Breathing control techniques in the management of asthma

Asthma is a growing problem, both in the United Kingdom and throughout the world. It is estimated that in the UK over 3.4 million people have asthma (NAC, 1999). Consequently the economic burden is huge. The annual cost of asthma to the National Health Service is estimated at £670 million per year, of which 83% (£557 million) is for medication (NAC, 1999). Accordingly, the development and evaluation of interventions to prevent asthma, to reduce its severity or improve its prognosis, are now among the top ten research and development priorities for the National Health Service (Pearson et al, 1999). Pharmacotherapy is the mainstay of asthma management (Beers and Berkow, 1999), but breathing techniques have also been used (Holloway and Ram, 2002). Recently the Buteyko breathing technique has attracted considerable attention. The technique is based on the theory that people with asthma primarily hyperventilate, and that the resulting hypocapnia causes the bronchoconstriction associated with the disease (Stalmatski, 1997). The Buteyko breathing technique uses breath control and breath holding ('control pause') to eliminate hyperventilation, to reset the body's normal carbon dioxide levels, and therefore reduce or eradicate the need for both bronchodilator and anti-inflammatory medication (Stalmatski, 1997). Currently, there is limited research on the effectiveness of the Buteyko breathing technique, and it is expensive to learn, both for patients and practitioners. Physiotherapists use similar breathing techniques to manage asthma, but without the breath holding component. Given the National Health Service priorities cited above, the development and evaluation of a simple technique involving both breathing control and breath holding is merited. If the technique is proved effective, through high quality research, it could be taught to patients by physiotherapists and other health professionals working in the field of asthma management. This could reduce the costs associated with the Buteyko breathing technique, reduce the burden of drug costs on the National Health Service, and form the basis of a management approach that empowers patients to be more pro-active in controlling their disease