This document summarizes a comprehensive review by Santino et al. (2020) which identifies asthma is one of the most common lung diseases. The disease hinders the passage of air in the patients by triggering an inflammatory reaction resulting in mucus hypersecretion, hyperresponsiveness, tissue remodelling, and smooth muscle spasms in the respiratory tract (Sankar & Das, 2018). As a consequence, the patient suffers from breathlessness and can even turn hypoxic in cases of exacerbation. To manage the health condition, multiple interventions and precautionary measures have been developed. The purpose of these strategies is to minimize the hazards and enhance the longevity of the patients who suffer from asthma. Breathing exercises are recommended for patients with respiratory disorders as it serves as a non-pharmacological therapy and aids in controlling signs and symptoms of diseases like asthma and COPD. Multiple techniques to perform breathing exercises have been developed. These techniques include the Buteyko method, Papworth breathing technique, Yogic breathing, as well as deep diaphragmatic breathing. These techniques are considered to be helpful for patients that suffer from the disease that causes respiratory distress through alteration of the breathing patterns. The core idea behind these interventions is to focus on the tidal volume and the minute volume of the lungs and to promote relaxation and abdominal breathing. Thus, in turn, the respiratory distress is minimized and resilience is built in the patient. Use of breathing exercises has been popularized as it serves to be an adjunct therapy that helps control the symptoms and serves as an effective mitigation strategy disease management.
The primary aim of the study was to evaluate the evidence concerned with the efficacy of breathing exercises as an intervention for asthma management in adults. The purpose of this review was identified by the authors, that was, the global high incidence of asthma resulting in high hospital costs with the prevalent use of breathing exercises as an adjunct therapy for management. Therefore, it is required to assess the efficacy of the popularly used intervention. To achieve the aim of the review paper, the authors chose to perform a systematic analysis of 22 published Randomized Controlled Trials (RCTs).
The intervention in this study was to select researches that evidenced the impact of breathing exercises on adults with asthma. A total of 2880 participants were reviewed. This primary intervention was analyzed against a comparative group of individuals that had been receiving asthma education and/or had no other form of intervention applied as they were in the waiting list. The participants in the interventional groups had been undergoing breathing exercise training with the prevalence of yoga and Prayanama as the primary interventions along with breathing retraining. The individuals were trained for breathing exercises for a range of 10-16 weeks in different studies and were suggested to complete the exercises on a daily routine for about 10-60 minutes with variations in different studies for an average period of two months. The participants were also under pharmacological treatment. The control group in the studies either depended only on a corticosteroid, pharmacological interventions, and nurse education only.
A total of 22 studies were reviewed in this paper with 2880 participants. 14 of 22 studies used yoga as a primary intervention, 4 studies used breathing retraining and other studies with combination methods. Breathing exercises in comparison to inactive control indicated improvement in the quality of life of patients by three months in the patients who were provided with breathing exercises in terms of improvement of hyperventilation symptoms. The inconclusive analysis was obtained in assessment for quality of life in the patients for three months. A positive impact was observed for patients that received breathing exercises for 4-6 months. Quality of life assessment for patients receiving asthma education versus the patients under breathing exercises was identified to be inconclusive for three months. But improvements were noted for individuals that received exercises after four to six months. Hyperventilation symptoms were improved in the patients that received breathing exercises with evidenced results after 4-6 months.
The authors of this study conclude that breathing exercises can have positive impacts on the quality of life of the patients as well as on hyperventilation symptoms and the functioning of the lungs. The authors also conclude that methodological variance in the application of the interventions affected the quality of evidence and thus resulted in low to moderate certainty on the quality of evidence. Therefore, authors conclude that descriptive analysis with a complete assessment of the treatment methods is required for a conclusive measurement of efficacy.
I agree with the conclusion by the authors as the results obtained in this study were inconclusive in meta-analysis. Therefore, a more detailed descriptive analysis along with a critical evaluation of the studies can be used to infer conclusive evidence for the determination of the efficacy of breathing exercises.
Asthma is one of the major health crises affecting a large section of society globally (Sankar & Das, 2018). With no absolute cure of this chronic condition, effective management and treatment options play an important role. In severe exacerbations of the disease, a patient may also become hypoxic leading to multiple organ damage-causing fatalities (Sankar & Das, 2018). This study provides a comprehensive analysis of the available literature to assess the efficacy of one of the major adjunct therapies used for asthmatic patients. The primary implication of this study is that it provides evidence for the efficacy of different breathing therapies in comparison to alternative interventions to improve the quality of life, lung capacity, and asthma symptom management in the patients. This study also provides scope for further developments in the research and the need for future analysis to derive conclusive evidence. The results of this study can be used for the development of interventions and management strategies for the patients. Therefore, through this study, it can be implied that breathing exercise is beneficial for adult patients with asthma. However, the magnitude of the impact is variable and future research is needed to drive quantitative concrete evidence for inferential analysis.
Sankar, J., & Das, R. R. (2018). Asthma–a disease of how we breathe: Role of breathing exercises and pranayam. The Indian Journal of Pediatrics, 85(10), 905-910. https://link.springer.com/article/10.1007/s12098-017-2519-6
Santino, T. A., Chaves, G. S., Freitas, D. A., Fregonezi, G. A., & Mendonça, K. M. (2020). Breathing exercises for adults with asthma. Cochrane Database of Systematic Reviews, (3). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001277.pub4/abstract.
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