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Ebert F, Ballenberger N, Hayden MC, Möller D, Limbach M, Schuler M, Nowak D, Schultz K. [Effects of pulmonary rehabilitation on dysfunctional respiratory patterns in patients with uncontrolled asthma]. DIE REHABILITATION 2024; 63:100-106. [PMID: 38244536 DOI: 10.1055/a-2192-3377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
PURPOSE Dysfunctional breathing patterns (DAM) are deviations from physiologic breathing patterns. DAM seem to be associated with lower asthma control. To date, it is unclear what effect inpatient rehabilitation can have on this problem. The aim of this work is to investigate the effect of pulmonary rehabilitation (PR) on DAM. METHODS The data are based on a randomized controlled trial with a waiting control group. The intervention group (IG) received PR 4 weeks after application approval and the control group (KG) after 5 months. Dysfunctional breathing was assessed by Nijmegen-Questionnaire (NQ). Values ≥ 23 points indicate an existing DAM. Values at the end of rehabilitation (T2) and after three months (T3) were compared (analysis of covariance). Supplemental moderator analysis was performed to examine whether the effect of PR was related to baseline NQ scores. RESULTS Significant differences in NQ score are found between IG (n=202) and KG (n=210) at T2 (AMD=10.5; 95%CI [9; 12]; d=1.4; p<0.001) and at T3 (AMD=5.8; 95%CI [4.3; 7.3]; d=0.8; p<0.001). There is an interaction effect between the difference in NQ score between the groups at T2 and baseline at T0 (b=5.6; 95%CI [2.2; 11.9]; p<0.001). At T3, this interaction effect was no longer detectable (b=4.5; 95%CI [-3.1; 14.1]; p=807). CONCLUSION Inpatient, multimodality, and interdisciplinary PR is associated with significant and clinically relevant improvement in DAM both at discharge and 3 months later. In the short term, patients with existing DAM benefit more from PR than patients without DAM.
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Affiliation(s)
- Franziska Ebert
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
| | | | - Markus C Hayden
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
| | - Dirk Möller
- Fakultät Wirtschafts- und Sozialwissenschaften, Hochschule Osnabrück
| | - Matthias Limbach
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
| | - Michael Schuler
- Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit Bochum
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits- und Umweltmedizin, Klinikum der Universität München
| | - Konrad Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
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Livingston R, Bellas H, Sahota J, Bidder T, Vogt F, Lund VJ, Gane SB, Robinson DS, Kariyawasam HH. Breathing pattern disorder in chronic rhinosinusitis with severe asthma: nasal obstruction and polyps do not increase prevalence. J Asthma 2024; 61:177-183. [PMID: 37668326 DOI: 10.1080/02770903.2023.2255277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) with severe asthma are associated with breathing pattern disorder (BPD). Mouth breathing is a sign of breathing pattern disorder, and nose breathing a fundamental part of breathing pattern retraining for BPD. The prevalence of BPD in relation to CRS subtypes and the relationship of nasal obstruction to BPD in CRS and associated severe asthma is unknown. The breathing pattern assessment tool (BPAT) can identify BPD. Our objective was to thus investigate the prevalence of BPD, nasal airflow obstruction and measures of airway disease severity in CRS with (CRSwNP) and without nasal polyps (CRSsNP) in severe asthma. METHODS We determined whether CRS status, peak nasal inspiratory flow (PNIF) or polyp disease increased BPD prevalence. Demographic factors, measures of airway function and breathlessness in relation to BPD status and CRS subtypes were also evaluated. RESULTS 130 Patients were evaluated (n = 69 had BPD). The prevalence of BPD in CRS with severe asthma was 53.1%. There was no difference between BPD occurrence between CRSwNP and CRSsNP. The mean polyp grade and PNIF were not statistically different between the BPD and non-BPD group. The presence of nasal polyps did not increase breathlessness. CONCLUSIONS BPD and CRS are commonly co-associated. CRS status and nasal obstruction per se does not increase BPD prevalence.
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Affiliation(s)
- Rebecca Livingston
- Therapy and Rehabilitation Department, University College London Hospital NHS Foundation Trust, London, UK
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Helene Bellas
- Therapy and Rehabilitation Department, University College London Hospital NHS Foundation Trust, London, UK
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Jagdeep Sahota
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
- Ear Institute, University College London, London, UK
| | - Therese Bidder
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
- Allergy and Clinical Immunology, Royal National ENT Hospital, London, UK
| | - Florian Vogt
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Valerie J Lund
- Ear Institute, University College London, London, UK
- Rhinology Section, Royal National ENT Hospital, London, UK
| | - Simon B Gane
- Ear Institute, University College London, London, UK
- Rhinology Section, Royal National ENT Hospital, London, UK
| | - Douglas S Robinson
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Harsha H Kariyawasam
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
- Allergy and Clinical Immunology, Royal National ENT Hospital, London, UK
- Rhinology Section, Royal National ENT Hospital, London, UK
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3
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Sikora M, Mikołajczyk R, Łakomy O, Karpiński J, Żebrowska A, Kostorz-Nosal S, Jastrzębski D. Influence of the breathing pattern on the pulmonary function of endurance-trained athletes. Sci Rep 2024; 14:1113. [PMID: 38212427 PMCID: PMC10784475 DOI: 10.1038/s41598-024-51758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
Proper functioning of the respiratory system is one of the most important determinants of human health. According to current knowledge, the diaphragmatic breathing pattern seems to be the most favourable. However, recent reports indicate that athletes often have dysfunctional breathing patterns, which may be associated with an increased risk of musculoskeletal injuries. The influence of the type of breathing pattern on the mechanical airways in athletes has not been investigated. The aim of the present study was to determine the characteristics and relationships between breathing patterns and respiratory function in athletes. This study included 69 Polish elite endurance athletes (♂40, ♀29) in different sports disciplines and 44 (♂17, ♀27) healthy nonathletes as a control group. All participants underwent pulmonary function tests (spirometry, plethysmography, diffusion capacity for carbon monoxide) with assessment of breathing patterns by the Hi-Lo test. Inspiratory and expiratory resistance (R) and reactance (X) of the respiratory system at a given frequency (5 Hz, 11 Hz, and 19 Hz) were measured by a noninvasive forced oscillation technique. In this study, almost half of the athletes (44.92%) had dysfunctional breathing patterns, although at a lower rate than that in the control group. Diaphragmatic breathing patterns were characterized by higher spirometric, plethysmographic and DLCO values compared to thoracic or abdominal breathing patterns. Similarly, lower inspiratory reactance at 5 Hz (X5%pred.) was observed in the diaphragmatic pattern compared to the thoracic pattern. A diaphragmatic breathing pattern is associated with better pulmonary function test results. However, this study revealed a dysfunctional breathing pattern in almost half of the athletes. These results suggest that the assessment of breathing patterns and the implementation of breathing exercises in athletes are essential to promote proper breathing patterns.
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Affiliation(s)
- Marcin Sikora
- Department of Physiological and Medical Sciences, Institute of Healthy Living, The Jerzy Kukuczka Academy of Physical Education, 72A Mikolowska Street, Katowice, Poland.
| | - Rafał Mikołajczyk
- Department of Physiological and Medical Sciences, The Jerzy Kukuczka Academy of Physical Education, 72A Mikolowska Street, Katowice, Poland
| | - Olga Łakomy
- Department of Physiological and Medical Sciences, Institute of Healthy Living, The Jerzy Kukuczka Academy of Physical Education, 72A Mikolowska Street, Katowice, Poland
| | - Jakub Karpiński
- Department of Exercise and Sport Performance, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, 72A Mikolowska Street, Katowice, Poland
| | - Aleksandra Żebrowska
- Department of Physiological and Medical Sciences, Institute of Healthy Living, The Jerzy Kukuczka Academy of Physical Education, 72A Mikolowska Street, Katowice, Poland
| | - Sabina Kostorz-Nosal
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
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4
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Ludlow S, Daly R, Elsey L, Hope H, Sheehan R, Fowler SJ. Multidisciplinary management of inducible laryngeal obstruction and breathing pattern disorder. Breathe (Sheff) 2023; 19:230088. [PMID: 37830100 PMCID: PMC10567073 DOI: 10.1183/20734735.0088-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/13/2023] [Indexed: 10/14/2023] Open
Abstract
We provide an overview of the assessment and management of inducible laryngeal obstruction and breathing pattern disorder. We highlight the multidisciplinary team members involved and their essential roles within a complex breathlessness service. We discuss treatments initiated by physiotherapy and speech and language therapy, the importance of joint working, and discuss the high incidence of comorbidities and the association with other respiratory disorders. Educational aims Inducible laryngeal obstruction and breathing pattern disorder are common causes of breathlessness.Inducible laryngeal obstruction is an inappropriate, transient, reversible narrowing of the laryngeal area that causes breathlessness and laryngeal symptoms.Breathing pattern disorder is an alteration in the normal biomechanical patterns of breathing that results in intermittent or chronic symptoms, which may be respiratory and/or non-respiratory.People with inducible laryngeal obstruction or breathing pattern disorder often have other comorbidities that will also need addressing.Multidisciplinary assessment and treatment is essential for comprehensive workup and holistic care.Timely assessment and diagnosis can prevent unnecessary medication use and hospital admissions and facilitate effective management of the condition using reassurance, advice, education, breathing retraining and vocal exercises.
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Affiliation(s)
- Siobhan Ludlow
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Medical Education, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rachel Daly
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lynn Elsey
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Helen Hope
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Reyenna Sheehan
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Stephen J. Fowler
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Ryan D, Kalayci Ö, Eigenmann P. Editorial comment on "Dysfunctional breathing and its impact on asthma control in children and adolescents". Pediatr Allergy Immunol 2023; 34:e13938. [PMID: 36974642 DOI: 10.1111/pai.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Dermot Ryan
- Locum General Practitioner and Honorary Clinical Research Fellow, Asthma UK Centre of Applied Research, Usher Institute, University of Edinburgh, Edinburgh, Scotland
- Vice-President Respiratory Effectiveness Group
- International Primary Care Respiratory Group
| | - Ömer Kalayci
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Philippe Eigenmann
- Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
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Lynch S, Lowry D, Finnerty C, O’Meara Y, Brennan D. The COMFORT trial: a randomised control trial comparing group-based COMpassion-FOcussed therapy and breathing pattern ReTraining with treatment as usual on the psychological functioning of patients diagnosed with cancer recurrence during COVID. Trials 2023; 24:89. [PMID: 36747246 PMCID: PMC9901386 DOI: 10.1186/s13063-023-07088-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A cancer diagnosis is a known precipitant of psychological distress, with fear of recurrence being a well-documented distressing consequence of cancer. Cancer recurrence often results in an additional psychological burden, which may exacerbate as a result of the COVID-19 pandemic. METHODS This is a single-centre, prospective, randomised controlled trial. Patients identified as having experienced cancer recurrence since March 2020 (the onset of the COVID-19 pandemic in Ireland) will be screened for participation. Eligible, consenting candidates who score 4 or higher on the Distress Thermometer will be enrolled in the study. Participants will be randomly allocated to receive either a 6-week, group-based, online, compassion-focussed therapy and breathing pattern retraining intervention or the control arm. Those in the control arm will all be offered the group intervention after the 18-week study period. The primary outcome is the Distress Thermometer score at 18 weeks post-baseline though secondary outcomes will include measures of mood, traumatic distress and mental adjustment to cancer. DISCUSSION To our knowledge, this protocol describes the first RCT which directly examines the effect of a group-based psychological intervention on Irish patients experiencing cancer recurrence in the context of COVID-19. The outcome of this trial is likely to be twofold: It will determine if the psychological intervention achieves its primary objective of distress amelioration 3 months post-intervention and to establish the feasibility of delivering this intervention in a virtual format. TRIAL REGISTRATION ClinicalTrials.gov NCT05518591. Registered on 25 August 2022. All items from the World Health Organization Trial Registration Data set have been included.
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Affiliation(s)
- Sinead Lynch
- grid.411596.e0000 0004 0488 8430Department of Psychology, Mater Misericordiae University Hospital, Dublin, Ireland ,grid.411596.e0000 0004 0488 8430Department of Psycho-Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Damien Lowry
- grid.411596.e0000 0004 0488 8430Department of Psychology, Mater Misericordiae University Hospital, Dublin, Ireland ,grid.411596.e0000 0004 0488 8430Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Clodagh Finnerty
- grid.7886.10000 0001 0768 2743COMFORT Trial, University College Dublin, Dublin, Ireland
| | - Yvonne O’Meara
- grid.7886.10000 0001 0768 2743Women’s Cancer Survivorship Research Coordinator, School of Medicine, University College Dublin, Dublin, Ireland
| | - Donal Brennan
- grid.411596.e0000 0004 0488 8430Mater Misericordiae University Hospital, Dublin, Ireland ,grid.7886.10000 0001 0768 2743School of Medicine, University College Dublin, Dublin, Ireland
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7
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Grillo L, Russell AM, Shannon H, Lewis A. Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation. BMJ Open Respir Res 2023; 10:10/1/e001395. [PMID: 36627142 PMCID: PMC9835958 DOI: 10.1136/bmjresp-2022-001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To explore physiotherapists' opinions of physiotherapy assessment of Breathing Pattern Disorder (BPD). METHODS Qualitative study using focus groups (FGs) with reflexive thematic analysis and survey methods. The survey was distributed via social media and email to UK specialist physiotherapy interest groups. Two FGs, conducted in different settings, included physiotherapists based in hospital outpatients/community, private practice and higher education. RESULTS One-hundred-and-three physiotherapists completed the survey. Respondents identified a lack of consensus in how to define BPD, but some agreement in the components to include in assessment. Fifteen physiotherapists participated in the FGs. Three themes emerged from FG discussions: (1) nomenclature and language of breathing, (2) BPD and breathlessness and (3) The value of assessment of breathlessness. CONCLUSION The inconsistent nomenclature of dysfunctional breathing pattern impacts assessment, management and understanding of the diagnosis. Clarity in diagnosis, informing consistency in assessment, is fundamental to improving recognition and treatment of BPD. The findings are useful in the planning of education, training, future research and guideline development in BPD assessment.
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Affiliation(s)
- Lizzie Grillo
- National Heart and Lung Institute, Imperial College London, London, UK .,Department of Physiotherapy, Royal Brompton and Harefield Hospitals, London, UK
| | | | - Harriet Shannon
- Physiotherapy, Institute of Child Health, Great Ormond Street Hospital, University College London, London, UK
| | - Adam Lewis
- Department of Health Sciences, Brunel University London, London, UK
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8
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Lewis A, Kal E, Nolan CM, Cave P, Grillo L, Conway J, Jones M. Pilot study of physiotherapist-led versus music therapist-led breathing control exercises for young adults living with breathing pattern disorder: a randomised controlled trial protocol. BMJ Open Respir Res 2022; 9:9/1/e001414. [PMID: 36104105 PMCID: PMC9476152 DOI: 10.1136/bmjresp-2022-001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Breathing pattern disorder (BPD) is an abnormal breathing pattern associated with biochemical, biomechanical and psychophysiological changes. While physiotherapy is often offered, limited evidence-based therapies for BPD are available. Music therapy-based singing exercises have been shown to improve quality of life for individuals with respiratory conditions and may also be beneficial for individuals living with BPD. No study has previously compared these participatory interventions in the treatment of people living with BPD. Methods and analysis This is a study protocol for an assessor blinded 1:1 randomised controlled trial and qualitative interview study. Forty participants aged 18–40 years who score at least 19 on the Nijmegen Questionnaire (NQ) and do not have any underlying respiratory conditions will be recruited. Participants will be randomised to receive either physiotherapy-led or music therapy-led breathing exercises for 6 weeks. The primary outcome will be between-group difference in NQ post-intervention. Semistructured interviews with a purposive sample of participants will be performed. Qualitative data will be analysed using thematic analysis to better understand participants’ intervention and trial experiences. Ethics and dissemination This study has received ethical approval by Brunel University London College of Health, Medicine and Life Science’s Research Ethics Committee (32483-MHR-Mar/2022-38624-3). The anonymised completed dataset will be made available as an open-access file via Brunel University London Figshare and the manuscript containing anonymised patient data will be published in an open-access journal. Trial registration number This trial is registered on the Open Science Framework Registry (https://osf.io/u3ncw).
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Affiliation(s)
- Adam Lewis
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Elmar Kal
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Claire Marie Nolan
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK.,Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, London, UK
| | - Phoene Cave
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Lizzie Grillo
- National Heart and Lung Institute, Imperial College London, London, UK.,Physiotherapy Department, Royal Brompton and Harefield Hospitals, London, UK
| | - Joy Conway
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Mandy Jones
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
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Sakkatos P, Bruton A, Barney A. Changes in quantifiable breathing pattern components predict asthma control: an observational cross-sectional study. Asthma Res Pract 2021; 7:5. [PMID: 33823934 PMCID: PMC8022412 DOI: 10.1186/s40733-021-00071-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background Breathing pattern disorders are frequently reported in uncontrolled asthma. At present, this is primarily assessed by questionnaires, which are subjective. Objective measures of breathing pattern components may provide additional useful information about asthma control. This study examined whether respiratory timing parameters and thoracoabdominal (TA) motion measures could predict and classify levels of asthma control. Methods One hundred twenty-two asthma patients at STEP 2- STEP 5 GINA asthma medication were enrolled. Asthma control was determined by the Asthma Control Questionnaire (ACQ7-item) and patients divided into ‘well controlled’ or ‘uncontrolled’ groups. Breathing pattern components (respiratory rate (RR), ratio of inspiration duration to expiration duration (Ti/Te), ratio of ribcage amplitude over abdominal amplitude during expiration phase (RCampe/ABampe), were measured using Structured Light Plethysmography (SLP) in a sitting position for 5-min. Breath-by-breath analysis was performed to extract mean values and within-subject variability (measured by the Coefficient of Variance (CoV%). Binary multiple logistic regression was used to test whether breathing pattern components are predictive of asthma control. A post-hoc analysis determined the discriminant accuracy of any statistically significant predictive model. Results Fifty-nine out of 122 asthma patients had an ACQ7-item < 0.75 (well-controlled asthma) with the rest being uncontrolled (n = 63). The absolute mean values of breathing pattern components did not predict asthma control (R2 = 0.09) with only mean RR being a significant predictor (p < 0.01). The CoV% of the examined breathing components did predict asthma control (R2 = 0.45) with all predictors having significant odds ratios (p < 0.01). The ROC curve showed that cut-off points > 7.40% for the COV% of the RR, > 21.66% for the CoV% of Ti/Te and > 18.78% for the CoV% of RCampe/ABampe indicated uncontrolled asthma. Conclusion The within-subject variability of timing parameters and TA motion can be used to predict asthma control. Higher breathing pattern variability was associated with uncontrolled asthma suggesting that irregular resting breathing can be an indicator of poor asthma control.
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Affiliation(s)
| | - Anne Bruton
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Anna Barney
- Institute for Sound and Vibration Research, University of Southampton, Southampton, UK
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10
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Leyro TM, Versella MV, Yang MJ, Brinkman HR, Hoyt DL, Lehrer P. Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression. Clin Psychol Rev 2021; 84:101980. [PMID: 33540222 PMCID: PMC8302658 DOI: 10.1016/j.cpr.2021.101980] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Respiratory abnormalities are a hallmark of anxiety symptomatology and may serve as clinically useful modifiers for alleviating anxiety symptoms. However, gold-standard anxiety treatments (e.g., cognitive-behavioral interventions) often do not directly address respiratory components despite their theoretical utility and clinical accessibility. This review examined the clinical effectiveness of respiratory interventions, interventions that directly target respiration abnormalities and processes, in treating trait anxiety symptoms. METHODS The final analysis included 40 randomized controlled trials including at least one measure of trait anxiety, a respiratory-focused intervention group, and a non-respiratory control-group (active or inactive treatment). Overall effects of respiratory focused interventions were examined, as well as the effect of hypothesized moderators. RESULTS Respiratory component interventions yielded significantly greater improvements (moderate to large effect) in anxiety symptoms than controls, with the stronger effects observed in comparison to inactive, rather than active, control conditions. Significant heterogeneity in findings suggests that variability in intervention design, population, and control comparison may obfuscate interpretation of findings. CONCLUSIONS Evidence supports the clinical utility of respiratory interventions as either an independent anxiety treatment, or as an adjunct to other interventions. Clinical and research implications of findings along with recommendations for ongoing investigations in this domain are discussed.
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Affiliation(s)
- Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, United States.
| | - Mark V Versella
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Min-Jeong Yang
- Department of Psychology, Rutgers, The State University of New Jersey, United States; Department of Health Outcomes and Behavior, Moffitt Cancer Center, United States
| | - Hannah R Brinkman
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Danielle L Hoyt
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Paul Lehrer
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, United States
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11
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McKeown P, O’Connor-Reina C, Plaza G. Breathing Re-Education and Phenotypes of Sleep Apnea: A Review. J Clin Med 2021; 10:jcm10030471. [PMID: 33530621 PMCID: PMC7865730 DOI: 10.3390/jcm10030471] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/13/2022] Open
Abstract
Four phenotypes of obstructive sleep apnea hypopnea syndrome (OSAHS) have been identified. Only one of these is anatomical. As such, anatomically based treatments for OSAHS may not fully resolve the condition. Equally, compliance and uptake of gold-standard treatments is inadequate. This has led to interest in novel therapies that provide the basis for personalized treatment protocols. This review examines each of the four phenotypes of OSAHS and explores how these could be targeted using breathing re-education from three dimensions of functional breathing: biochemical, biomechanical and resonant frequency. Breathing re-education and myofunctional therapy may be helpful for patients across all four phenotypes of OSAHS. More research is urgently needed to investigate the therapeutic benefits of restoring nasal breathing and functional breathing patterns across all three dimensions in order to provide a treatment approach that is tailored to the individual patient.
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Affiliation(s)
- Patrick McKeown
- Buteyko Clinic International, Loughwell, Moycullen, Co., H91 H4C1 Galway, Ireland;
| | - Carlos O’Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain;
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, 28023 Madrid, Spain
- Correspondence:
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12
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Vagedes J, Helmert E, Kuderer S, Vagedes K, Wildhaber J, Andrasik F. The Buteyko breathing technique in children with asthma: a randomized controlled pilot study. Complement Ther Med 2020; 56:102582. [PMID: 33197659 DOI: 10.1016/j.ctim.2020.102582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Evidence supports the Buteyko breathing technique (BBT) as reducing medication and improving control and quality of life in adults with asthma, but having minimal impact on spirometry. For children with asthma, evidence addressing the utility of BBT is sparse. We evaluated the effectiveness of BBT in managing various aspects of asthma in children. METHODS Thirty-two children with partly controlled asthma (age 6-15 years, 66% male) were randomized to either Treatment as Usual (TAU) or TAU combined with Buteyko training (Buteyko group, BG). Children in the BG received an intensive five-day training followed by three months of home practice. Primary outcome was bronchodilator reduction. Secondary outcomes were changes in physiological parameters FEV1_AR (at rest), FEV1_ER (after ergometry), FEV1_BR (after bronchospasmolysis), corticosteroid use, FeNO, SpO2, breath-hold test and questionnaire data [Asthma Control Questionnaire and Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ)]. All measures were collected at Baseline and a three-month follow-up. RESULTS For the primary outcome, no significant between-group difference was found. Regarding the secondary outcomes, children receiving treatment augmented with BBT revealed significantly greater improvement at the follow-up than those receiving TAU for FEV1_AR (p = .04, d=-0.50), FEV1_ER (p = .02, d=-0.52), and the emotional function subscale of the PACQLQ (p < .01, d = 1.03). No between-group differences were found for the remaining secondary measures of outcome. CONCLUSIONS Our preliminary findings suggest that the addition of BBT to treatment as usual for children with asthma enhances outcomes with respect to spirometry and parental emotional function but does not lead to reductions in medication, at least over the short term.
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Affiliation(s)
- Jan Vagedes
- ARCIM Institute, Filderstadt, Germany; Department of Pediatrics, Filderklinik, Filderstadt, Germany; Department of Neonatology, Children's Hospital, University of Tübingen, Tübingen, Germany.
| | | | | | | | | | - Frank Andrasik
- Department of Psychology, University of Memphis, Memphis, TN, USA
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Santino TA, Chaves GSS, Freitas DA, Fregonezi GAF, Mendonça KMPP. Breathing exercises for adults with asthma. Cochrane Database Syst Rev 2020; 3:CD001277. [PMID: 32212422 PMCID: PMC7096190 DOI: 10.1002/14651858.cd001277.pub4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Breathing exercises have been widely used worldwide as a non-pharmacological therapy to treat people with asthma. Breathing exercises aim to control the symptoms of asthma and can be performed as the Papworth Method, the Buteyko breathing technique, yogic breathing, deep diaphragmatic breathing or any other similar intervention that manipulates the breathing pattern. The training of breathing usually focuses on tidal and minute volume and encourages relaxation, exercise at home, the modification of breathing pattern, nasal breathing, holding of breath, lower rib cage and abdominal breathing. OBJECTIVES To evaluate the evidence for the efficacy of breathing exercises in the management of people with asthma. SEARCH METHODS To identify relevant studies we searched The Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL and AMED and performed handsearching of respiratory journals and meeting abstracts. We also consulted trials registers and reference lists of included articles. The most recent literature search was on 4 April 2019. SELECTION CRITERIA We included randomised controlled trials of breathing exercises in adults with asthma compared with a control group receiving asthma education or, alternatively, with no active control group. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study quality and extracted data. We used Review Manager 5 software for data analysis based on the random-effects model. We expressed continuous outcomes as mean differences (MDs) with confidence intervals (CIs) of 95%. We assessed heterogeneity by inspecting the forest plots. We applied the Chi2 test, with a P value of 0.10 indicating statistical significance, and the I2 statistic, with a value greater than 50% representing a substantial level of heterogeneity. The primary outcome was quality of life. MAIN RESULTS We included nine new studies (1910 participants) in this update, resulting in a total of 22 studies involving 2880 participants in the review. Fourteen studies used Yoga as the intervention, four studies involved breathing retraining, one the Buteyko method, one the Buteyko method and pranayama, one the Papworth method and one deep diaphragmatic breathing. The studies were different from one another in terms of type of breathing exercise performed, number of participants enrolled, number of sessions completed, period of follow-up, outcomes reported and statistical presentation of data. Asthma severity in participants from the included studies ranged from mild to moderate, and the samples consisted solely of outpatients. Twenty studies compared breathing exercise with inactive control, and two with asthma education control groups. Meta-analysis was possible for the primary outcome quality of life and the secondary outcomes asthma symptoms, hyperventilation symptoms, and some lung function variables. Assessment of risk of bias was impaired by incomplete reporting of methodological aspects of most of the included studies. We did not include adverse effects as an outcome in the review. Breathing exercises versus inactive control For quality of life, measured by the Asthma Quality of Life Questionnaire (AQLQ), meta-analysis showed improvement favouring the breathing exercises group at three months (MD 0.42, 95% CI 0.17 to 0.68; 4 studies, 974 participants; moderate-certainty evidence), and at six months the OR was 1.34 for the proportion of people with at least 0.5 unit improvement in AQLQ, (95% CI 0.97 to 1.86; 1 study, 655 participants). For asthma symptoms, measured by the Asthma Control Questionnaire (ACQ), meta-analysis at up to three months was inconclusive, MD of -0.15 units (95% CI -2.32 to 2.02; 1 study, 115 participants; low-certainty evidence), and was similar over six months (MD -0.08 units, 95% CI -0.22 to 0.07; 1 study, 449 participants). For hyperventilation symptoms, measured by the Nijmegen Questionnaire (from four to six months), meta-analysis showed less symptoms with breathing exercises (MD -3.22, 95% CI -6.31 to -0.13; 2 studies, 118 participants; moderate-certainty evidence), but this was not shown at six months (MD 0.63, 95% CI -0.90 to 2.17; 2 studies, 521 participants). Meta-analyses for forced expiratory volume in 1 second (FEV1) measured at up to three months was inconclusive, MD -0.10 L, (95% CI -0.32 to 0.12; 4 studies, 252 participants; very low-certainty evidence). However, for FEV1 % of predicted, an improvement was observed in favour of the breathing exercise group (MD 6.88%, 95% CI 5.03 to 8.73; five studies, 618 participants). Breathing exercises versus asthma education For quality of life, one study measuring AQLQ was inconclusive up to three months (MD 0.04, 95% CI -0.26 to 0.34; 1 study, 183 participants). When assessed from four to six months, the results favoured breathing exercises (MD 0.38, 95% CI 0.08 to 0.68; 1 study, 183 participants). Hyperventilation symptoms measured by the Nijmegen Questionnaire were inconclusive up to three months (MD -1.24, 95% CI -3.23 to 0.75; 1 study, 183 participants), but favoured breathing exercises from four to six months (MD -3.16, 95% CI -5.35 to -0.97; 1 study, 183 participants). AUTHORS' CONCLUSIONS Breathing exercises may have some positive effects on quality of life, hyperventilation symptoms, and lung function. Due to some methodological differences among included studies and studies with poor methodology, the quality of evidence for the measured outcomes ranged from moderate to very low certainty according to GRADE criteria. In addition, further studies including full descriptions of treatment methods and outcome measurements are required.
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Affiliation(s)
- Thayla A Santino
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAv. Senador Salgado Filho, 3000NatalRio Grande do NorteBrazil59.078‐970
| | | | - Diana A Freitas
- Centro Universitário Facex (UNIFACEX)Rua Orlando Silva, 2896Bairro Capim MacioNatalRio Grande do NorteBrazil59080‐020
| | - Guilherme AF Fregonezi
- Federal University of Rio Grande do NortePneumoCardioVascular Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH) & Department of Physical TherapyNatalRio Grande do NorteBrazil59078‐970
| | - Karla MPP Mendonça
- Federal University of Rio Grande do NortePhD Program in Physical TherapyAvenida Senador Salgado Filho, 300Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
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