Physiotherapy breathing retraining for asthma: a randomised controlled trial

Prof Anne Bruton, PhD, Prof Amanda Lee, PhD, Prof Lucy Yardley, PhD, Prof James Raftery, PhD, Emily Arden-Close, PhD, Sarah Kirby, PhD, Shihua Zhu, PhD, Manimekalai Thiruvothiyur, MSc, Frances Webley, Lyn Taylor, Denise Gibson, MSc, Guiqing Yao, PhD, Mark Stafford-Watson, Jenny Versnel, PhD, Prof Michael Moore, FRCGP, Steve George, FRCGP, Prof Paul Little, FMedSci, Prof Ratko Djukanovic, PhD, Prof David Price, FRCGP, Prof Ian D Pavord, FMedSci, Prof Stephen T Holgate, FMedSci, Prof Mike Thomas, PhD

Correspondence information about the author Prof Mike ThomasEmail the author Prof Mike Thomas

Published: 13 December 2017

Open Access

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DOI: http://dx.doi.org/10.1016/S2213-2600(17)30474-5

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Summary

Background

Despite effective pharmacotherapy, asthma continues to impair quality of life for most patients. Non-pharmacological approaches, including breathing retraining, are therefore of great interest to patients.

However, clinicians rarely advocate breathing retraining and access to this intervention is restricted for most patients due to the limited availability of suitable physiotherapists and poor integration of breathing retraining into standard care. We aimed to assess the effectiveness of a digital self-guided breathing retraining intervention.

Methods

In this randomised controlled trial, we recruited patients from 34 general practices in the UK. Eligibility criteria for patients with asthma were broad, comprising a physician diagnosis of asthma, age of 16–70 years, receipt of at least one anti-asthma medication in the previous year, and impaired asthma-related quality of life (Asthma Quality of Life Questionnaire [AQLQ] score of<5 12="" 2:1:2="" a="" acceptability="" achieved="" active="" and="" aqlq="" as="" assigned="" asthma="" at="" between="" booklet="" both="" breathing="" by="" care.="" care="" clinical="" control="" controlled="" costs.="" delivered="" developed="" dvd="" dvdb="" either="" equivalence="" face-to-face="" for="" generators.="" groups="" health-care="" in="" included="" intention-to-treat="" international="" intervention="" isrctn88318003.="" measures="" months.="" number="" of="" or="" outcome="" outcomes="" over="" p="" participants="" patient-reported="" patient="" physiological="" plus="" population="" powered="" primary="" printed="" random="" randomisation="" randomised="" randomly="" ratio="" receive="" registered="" registry="" retraining="" score="" secondary="" self-guided="" service="" sessions="" show="" southampton="" standard="" superiority="" telephone="" the="" this="" three="" to="" trial="" trials="" two="" unit="" use="" using="" usual="" was="" we="" were="" which="" with="">

Findings

Between Nov 5, 2012 and Jan 28, 2014, invitations to participate in the study were sent to 15 203 patients with general practitioner-diagnosed asthma, of whom 655 were recruited into the study. AQLQ scores at 12 months were significantly higher in the DVDB group (mean 5·40, SD 1·14) than in the usual care group (5·12, SD 1·17; adjusted mean difference 0·28, 95% CI 0·11 to 0·44), and in the face-to-face group (5·33, SD 1·06) than in the usual care group (adjusted mean difference 0·24, 95% CI 0·04 to 0·44); AQLQ scores were similar between the DVDB group and the face-to-face group (0·04, 95% CI −0·16 to 0·24). There were no significant differences between the randomisation groups in FEV1 or fraction of exhaled nitric oxide. 744 adverse events occurred in 272 patients: 101 (39%) of 261 patients in the DVDB group, 55 (42%) of 132 patients in the face-to-face group, and 132 (50%) of 262 in the usual care group, with patients reporting one or more event. 11 (4%) patients in the DVDB group, four (3%) patients in the face-to-face group, and 20 (8%) patients in the usual care group had a serious adverse event.

Interpretation

Breathing retraining programmes improve quality of life in patients with incompletely controlled asthma despite having little effect on lung function or airway inflammation. Such programmes can be delivered conveniently and cost-effectively as a self-guided digital audiovisual programme, so might also reduce health-care costs.