Breathing Control Techniques in the Management of Asthma

Body Oxygen Level Test (BOLT) is not associated with exercise performance in highly-trained individuals

Introduction

The analysis of chemoreflex and baroreflex sensitivity may contribute to optimizing patient care and athletic performance. Breath-holding tests, such as the Body Oxygen Level Test (BOLT), have gained popularity as a feasible way to evaluate the reflex control over the cardiorespiratory system. According to its proponents, the BOLT score reflects the body's sensitivity to carbon dioxide and homeostasis disturbances, providing feedback on exercise tolerance. However, it has not yet been scientifically validated or linked with exercise performance in highly-trained individuals. Therefore, we investigated the association of BOLT scores with the results of standard performance tests in elite athletes.

Methods

A group of 49 speedskaters performed BOLT, Wingate Anaerobic Test (WAnT), and cardiopulmonary exercise test (CPET) on a cycle ergometer. Peak power, total work, and power drop were measured during WAnT. Time to exhaustion and maximum oxygen uptake were measured during CPET. Spearman's rank correlation and multiple linear regression were performed to analyze the association of BOLT scores with parameters obtained during the tests, age, somatic indices, and training experience.

Results

No significant correlations between BOLT scores and parameters obtained during WAnT and CPET were found, r(47) = -0.172-0.013, p = 0.248-0.984. The parameters obtained during the tests, age, somatic indices, and training experience were not significant in multiple linear regression (p = 0.38-0.85). The preliminary regression model showed an R 2 of 0.08 and RMSE of 9.78 sec.

Conclusions

Our findings did not demonstrate a significant relationship between BOLT scores and exercise performance. Age, somatic indices, and training experience were not significant in our analysis. It is recommended to interpret BOLT concerning exercise performance in highly-trained populations with a great degree of caution.

Buteyko: A useful tool in the management of asthma?

Medical management of asthma focuses on drugs which, although effective, are costly and produce side-effects. Recent evidence suggests a role for breathing interventions that reduce total ventilation, such as the Buteyko method, which has strong similarities to techniques already used by therapists to manage hyperventilation. Both approaches should be made readily available to patients with asthma. Asthma nurses and therapists should consider these techniques to enable patients to ‘step down’ drug treatments in accordance with medical guidelines. This may involve a re-thinking of their role, from one where the main emphasis is on supporting the established medical model towards one that also offers a non-pharmacological alternative.

This article explains the aims of Buteyko and discusses the increasing evidence base for methods that reduce ventilation and may benefit many patients with asthma, not just those with established chronic hyperventilation.