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| Journal of the New Zealand Medical Association,
19-May-2006, Vol 119 No 1234
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Buteyko breathing technique and asthma in children: a case
series
Asthma is a common disorder in New Zealand, with estimates
of prevalence as high as one in six of the population affected.1 The annual cost
of asthma drugs is high—in 2005, 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 1–3 weeks as well as being
pro-inflammatory to the airways.3 Interventions that have the potential to
reduce β2-agonist insult to the airways of people with chronic asthma are
deserving of further investigation.
The Buteyko breathing technique (BBT) is an intervention for
asthma that is associated with significant reductions in medication use as well
as improvements in other 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 has been no published work looking at the impact in
children.
We report a case series that considers the place of BBT in
children.
MethodsTo find suitable participants (Table 1), we approached local
general practices and advertised in the local (Gisborne) newspaper. Twenty-six
children were identified of whom 8 (aged 7–16 years) were eligible for
inclusion; being previously diagnosed with asthma by their GP and using
medication for asthma for at least 6 months with significant use of medication
for asthma in the 2 weeks prior; no prior instruction in BBT; and no significant
unstable medical condition.
InterventionParticipants underwent training in BBT (by a representative
of the Buteyko Institute of Breathing and Health) over five sessions of
60–90 minutes held over 5 consecutive days. BBT consists of a series of
exercises promoting nasal breathing and periods of hypoventilation.8
Outcome measuresPrior to tuition, and at 3 months following instruction in
BBT, participants (along with their parent/guardian) self completed a
questionnaire ascertaining:
At 3 months,
participants were also asked whether BBT had been helpful or not in the
management of their asthma. Any changes in medication after instruction were to
be in association with their own general practitioner.
ResultsTable 1. Characteristics of
participants at end of run-in
BBT=Buteyko breathing
technique.
Changes in medication useAverage
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
 Qualitative measuresThere were no admissions to hospital in the 3 months before
or after instruction in BBT for any of the participants. In the 3 months prior
to instruction in BBT, 8 days of school were missed by three participants. There
were 4 days missed by two participants in the 3 months after BBT tuition. The
post-instruction period of 3 months did, however, include 6 weeks of school
holidays.
In the 3 months prior to tuition in BBT, three participants
had 11 courses of oral steroids, and in the 3 months post-tuition, one
participant had one course of oral steroids. Average symptom scores in the 3
months before tuition in BBT went from 1.5 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”.
DiscussionThere 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 this has 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 in children that mirrors results found in adults
(Table 2).
Table
2. Comparison of medication reductions in BBT trials to date
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 was finished.
In addition to reduction in medication there were
improvements in measures of quality of life scores, symptom scores, and also a
reduced number of courses of oral steroids.
The small size and self-selection of the patient group in
this case series limits any more meaningful commentary on the results.
However given the association between BBT and medication
reduction in this group of children, and the similarity with adults, we suggest
that BBT would merit exploration by a randomised controlled trial in children.
In addition, we agree with a recent review of BBT which states that further
research is necessary to establish whether 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.
Bruce Duncan
Public Health Physician Tairawhiti District Health, Gisborne Frank Houghton
Assistant Lecturer (and Health Geographer), Department of Humanities Limerick Institute of Technology, Limerick, Ireland References:
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