The Buteyko breathing technique for asthma: A review

Summary

Breathing exercises and breathing retraining are often used in the management of asthma. One specific form of breathing therapy, known as the Buteyko breathing technique (BBT) has received considerable attention, but there is a paucity of rigorous research evidence to support its recommendation for asthma patients. There are only four published clinical trials and two conference abstracts evaluating BBT. Although all have reported improvements in one or more outcome measures, results have not been consistent.

This article provides the background to the BBT, reviews the available evidence for its use and examines the physiological hypothesis claimed to underpin it. In common with other therapies, BBT is not a standardised treatment modality. The BBT ‘package’ is complex, as it also includes advice and education about medication use, nutrition and exercise, and general relaxation. This makes it difficult, and possibly inappropriate, to attempt to tease out a single mechanism. Buteyko's theory relating to carbon dioxide levels and airway calibre is an attractive one, and has some basis in evidence from experimental studies. However, it is not known whether altering breathing patterns can raise carbon dioxide levels significantly, and there is currently insufficient evidence to confirm that this is the mechanism behind any effect that BBT may exert. Further research is necessary to establish unequivocally whether BBT is effective, and if so, how it may work.

Introduction

The burden of asthma is increasing causing severe socioeconomic strain.¹ Although the greatest healthcare costs are as a result of hospitalization, the second greatest cost is for medication (£850 million p.a. in the UK).² Breathing exercises have been incorporated into various therapies for asthma and hyperventilation. The nature of the breathing exercise varies with the nature of the therapy, the therapists and the cultural background.³ However, two systematic reviews of breathing exercises for asthma have identified little published suitable for inclusion.4, 5 There is, therefore, insufficient evidence to support the recommendation of breathing exercises in asthma.⁶ Opinions differ as to the proportion of UK asthma sufferers who currently use such therapy. The National Asthma Campaign found that 30% of respondents were using breathing exercises.⁷ However, Partridge et al.'s⁸ study evaluating a stratified cross section of the asthma population found only 6% using such therapy. The House of Lords Select Committee's enquiry into complementary and alternative medicine (CAM)⁹ revealed that around 5 million people had consulted a CAM practitioner in 1999, despite a lack of robust research evidence.

Physiotherapists and others have routinely used breathing exercises to treat patients with hyperventilation symptoms. The aim is to develop a more efficient pattern of respiration by ‘normalising’ the breathing pattern, thereby reducing breathlessness. The relationship between asthma and hyperventilation is complex and it can be difficult to distinguish true asthma from asthma-like symptoms induced by overbreathing.¹⁰ Nevertheless, whatever the underlying mechanism for hyperventilation, there is evidence to suggest that it can lead to significant increases in airway resistance.¹¹ Recently a technique with similar aims to physiotherapy, the Buteyko breathing technique (BBT), has received considerable attention. The purpose of this article is to provide some background to BBT, review the available evidence for its effectiveness, and examine the physiological hypothesis behind it.