Breathing and relaxation training improves respiratory symptoms and quality of life in asthmatic adults

QuestionDoes breathing and relaxation training improve respiratory symptoms and quality of life in adults with asthma?DesignRandomised controlled trial.SettingPrimary care (GP practice) in Hertfordshire, UK.ParticipantsAdults diagnosed with asthma and registered with the GP practice were recruited via a postal survey and invited to attend for a physiotherapy assessment of their asthma; 85 met the inclusion criteria (age 16–70 years, proficient in English, no serious co-morbidity) and agreed to participate in the trial. They were randomised to the intervention (n = 39) or control (n = 46) group.InterventionsBoth groups received usual medical care. The intervention group received 5 × 60-minute sessions of individual treatment by the Papworth method. The method involves relaxation training, teaching of appropriate tidal and minute volumes for current metabolic activity, minimisation of inappropriate use of accessory muscles, diaphragmatic breathing, nasal breathing, and integration of these techniques into activities of daily living.OutcomesAssessments were undertaken at baseline, post-treatment (6 months after baseline), and at 12 months. The primary outcome measure was the St. George's Respiratory Questionnaire (SGRQ). Secondary outcome measures were the Hospital Anxiety and Depression Scale (HADS), the Nijmegen hyperventilation questionnaire, resting respiratory rate and end-tidal carbon dioxide level, and spirometry.ResultsPost-treatment and 12-month data were available for 78 and 72 patients respectively. Post treatment, the Symptoms subscale of the SGRQ was significantly better in the intervention group (by 11 points, 95% CI 2 to 20). This treatment effect was still present at 12 months (by 9 points, 95% CI 1 to 17). The other subscales of the SGRQ (Activities, Impacts) did not show a significant treatment effect, but the total SGRQ score was significantly better in the intervention group at 12 months, after adjustment for baseline values (p = 0.05). Nijmegen scores were significantly better in the intervention group at post-treatment (by 4 points, 95% CI 0 to 8), and at 12 months after adjustment for baseline values (p = 0.01). The only other significant differences in the remaining secondary outcomes were a reduction in relaxed breathing rate for the intervention group post treatment (by 5 breaths per minute, 95% CI 4 to 7), and at 12 months (by 6 breaths per minute, 95% CI 4 to 7).ConclusionThis study supports the hypothesis that the Papworth method ameliorates respiratory symptoms, reduces ventilation rate and improves quality of life in a general practice population of adults diagnosed with asthma