Breathing exercises for asthma

 

Abstract

Background

There is much anecdotal evidence in Eastern and Western literature describing considerable benefits for patients with asthma when treated with breathing interventions. The term 'breathing exercise, training and retraining' has numerous interpretations depending on the nature of the therapy, therapist and cultural background.

Objectives

To assess the evidence for the efficacy of breathing retraining in the treatment of patients with asthma.

Search methods

Trials were searched for in the Cochrane Airways Group trials register, Cochrane Complementary Medicine Field trials register, EMBASE: Physical Medicine & Rehabilitation Field, and Databases of the physiotherapy library of current research, World Congress of Physical Therapy Proceedings (1995) and AMED (Allied & Complementary Medicine Database 1985-2003/4). Hand searching of the Association of Chartered Physiotherapists in Respiratory Care Journals was undertaken.

Chartered physiotherapists in the field of respiratory medicine were contacted and appeals made in the 'Physiotherapy' Journal and the Physiotherapy Respiratory Care magazine. Searches were undertaken of bibliographies from the included studies and other appropriate papers. Authors of included studies were contacted for information concerning other relevant trials.

Selection criteria

Randomised or quasi-randomised controlled trials of breathing retraining in patients of all ages with a diagnosis of asthma. Breathing retraining should be a major component of the treatment intervention.

Data collection and analysis

Two reviewers (EH & FR) independently assessed trial quality and extracted data. Authors of included trials were contacted for additional data. Where possible adverse effects were noted.

Main results

Abstracts were identified and 42 full text papers were obtained for assessment and possible inclusion. Thirty five studies were excluded. A total of five studies were included in the original review. Two further studies have been added to this update. Most studies were of small size. Two studies demonstrated significant reductions in rescue bronchodilator use and three studies showed reductions in acute exacerbations, although these were measured in different ways. Two single studies showed significant improvements in quality of life measures. Overall, benefits of breathing exercises were found in isolated outcome measures in single studies. Five studies compared breathing retraining with no active control and two with asthma education control groups.

Authors' conclusions

Comparisons and conclusions were difficult to evaluate as treatment interventions and outcome measurements from the seven trials varied considerably. At present therefore no reliable conclusions can be drawn concerning the use of breathing exercises for asthma in clinical practice. However trends for improvement, notably in quality of life measurements, are encouraging and further studies including full descriptions of treatment methods and outcome measurements are required.

 

Plain language summary

Breathing exercises for asthma

The term 'breathing exercise or re-training' has numerous interpretations depending on the nature of the therapy, therapist and cultural background. The objective of this review was to assess the evidence for the effectiveness of breathing retraining for patients with asthma. Due to the small number of studies meeting the criteria for inclusion into this review, the small number of patients in the studies and the use of diverse interventions in the included studies, no reliable conclusions can be drawn as to the beneficial effects of breathing retraining in asthma. However with the introduction of two further studies trends for improvement in an increased number of outcomes were found. There is therefore a need for large scale trials involving breathing retraining in order to observe its effectiveness in the treatment and management of asthma.

 

摘要

背景

氣喘的呼吸運動

在東歐和西方文學中有許多傳聞證據描述呼吸干預方法用於治療氣喘患者有相當大的利益。呼吸運動、訓練和再訓練一詞有很多不同的解釋根據療法，治療師和文化背景的本質。

目標

為了評估呼吸再訓練在治療氣喘病人的有效性證據。

搜尋策略

檢索在the Cochrane Airways Group trials register、Cochrane Complementary Medicine Field trials register,、EMBASE:Physical Medicine & Rehabilitation Field和Databases of the physiotherapy library of current research、World Congress of Physical Therapy Proceedings (1995) 及AMED (Allied & Complementary Medicine Database 1985 – 2003/4)中的試驗。手動了檢索the Association of Chartered Physiotherapists in Respiratory Care Journals。聯繫了在此領域的呼吸醫學特許物理治療師，並向“Physiotherapy”雜誌和the Physiotherapy Respiratory Care magazine請求援助。進行檢索包括從研究和其他有關文件所獲得的書目。聯繫了被收案的研究的作者以了解與其他試驗的相關訊息。

選擇標準

針對各年齡層被診斷為氣喘的患者呼吸訓練的隨機或半隨機對照試驗。呼吸訓練應該是治療干預方法的一個主要組成部分。

資料收集與分析

兩名審查員(EH與FR)獨立的評估試驗品質和分析數據。聯繫了被收案的試驗作者以取得更多的數據。凡可能產生的不良影響均被標示。

主要結論

確認了摘要。42篇論文全文已獲得評估並可能被列入此次審查中。排除了35個研究。總共有5個研究被包括在原來的審查中。另外兩項研究已於此次更新中被列入。大多數研究為規模較小的研究。有兩個研究顯示，救援性的支氣管擴張劑的使用是大幅減少的。三份研究報告顯示，急性發作頻率是有減少的。但這些結論都是以不同的方式來衡量。兩個單一的研究顯示生活品質的測量值有顯著改善。整體而言，單一的研究中所量測的獨立的結果中，有發現呼吸運動的好處。五個研究比較呼吸運動與沒有積極採取控制方式。其中兩個研究有氣喘教育對照組。

作者結論

此次審查的比較性和結論是難以評估的，因為七項試驗中有關治療干預措施和測量的成果是相差很大的。因此，關於在臨床治療中利用呼吸運動治療氣喘，目前沒有辦法得到可靠的結論。不過，有改善的趨勢，尤其是對生活品質的量測，是令人振奮的。包括治療方法的充分描述和結果的測量的進一步研究是必需的。

翻譯人

本摘要由臺北醫學大學萬芳醫院劉怡敏翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

呼吸運動或再訓練′一詞，依據治療治、療師和文化背景的特性，有許多不同的解釋。這次審查的目標是為了評估呼吸再訓練在治療氣喘病人的有效性證據。。由於只有少數的研究符合列入此次審查的標準、此次研究僅有少量病人和在納入研究中使用各種不同的干預措施等因素，所以沒有得到任何可靠的結論可以說呼吸再訓練對氣喘治療是有有利的影響。然而，隨著兩個更新的研究發現越來越多的治療結果有改善的趨勢。因此，需要大規模有關呼吸再訓練的試驗以觀察其對氣喘治療和管理的效果。