Asthma is a complex disease that can be difficult to manage which often impacts on quality of life. Current guidelines recommend the consideration of non-pharmacological management strategies in asthma such as breathing retraining exercises (BRE). BRE, has the potential to improve outcomes for patients particularly when directed by a physiotherapist. Despite this health care practitioners rarely offer BRE as a possible treatment for asthma management, because of possible lack of awareness and poor service provision.
To explore this further, researchers in Southampton conducted a randomised controlled trial investigating breathing retraining approaches in asthma. They recruited 655 participants, who had a diagnosis of asthma recorded in their medical records, impaired quality of life (AQLQ score of <5·5) at 34 GP practices in Hampshire and Dorset. Following enrolment at a baseline visit, patients were randomised to receive either (1) usual care, (2) face to face BRE with a physiotherapist or (3) DVD and printed booklet with full explanation of how to complete BRE.
The primary outcome was an improvement to the AQLQ scores in the intervention groups at the 12 month follow up point. They found that the DVD group had significantly improved AQLQ scores compared to the usual care group, and scores were similar to that of the face to face physiotherapy group. Health care costs over the follow up period did improve, but this was not statistically significant. To summarise, BRE undertaken by asthma patients via DVD was successful in improving their quality of life. It may be a cost-effective and safe way to help manage asthma better and improve outcomes and QOL for patients.
This work has led the study group to develop an online tool, which is freely available for people to use: http://www.breathestudy.co.uk/. The study group are aiming to further develop the BRE programme into a digital app.
Lancet Respir Med 2018; 6: 19–28. DOI:https://doi.org/10.1016/S2213-2600(17)30474-5