Do breathing exercises as adjunct to the standard treatment help improve quality of life in adult patients with incompletely controlled asthma?

To find an answer to this question, Andreasson et al randomized 99 patients, median age, 51 years, to two treatment groups: usual specialist care and 94 patients, median age, 55 years, to usual specialist care plus 3 sessions of breathing exercises under the supervision of physiotherapists coupled with home exercise. Women comprised more than 60% of the study population in both groups.¹

The primary outcome of the study was Asthma-related QoL at 6 months, which was assessed by the Mini-Asthma Quality of Life Questionnaire (Mini-AQLQ). The secondary outcomes were physical activity level, Mini-AQLQ at 12 months, the six-item Asthma Control Questionnaire (ACQ6), lung function, 6-minute-walk test, Hospital Anxiety and Depression Scale, Nijmegen Questionnaire, and adverse events.

The asthma-related QoL at 6 months, which was the primary outcome of the study and was assessed by the Mini-Asthma Quality of Life Questionnaire (Mini-AQLQ) was superior in patients with breathing exercises added to the usual asthma treatment compared to patients allocated to usual care alone with an adjusted mean change difference of 0.35 points. This superiority persisted at 12 months (0.38).

At 6 months, the Hospital Anxiety and Depression Scale depression score showed small but statistically significant improvement in favor of the breathing exercise group. No significant differences were noted between the two groups with regard to asthma-related adverse events; 14.9% in the usual care + breathing exercises group versus 18.1% in the usual care group alone. There were no adverse effects.

This study provides evidence supporting the addition of breathing exercises to the standard treatment of asthma is beneficial, even in patients with moderate to severe disease. It became apparent at 6 months and persisted up to one year. Hence, clinicians should prescribe breathing exercises to all patients with partially controlled asthma despite treatment.

The updated 2022 GINA (Global Initiative for Asthma) guidelines also recommend breathing exercise as “a supplement to conventional asthma management strategies for symptoms and quality of life” with high level of evidence (Grade A). It may also help to deal with the emotional stress of the disease (Evidence level B).²

References

1. Karen H Andreasson, et al. Breathing exercises for patients with asthma in specialist care: a multicenter randomized clinical trial. Ann Am Thorac Soc. 2022 Sep;19(9):1498-1506. doi: 10.1513/AnnalsATS.202111-1228OC.
2. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2022. Available from: www.ginasthma.org.