There is undoubtedly a role for non-pharmacologic treatment of asthma and other kinds of respiratory disorders.  While they may not replace medication per se, a well conditioned, exercised lung probably manages inflammation and other forms of impairment better than an under utilized, poorly conditioned lung. Dr. Susarla

Really? Breathing Exercises Can Relieve Asthma

THE FACTS

Breathing exercises are among the most popular alternative therapies for asthmatics. But do they work?

According to a recent report by the Agency for Healthcare Research and Quality, the answer depends on the technique. Some appear effective in reducing asthma severity, but there is little evidence to support others.

In the exhaustive, 219-page report, researchers examined 22 randomized studies of breathing techniques. Among the most common are hyperventilation-reduction techniques like the Buteyko method, which instructs asthmatics to breathe shallowly and slowly through the nose when short of breath. The report also looked at yoga breathing exercises and so-called inspiratory-muscle training, which involves exercises and devices that make inhaling more difficult in order to strengthen muscles.

The researchers found the most robust body of evidence supported hyperventilation-reduction breathing techniques, which achieved “medium to large improvements in asthma symptoms and reductions in reliever medication use of approximately 1.5 to 2.5 puffs per day.”

Looking at inspiratory training approaches, the researchers could not find enough credible research to draw any firm conclusions. They did find some evidence for yoga exercises, which typically require deep breaths — usually through the nose — with extended exhalation. But most of the evidence came from studies in India, where yoga exercises are more intensive and frequent than in the United States.

Still, the authors said, “Patients with asthma who are students of yoga and willing to undertake intensive training may find benefits of asthma-targeted practice with a trained yoga practitioner.”

THE BOTTOM LINE

Breathing exercises may help relieve asthma, though the efficacy varies.

Read article here.

Effects of Exercise Training on Airway Hyperreactivity in Asthma: A Systematic Review and Meta-Analysis.

Abstract

BACKGROUND:

Although physical exercise is recommended for asthmatics, evidence on the effects of exercise on clinical key factors is still missing.

OBJECTIVES:

We performed a systematic review and meta-analysis to determine the effect of exercise training (EXT) on quality of life (QoL), bronchial hyperresponsiveness (BHR), exercise-induced bronchoconstriction (EIB), lung function and exercise capacity, plus the factors affecting changes in QoL and exercise capacity in asthmatics after a period of EXT.

DATA SOURCES:

A computerized search was conducted in MEDLINE, EMBASE, and CINAHL (last search on 15 November 2012), without language restriction, and references of original studies and reviews were searched for further relevant studies.

STUDY SELECTION:

Two independent investigators screened full-text studies with asthmatic subjects undertaking EXT (defined as training for ≥7 days, ≥2 times per week, ≥5 training sessions in total) that assessed at least one of the following outcomes: QoL, airway hyperreactivity, forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), inflammatory parameters, exercise capacity, or exercise endurance. Potentially relevant studies were excluded if only respiratory muscle training, breathing exercises or yoga was performed, if asthmatic subjects with co-morbidities were investigated, if only data of mixed patient groups without separate results for asthmatics were presented, if training regimens were not sufficiently specified, if no numerical outcome data were presented, and if new long-term medication was introduced in addition to physical training. Of 500 potentially relevant articles, 13.4 % (67 studies including 2,059 subjects) met the eligibility criteria and were included for further analyses.

STUDY APPRAISAL AND SYNTHESIS METHODS:

Data extraction and risk of bias assessment was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis of all randomized controlled trials (RCTs) was performed to determine the effect of EXT on asthma symptoms, BHR, EIB, FEV1, exercise capacity and exercise endurance compared with control training. In addition, relative pre/post changes were analysed in all RCTs and controlled trials. Finally, multiple linear regression models were used to identify effects of relative changes in airway hyperreactivity (BHR or EIB), lung function (FEV1 or PEF) and training hours on QoL and exercise performance.

RESULTS:

In a total of 17 studies including 599 subjects, meta-analyses showed a significant improvement in days without asthma symptoms, FEV1and exercise capacity while BHR only tended to improve. The analysis of relative within-group changes after EXT showed, however, significant improvements in QoL (17 %), BHR (53 %), EIB (9 %), and FEV1 (3 %) compared with control conditions. Multiple linear regression models revealed that changes in airway hyperreactivity and lung function significantly contributed to the change in QoL, while mainly the changes in airway hyperreactivity contributed to the change in exercise capacity.

CONCLUSION:

EXT was shown to improve asthma symptoms, QoL, exercise capacity, BHR, EIB, and FEV1 in asthmatics and improvements in BHR explained part of the improvement in QoL and exercise capacity. Thus, physical activity should be recommended as a supplementary therapy to medication. However, more well controlled studies should be performed assessing the relationship of physical activity, QoL, airway hyperreactivity, lung function and especially airway inflammation as well as medication intake.

Read article here.