Breathing exercises for dysfunctional breathing/hyperventilation syndrome

Background
Dysfunctional breathing/hyperventilation syndrome (DB/HVS) is a breathing problem that involves breathing too deeply and/or too rapidly (hyperventilation). There are many possible causes of DB/HVS and if left untreated it can lead to a variety of unpleasant symptoms such as breathlessness, dizziness, pins and needles and chest pain.

Review question
The aim of this review was to investigate whether breathing exercises are useful in the treatment of dysfunctional breathing/hyperventilation syndrome. The overall aim of all breathing exercises is to teach the patient to breathe gently using the lower part of their chest, at a rate that matches their activity level.

Key results
Only one study met the criteria for inclusion in this review, in which participants also received relaxation therapy. This study had a small number of participants and provided very little detail as to how it was undertaken. Although the trial report suggested that breathing exercises may be beneficial in the treatment of this particular patient group no numerical data were presented so we could not be sure. No reliable conclusions can be drawn from this small, isolated study.

This Cochrane plain language summary is up to date as of February 2013.

Authors' conclusions: 

The results of this systematic review are unable to inform clinical practice, based on the inclusion of only one small, poorly reported RCT. There is no credible evidence regarding the effectiveness of breathing exercises for the clinical symptoms of DB/HVS. It is currently unknown whether these interventions offer any added value in this patient group or whether specific types of breathing exercise demonstrate superiority over others. Given that breathing exercises are frequently used to treat DB/HVS, there is an urgent need for further well designed clinical trials in this area. Future trials should conform to the CONSORT statement for standards of reporting and use appropriate, validated outcome measures. Trial reports should also ensure full disclosure of data for all important clinical outcomes.

Read the full abstract...
Background: 

Dysfunctional breathing/hyperventilation syndrome (DB/HVS) is a respiratory disorder, psychologically or physiologically based, involving breathing too deeply and/or too rapidly (hyperventilation) or erratic breathing interspersed with breath-holding or sighing (DB). DB/HVS can result in significant patient morbidity and an array of symptoms including breathlessness, chest tightness, dizziness, tremor and paraesthesia. DB/HVS has an estimated prevalence of 9.5% in the general adult population, however, there is little consensus regarding the most effective management of this patient group.

Objectives: 

1) To determine whether breathing exercises in patients with DB/HVS have beneficial effects as measured by quality of life indices

2) To determine whether there are any adverse effects of breathing exercises in patients with DB/HVS

Search strategy: 

We identified trials for consideration using both electronic and manual search strategies. We searched CENTRAL, MEDLINE, EMBASE, and four other databases. The latest search was in February 2013.

Selection criteria: 

We planned to include randomised, quasi-randomised or cluster randomised controlled trials (RCTs) in which breathing exercises, or a combined intervention including breathing exercises as a key component, were compared with either no treatment or another therapy that did not include breathing exercises in patients with DB/HVS. Observational studies, case studies and studies utilising a cross-over design were not eligible for inclusion.

We considered any type of breathing exercise for inclusion in this review, such as breathing control, diaphragmatic breathing, yoga breathing, Buteyko breathing, biofeedback-guided breathing modification, yawn/sigh suppression. Programs where exercises were either supervised or unsupervised were eligible as were relaxation techniques and acute-episode management, as long as it was clear that breathing exercises were a key component of the intervention.

We excluded any intervention without breathing exercises or where breathing exercises were not key to the intervention.

Data collection and analysis: 

Two review authors independently checked search results for eligible studies, assessed all studies that appeared to meet the selection criteria and extracted data. We used standard procedures recommended by The Cochrane Collaboration.

Main results: 

We included a single RCT assessed at unclear risk of bias, which compared relaxation therapy (n = 15) versus relaxation therapy and breathing exercises (n = 15) and a no therapy control group (n = 15).

Quality of life was not an outcome measure in this RCT, and no numerical data or statistical analysis were presented in this paper. A significant reduction in the frequency and severity of hyperventilation attacks in the breathing exercise group compared with the control group was reported. In addition, a significant difference in frequency and severity of hyperventilation attacks between the breathing and relaxation group was reported. However, no information could be extracted from the paper regarding the size of the treatment effects.

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