Breathing exercises improve quality of life in incompletely controlled asthma

The addition of breathing exercises to usual care enhanced asthma-related quality of life in patients with incompletely controlled asthma, regardless of severity, without evidence of causing harm, according to study results.

“Moderate to severe asthma is associated with impaired asthma control and quality of life (QoL) despite access to specialist care and modern pharmacotherapy,” Karen H. Andreasson, PhD, of the department of physiotherapy and occupational therapy and the department of respiratory medicine at Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark, and the Institute of Regional Health Research at the University of Southern Denmark, Odense, Denmark, and colleagues wrote in Annals of the American Thoracic Society. “Breathing exercises (BrEX) improve QoL in incompletely controlled mild asthma, but impact in moderate to severe asthma is unknown.”

This led Andreasson and colleagues to evaluate the impact of BrEX as adjuvant treatment on QoL in patients with uncontrolled moderate to severe asthma who were attending respiratory specialist clinics.

Asthma-related QoL — as determined by the Mini-Asthma Quality of Life Questionnaire (Mini-AQLQ) — at 6 months on the basis of intention-to-treat analysis served as the study’s primary outcome. Secondary outcomes included Mini-AQLQ at 12 months, the six-item Asthma Control Questionnaire (ACQ6), lung function, 6-minute-walk test, physical activity level, Nijmegen Questionnaire, Hospital Anxiety and Depression Scale, and adverse events.

The study included 193 participants who were randomly assigned to usual specialist care (UC; n = 99; 64.7% women; median age, 51 years; interquartile range [IQR], 42-61) or UC plus BrEX (UC + BrEX; n = 94; 61.7% female; median age, 55 years; IQR, 44-65) with three individual physiotherapist-delivered sessions and home exercises focused on nasal inhalation; breathing from the diaphragm and lower chest; shoulder, neck, tongue and jaw relaxation; and exhalation prolongation, among other techniques.

Compared with UC alone, UC + BrEX was superior in the primary outcome, with an adjusted mean change difference of 0.35 Mini-AQLQ points (95% CI, 0.07-0.62); this superiority was sustained at 12 months (0.38 Mini-AQLQ points; 95% CI, 0.12-0.65).

Data also indicated a minor improvement with UC + BrEX in Hospital Anxiety and Depression Scale depression score at 6 months (–0.9; 95% CI, –1.67 to –0.14), with both groups showing improvements in their anxiety score.

Both groups also showed improvement on the Nijmegen Questionnaire and ACQ6, but not for any physiological outcomes.

The rates of asthma-related adverse events between groups were comparable (UC + BrEX, 14.9% vs. UC, 18.1%; P = .38).

“We found that add-on physiotherapist-delivered BrEX improve asthma-related QoL at 6 months with sustained effects at 12 months, without evidence of harm, in patients with incompletely controlled moderate to severe asthma receiving standard asthma care by respiratory specialists,” Andreasson and colleagues concluded. “Our results suggest that BrEX should be offered to all patients with asthma, regardless of asthma severity, who experience impaired asthma control despite optimization on pharmacotherapy and other factors.”