behind the Breathe Study have made the contents of the DVD and the supporting booklet freely available through their trial website. New versions of the video and booklet materials will also be available for free on the Asthma UK website in 2018.

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