Buteyko method

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The Buteyko method or Buteyko breathing technique is a form of complementary or alternative physical therapy that proposes the use of breathing exercises primarily as a treatment for asthma and other respiratory conditions. [1]

Contents

Buteyko asserts that numerous medical conditions, including asthma, are caused or exacerbated by chronically increased respiratory rate or hyperventilation. The method aims to correct hyperventilation and encourage shallower, slower breathing. Treatments include a series of reduced-breathing exercises that focus on nasal-breathing, breath-holding and relaxation.

Advocates of the Buteyko method claim that it can alleviate symptoms and reliance on medication for patients with asthma, chronic obstructive pulmonary disease (COPD), and chronic hyperventilation. The medical community questions these claims, given limited and inadequate evidence supporting the theory and efficacy of the method. [1] [2]

History

The Buteyko method was originally developed in the 1950s by physiologist Konstantin Buteyko in the Soviet Union. [3]

The first official study into the effectiveness of the Buteyko method on asthma was undertaken in 1968 at the Leningrad Institute of Pulmonology. The second, held at the First Moscow Institute of Pediatric Diseases in April 1980, eventually led to the head of the ministry of health to issue an order (No 591) for the implementation of the Buteyko method in the treatment of bronchial asthma. [4] Later, this method was introduced to Australia, New Zealand, Britain and the United States, where it has received increasing exposure. [3] Anecdotal reports of life-changing improvements attributed to the Buteyko method abound on the Internet and in books. [5]

The Buteyko method is one of a number of breathing retraining methods in use for treating lung diseases, including conventional techniques such as physiotherapist-led breathing exercises as well as alternative medicine techniques such as yoga. [6]

In 2019, the popular Indonesian singer Andien posted images of herself, her husband and their two-year-old son with tape over their mouths on social media. The pictures prompted discussion and interest in the Buteyko method. [7]

Method

The Buteyko method emphasizes the role of carbon dioxide and hyperventilation in respiratory diseases as well as overall health. It is known that hyperventilation can lead to low carbon dioxide levels in the blood (or hypocapnea), which can subsequently lead to disturbances of the acid-base balance in the blood and lower tissue oxygen levels. Advocates of this method assert that the effects of chronic hyperventilation have wider effects than is commonly accepted. [5] These effects include widespread spasms of the muscle in the airways (bronchospasm), [8] disturbance of cell energy production via the Krebs cycle, as well as disturbance of numerous vital homeostatic chemical reactions in the body. The Buteyko method purports to retrain the body's breathing pattern to correct for the presumed chronic hyperventilation and hypocapnia, thereby treating or curing the body of these medical problems. [5]

The Buteyko method is not widely supported in the medical community, in part due to the lack of research supporting the theory that hyperventilation and hypocapnia causes disease, [5] with one review noting the absence of convincing evidence to indicate that trying to change asthmatics' carbon dioxide level is either "desirable or achievable." [8] Some studies that looked to corroborate the theory sought evidence such as by measuring the carbon dioxide levels in practitioners of Buteyko but failed to find conclusive support, leading some to propose alternate theoretical pathways for this method to improve symptoms. [5]

Although variations exist among teachers of the technique in different countries, the main objective is "normalization" of breathing and the three core principles of Buteyko remain the same: nasal breathing, reduced breathing, and relaxation.

Nasal breathing

The Buteyko method emphasizes the importance of nasal breathing, which protects the airways by humidifying, warming, and cleaning the air entering the lungs. Many asthmatics have problems sleeping at night, and this is thought by Buteyko practitioners to be linked with poor posture and/or mouth breathing. By keeping the nose clear and encouraging nasal breathing during the day, night-time symptoms can also improve. Strictly nasal breathing during physical exercise is another key element of the Buteyko method. [1]

Reduced breathing exercises

The core Buteyko exercises involve breath control: consciously reducing either breathing rate or breathing volume. [9] Many teachers refer to Buteyko as 'breathing retraining' and compare the method to learning to ride a bicycle. They say that after adequate practice time, the techniques become instinctive and the exercises are gradually phased out as the condition improves.

Buteyko uses a measurement called the control pause (CP), the amount of time between breaths that an individual can comfortably hold breath. [5] According to Buteyko teachers, people with asthma who regularly practice Buteyko breathing will notice an increase in CP and decrease in pulse rate that corresponds to decreased asthma symptoms.

Relaxation

Buteyko practice emphasizes relaxation to counter asthma attacks. The first feeling of an asthma attack is unsettling and can result in a short period of rapid breathing. Buteyko method claims that by controlling this initial over-breathing phase, asthmatics can prevent a "vicious circle of over-breathing" from developing and spiraling into an asthma attack.

Medical evidence

Advocates of the Buteyko method claim that it can treat a wide range of other diseases and symptoms (numbering up to 150), including diabetes. However, studies into the effectiveness of Buteyko have focused almost exclusively on asthma with a small amount of research on sleep apnea. [5] Members of the medical community have been skeptical of the efficacy of Buteyko due to the often "exaggerated and unsubstantiated claims" earlier made by Buteyko practitioners. [6]

There are few high quality studies such as randomized controlled trials looking at the efficacy of treating asthma with "breathing retraining" methods in general, which include the Buteyko method, yoga training and other relaxation techniques. [10] Many of the studies that have evaluated breathing retraining have significant methodological flaws, including small sample sizes, [11] possible patient selection bias as well as heterogeneity in design that makes coming to a firm conclusion difficult. [12] These studies are also hampered by the difficulty in proper blinding and placebo control which could introduce more bias into these studies. [11]

In 2015 the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; the Buteyko method was one of 17 therapies evaluated for which no clear evidence of effectiveness was found. [1] A 2020 Cochrane review has found that breathing exercises may have some positive impact on quality of life, hyperventilation symptoms and lung function (moderate to very low certainty). [10] A 2014 British clinical guideline said that for adults the Buteyko method could improve some asthma symptoms and quality of life, but that it had little impact on lung function. [2]

See also

Related Research Articles

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<span class="mw-page-title-main">Respiratory failure</span> Inadequate gas exchange by the respiratory system

Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise in arterial carbon dioxide levels is called hypercapnia. Respiratory failure is classified as either Type 1 or Type 2, based on whether there is a high carbon dioxide level, and can be acute or chronic. In clinical trials, the definition of respiratory failure usually includes increased respiratory rate, abnormal blood gases, and evidence of increased work of breathing. Respiratory failure causes an altered state of consciousness due to ischemia in the brain.

<span class="mw-page-title-main">Shortness of breath</span> Feeling of difficulty breathing

Shortness of breath (SOB), known as dyspnea or dyspnoea, is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity", and recommends evaluating dyspnea by assessing the intensity of its distinct sensations, the degree of distress and discomfort involved, and its burden or impact on the patient's activities of daily living. Distinct sensations include effort/work to breathe, chest tightness or pain, and "air hunger". The tripod position is often assumed to be a sign.

Hyperventilation is irregular breathing that occurs when the rate or tidal volume of breathing eliminates more carbon dioxide than the body can produce. This leads to hypocapnia, a reduced concentration of carbon dioxide dissolved in the blood. The body normally attempts to compensate for this homeostatically, but if this fails or is overridden, the blood pH will rise, leading to respiratory alkalosis. The symptoms of respiratory alkalosis include dizziness, tingling in the lips, hands, or feet, headache, weakness, fainting, and seizures. In extreme cases, it may cause carpopedal spasms, a flapping and contraction of the hands and feet.

Hypoventilation occurs when ventilation is inadequate to perform needed respiratory gas exchange. By definition it causes an increased concentration of carbon dioxide (hypercapnia) and respiratory acidosis. Hypoventilation is not synonymous with respiratory arrest, in which breathing ceases entirely and death occurs within minutes due to hypoxia and leads rapidly into complete anoxia, although both are medical emergencies. Hypoventilation can be considered a precursor to hypoxia and its lethality is attributed to hypoxia with carbon dioxide toxicity.

<span class="mw-page-title-main">Hypercapnia</span> Abnormally high tissue carbon dioxide levels

Hypercapnia (from the Greek hyper = "above" or "too much" and kapnos = "smoke"), also known as hypercarbia and CO2 retention, is a condition of abnormally elevated carbon dioxide (CO2) levels in the blood. Carbon dioxide is a gaseous product of the body's metabolism and is normally expelled through the lungs. Carbon dioxide may accumulate in any condition that causes hypoventilation, a reduction of alveolar ventilation (the clearance of air from the small sacs of the lung where gas exchange takes place) as well as resulting from inhalation of CO2. Inability of the lungs to clear carbon dioxide, or inhalation of elevated levels of CO2, leads to respiratory acidosis. Eventually the body compensates for the raised acidity by retaining alkali in the kidneys, a process known as "metabolic compensation".

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<span class="mw-page-title-main">Ventilation–perfusion coupling</span> Relationship between respiratory and cardiovascular processes

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References

  1. 1 2 3 4 Baggoley C (2015). "Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance" (PDF). Australian Government – Department of Health. Archived from the original (PDF) on 26 June 2016. Retrieved 12 December 2015.
  2. 1 2 Scottish Intercollegiate Guidelines Network (2014). "British guideline on the management of asthma". Thorax (Practice guideline). 69 (Suppl 1): 1–192. PMID   25323740.
  3. 1 2 Bruton A, Lewith GT (March 2005). "The Buteyko breathing technique for asthma: a review". Complement Ther Med. 13 (1): 41–6. doi:10.1016/j.ctim.2005.01.003. PMID   15907677.
  4. ↑ Burenkov S (1990). "USSR Ministry of Health, Order No 591". In Buteyko KP (ed.). Buteyko Method: The experience of implementation in medical practice. Moscow: Patriot Press. pp. 166–167. ISBN   978-5-7030-0456-2.
  5. 1 2 3 4 5 6 7 Courtney, Rosalba (Summer 2008). "Strengths, Weaknesses, and Possibilities of the Buteyko Breathing Method". Biofeedback. 36 (2): 59–63.
  6. 1 2 Bruton A, Thomas M (February 2011). "The role of breathing training in asthma management". Curr Opin Allergy Clin Immunol. 11 (1): 53–7. doi:10.1097/ACI.0b013e3283423085. PMID   21150439. S2CID   5415920.
  7. ↑ "Buteyko: Why Indonesia singer Andien sleeps with tape on her mouth". BBC News. 12 July 2019.
  8. 1 2 Bruton A, Holgate ST (May 2005). "Hypocapnia and asthma: a mechanism for breathing retraining?". Chest. 127 (5): 1808–11. doi:10.1378/chest.127.5.1808. PMID   15888863.
  9. ↑ Thomas, Mike; Bruton, Anne (December 2014). "Breathing exercises for asthma". Breathe. 10 (4): 313–322. doi: 10.1183/20734735.008414 .
  10. 1 2 Santino, Thayla A.; Chaves, Gabriela Ss; Freitas, Diana A.; Fregonezi, Guilherme Af; Mendonça, Karla Mpp (25 March 2020). "Breathing exercises for adults with asthma". The Cochrane Database of Systematic Reviews. 2020 (3): CD001277. doi:10.1002/14651858.CD001277.pub4. ISSN   1469-493X. PMC   7096190 . PMID   32212422.
  11. 1 2 Ernst E (May 2000). "Breathing techniques--adjunctive treatment modalities for asthma? A systematic review". Eur. Respir. J. 15 (5): 969–72. doi: 10.1183/09031936.00.15596900 . PMID   10853868.
  12. ↑ Györik SA, Brutsche MH (January 2004). "Complementary and alternative medicine for bronchial asthma: is there new evidence?". Curr Opin Pulm Med. 10 (1): 37–43. doi:10.1097/00063198-200401000-00007. PMID   14749604. S2CID   25254146.
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