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MEDICAL JOURNALVol 119 No 1234 ISSN 1175 8716 Buteyko breathing technique and asthma in children: a case
series
Asthma is a common disorder in New Zealand, with estimates of prevalence as highas one in six of the population affected.1 The annual cost of asthma drugs is high—in2005, approximately NZ$34 million was spent on inhaled corticosteroids and β2-agonists.2 The use of β2-agonist in chronic asthma is itself contentious, with a recent meta-analysis concluding that regular use of β2-agonist resulted in tolerance within 1–3weeks as well as being pro-inflammatory to the airways.3 Interventions that have thepotential to reduce β2-agonist insult to the airways of people with chronic asthma aredeserving of further investigation.
The Buteyko breathing technique (BBT) is an intervention for asthma that isassociated with significant reductions in medication use as well as improvements inother indices such as symptom scores and quality of life in adults.4–7 Previous work demonstrates the effectiveness of BBT in adults.4,6 To date, there hasbeen no published work looking at the impact in children.
We report a case series that considers the place of BBT in children.
To find suitable participants (Table 1), we approached local general practices andadvertised in the local (Gisborne) newspaper. Twenty-six children were identified ofwhom 8 (aged 7–16 years) were eligible for inclusion; being previously diagnosedwith asthma by their GP and using medication for asthma for at least 6 months withsignificant use of medication for asthma in the 2 weeks prior; no prior instruction inBBT; and no significant unstable medical condition.
Intervention
Participants underwent training in BBT (by a representative of the Buteyko Instituteof Breathing and Health) over five sessions of 60–90 minutes held over 5 consecutivedays. BBT consists of a series of exercises promoting nasal breathing and periods ofhypoventilation.8 Outcome measures
Prior to tuition, and at 3 months following instruction in BBT, participants (alongwith their parent/guardian) self completed a questionnaire ascertaining: • Medication use over the previous 2 weeks; • Symptom scores over the previous 2 weeks; • Courses of oral steroids over the previous 3 months; and URL: http://www.nzma.org.nz/journal/119-1234/1988/ • Absences from school due to asthma over the previous 3 months and admissions to hospital over the previous 3 months.
At 3 months, participants were also asked whether BBT had been helpful or not in themanagement of their asthma. Any changes in medication after instruction were to bein association with their own general practitioner.
Table 1. Characteristics of participants at end of run-in
Variable
BBT Group
2-agonist dose in mcg equiv salbutamol (standard deviation) Mean daily adjusted inhaled steroid dose in mcg equiv fluticasone (standard deviation) Changes in medication use
Average β2-agonist use reduced from 743 mEq of salbutamol per day to 254
mEq/day, a drop of 66%. Inhaled steroid use reduced from 138 mEq of fluticasone per
day to 81 mEq/day, a drop of 41% (Figure 1).
Figure 1. Medication use (mEq) by participants before and after training in
Buteyko breathing technique
M e dication Use
URL: http://www.nzma.org.nz/journal/119-1234/1988/ Qualitative measures
There were no admissions to hospital in the 3 months before or after instruction inBBT for any of the participants. In the 3 months prior to instruction in BBT, 8 days ofschool were missed by three participants. There were 4 days missed by twoparticipants in the 3 months after BBT tuition. The post-instruction period of 3months did, however, include 6 weeks of school holidays.
In the 3 months prior to tuition in BBT, three participants had 11 courses of oralsteroids, and in the 3 months post-tuition, one participant had one course of oralsteroids. Average symptom scores in the 3 months before tuition in BBT went from1.5 to 0.875 in the 3 months post-tuition (where 0=no symptoms, 1=mild,2=moderate, and 3=severe).
Of the eight participants, one reported “no change” in his/her asthma, six reported“slightly improved”, and one reported “markedly improved”. There were no reports of“slightly deteriorated” or “marked deteriorated”.
Discussion
There have been several published randomised controlled trials involving the use of
BBT in adults with asthma.4,6,7 These trials have all shown positive results with
marked reductions in inhaled β2-agonist along with reductions in inhaled
corticosteroids without negative impact on measures of lung function and with no
apparent adverse effect. There is, however, no data for BBT in a paediatric setting.
In this study we used accepted diagnostic criteria for asthma.9 We recognise that thishas the potential to include a broad group, including dysfunctional breathing.10 In this series, we have identified that BBT is associated with change in medication inchildren that mirrors results found in adults (Table 2).
Table 2. Comparison of medication reductions in BBT trials to date
Brisbane3
Gisborne5
Nottingham6
This series
BBT=Buteyko breathing technique; *Results are reported as mean unless marked with * in which case are median;**Nottingham did not attempt reductions in inhaled steroid use until assessment of airways hyper-reactivity wasfinished.
In addition to reduction in medication there were improvements in measures ofquality of life scores, symptom scores, and also a reduced number of courses of oralsteroids.
The small size and self-selection of the patient group in this case series limits anymore meaningful commentary on the results.
However given the association between BBT and medication reduction in this groupof children, and the similarity with adults, we suggest that BBT would meritexploration by a randomised controlled trial in children. In addition, we agree with a URL: http://www.nzma.org.nz/journal/119-1234/1988/ recent review of BBT which states that further research is necessary to establishwhether BBT is effective, and if so, how it may work.11 Acknowledgements: This study was funded by grants from the JN Williams Memorial Trust and The
Tairawhiti Complementary and Traditional Therapies Research Trust. We also thank BIBH for
providing an instructor (Russell and Jennifer Stark) and teaching the BBT as well as the GPs and
practice nurses for participating in the study.
Patrick McHughClinical Director, Emergency DepartmentGisborne Hospital, Gisborne(mchugh@tdh.org.nz) Bruce DuncanPublic Health PhysicianTairawhiti District Health, Gisborne Frank HoughtonAssistant Lecturer (and Health Geographer), Department of HumanitiesLimerick Institute of Technology, Limerick, Ireland References:
1. Crane J, Lewis S, Slater T, et al. The self reported prevalence of asthma symptoms amongst adult New Zealanders. N Z Med J 1994;107:417–21.
2. PHARMAC. Annual Review 2005: Improving Health. Wellington: PHARMAC; 2005.
Available online. URL: http://www.pharmac.govt.nz/pdf/ARev05.pdf Accessed May 2006.
3. Salpeter SR, Ormiston TM, Salpeter EE. Meta-analysis: Respiratory tolerance to regular beta2-agonist use in patients with asthma. Ann Intern Med 2004; 140:802–13.
4. Bowler SD, Green A, Mitchell CA. Buteyko breathing technique in asthma: a blinded randomised controlled trial. Med J Aust. 1998;169:575–8. Available online. URL:http://www.mja.com.au/public/issues/xmas98/bowler/bowler.html Accessed May 2006.
5. Opat AJ, Cohen MM, Bailey MJ, Abramson MJ. A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video. J Asthma. 2000;37:557–64.
6. McHugh P, Aitcheson F, Duncan B, Houghton F. Buteyko breathing technique for asthma: an effective intervention. N Z Med J. 2003;116(1187). URL:http://www.nzma.org.nz/journal/116-1187/710/ 7. Cooper S, Oborne J, Newton S, et al. Effect of two breathing exercises (Buteyko and pranayama) in asthma: a randomised controlled trial. Thorax. 2003;58:674–9.
8. Buteyko Method: Butyeko Institute of Breathing and Health, Manuka, Australia. Available online. URL: http://www.buteyko.info/ Accessed May 2006.
9. Holt S, Kljakovic M, Reid J; POMS Steering Committee. Asthma morbidity, control and treatment in New Zealand: results of the Patient Outcomes Management Survey (POMS),2001. N Z Med J. 2003;116(1174). URL: http://www.nzma.org.nz/journal/116-1174/436/ 10. Thomas M, McKinley RK, Freeman E, Foy C. Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey. BMJ. 2001;322:1098–100.
11. Bruton A, Lewith GT. The Buteyko breathing technique for asthma: a review. Complement URL: http://www.nzma.org.nz/journal/119-1234/1988/

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