The NICE guideline for asthma management in adults includes a recommendation for breathing exercise programmes as an adjunct to pharmacological treatment, citing evidence from multiple randomised controlled trials. Despite this, the majority of adults with asthma are not offered breathing retraining by their healthcare providers and manage their condition with bronchodilators and corticosteroids alone. This is a meaningful treatment gap. Breathing retraining does not replace medication, but the evidence for its adjunctive benefits is sufficient to make it a first-line addition.
The Buteyko Method
The Buteyko method, developed by Ukrainian physician Konstantin Buteyko, is based on the premise that many asthma symptoms are maintained or worsened by chronic hyperventilation and low CO2 tolerance. The method involves exercises to reduce breathing volume, increase CO2, and restore nasal breathing. A Cochrane review of Buteyko for asthma, updated in 2013, found evidence for reductions in bronchodilator use and modest improvements in quality of life, with no adverse events. A New Zealand randomised trial by McHugh et al. found that Buteyko patients reduced beta-agonist use by 86 percent and inhaled steroid use by 50 percent compared to a control breathing programme.
Physiotherapy-Led Breathing Programmes
Beyond Buteyko, general physiotherapy-led breathing retraining, focusing on diaphragmatic breathing, reduced respiratory rate, and nasal breathing re-education, has been shown to reduce asthma symptom scores significantly. A randomised controlled trial by Thomas et al. in Thorax found that patients receiving three sessions of physiotherapy-led breathing retraining reported significantly greater improvements in asthma quality of life scores than those receiving usual care, with benefits maintained at 12 months. The active components appear to be diaphragmatic breathing restoration and reduction in habitual hyperventilation.
Exercise-Induced Bronchoconstriction
Exercise-induced bronchoconstriction in asthma is partly driven by rapid breathing of dry, unconditioned air through the mouth during exercise. Nasal breathing during exercise warms and humidifies air before it reaches the lower airways, reducing the osmotic and thermal triggers of exercise-induced bronchoconstriction. Training nasal breathing during exercise, beginning at low intensity and building tolerance over weeks, is a practical and evidence-informed approach to reducing exercise-induced symptoms without increasing medication.
- Ask your GP or respiratory physiotherapist about a formal breathing retraining programme
- Begin nasal breathing practice at low-intensity exercise and build gradually over four to six weeks
- Do not reduce inhaler use without medical guidance even if symptoms improve with retraining
- Practice reduced breathing volume exercises, available through Buteyko-trained practitioners
- Track symptom frequency and bronchodilator use before and after four weeks of breathing retraining
Sources
- NICE. (2017). Asthma: diagnosis, monitoring and chronic asthma management (NG80). National Institute for Health and Care Excellence.
- McHugh, P., et al. (2003). Buteyko breathing technique for asthma: an effective intervention. New Zealand Medical Journal, 116(1187).
- Thomas, M., et al. (2009). Breathing exercises for asthma: a randomised controlled trial. Thorax, 64(1), 55-61.