• E Holloway and F S F Ram.
• 71 London Road, Knebworth, Hertfordshire, UK, SG3 6HG.
• Cochrane Db Syst Rev. 2004 Jan 1 (1): CD001277.

BackgroundThere 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.ObjectivesTo assess the evidence for the efficacy of breathing retraining in the treatment of patients with asthma.Search StrategyTrials 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 CriteriaRandomised 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 AnalysisTwo 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 ResultsAbstracts 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.Reviewer's ConclusionsComparisons 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.

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