“Breathing Training Exercises for Asthma” presented by Prof. Mike Thomas

As part of our ongoing seminar series, the Centre of Excellence in Severe Asthma hosted Prof. Mike Thomas for a webinar on “Breathing Training Exercises for Asthma” on 28 July 2015.

Presentation Summary:

Breathlessness refers to the subjective experience of breathing discomfort. Large variation exists in how people perceive breathlessness. Breathlessness is a common symptom of asthma. Functional breathing disorders can be mis-diagnosed as asthma and also co-occur with asthma.

Breathing exercises are a useful non-pharmacological approach to manage breathlessness. They can be a useful complement to standard asthma medications. Common elements of breathing retraining include slow regular diaphragmatic breathing, nasal breathing, hypo-ventilation and anxiety management.

There is now high-quality evidence for the efficacy of breathing exercises for asthma. Breathing exercises may be useful for anyone with asthma and uncontrolled symptoms. Breathing exercises for asthma reduce symptoms and improve asthma-related quality of life. However, exercises do not effect asthma pathophysiology or inflammation.

Breathing exercises for asthma can be accessed by referral to an appropriately trained therapist. Digital guides are also being trialled as self-help materials

Key Points:

• Drug treatment of asthma does not achieve effective symptom control for many patients and poor asthma control is common
• Non-pharmacological treatment approaches may complement existing medications
• Asthma symptoms often do not correlate with lung function
• Breathlessness refers to the subjective experience of breathing discomfort
• Breathlessness consists of 2 components; severity and unpleasantness, which are mediated in different ways
• Treatment of breathlessness is typically disease-specific, with goals to correct the problem or reduce unpleasantness
• Complex physiological mechanisms regulate breathlessness
• Breathlessness is perceived through activation of specific areas of the brain
• Perception of breathlessness is impacted by emotional state
• Large variation exists in people’s perception of breathlessness
• Symptoms are related to psychological state and social factors
• Functional breathing disorders can contribute to breathlessness (e.g. vocal cord dysfunction or dysfunctional breathing)
• Typical symptoms are unresponsive to standard medications, and include predominant use of intercostal muscles, rapid and shallow breathing and hyperventilation
• Chronic Hyperventilation Syndrome (HVS) is under recognised and can contribute to breathlessness
• Dysfunctional breathing (DB) refers to functional abnormalities in breathing that result in symptoms and respond to breathing retraining interventions
• Breathing abnormalities in asthma include over-breathing, mouth breathing, irregular / asynchronous breathing and upper chest breathing
• Dysfunctional breathlessness or VCD affect 10-15% of people with severe asthma (Heaney, Lancet, 2005)
• Most treatment approaches for dysfunctional breathing use breathing modification exercises
• Yoga and breathing control exercises have been widely used to treat asthma in some countries
• Common elements of breathing retraining include slow regular diaphragmatic breathing, nasal breathing, hypo-ventilation and anxiety management
• Physiotherapist-guided breathing retraining exercises improve asthma-related quality of life and asthma control, but have no effect on asthma pathophysiology (Thomas, Thorax, 2009)
• Guidelines recommend breathing exercises to help improve asthma symptoms and asthma-related quality of life
• Specific mechanisms of how breathing exercises improve asthma outcomes remains unclear
• Breathing exercises may be useful for anyone with asthma causing ongoing symptoms and reduced quality of life
• Breathing exercises are useful as a complement to standard asthma medications
• Implementation can be through referral to a trained specialist and is also being trialled in a video-based format

About Prof. Mike Thomas:

Prof. Mike Thomas holds the Chair of Primary Care Research at the University of Southampton, UK, an institution with an international profile in respiratory research, and leads the community-based respiratory research programme.

His research interests centre on respiratory disease management in community settings, including the diagnosis and management of asthma and COPD and the assessment of effectiveness of pharmacological and non-pharmacological therapies in every-day clinical settings. He has a particular interest in ‘real-world’ outcomes and pragmatic clinical research and has published and lectured widely on these topics.

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