Breathing exercises for children with asthma

Background

Asthma is a chronic (persistent) inflammatory disease of the lungs that can lead to airflow obstruction (blockage) causing difficulty in breathing. The worldwide high prevalence of asthma has become a public health problem due to the great healthcare costs resulting from hospitalisation and medicines. Moreover, asthma is the most common chronic disease in childhood. Breathing exercises are a non-drug treatment that have been routinely used in the treatment of people with asthma. Breathing exercises aim to control the hyperventilation (overbreathing) symptoms of asthma and can include the Papworth method, Buteyko breathing technique, yoga or any other similar method that focusses on changing the breathing pattern.

Review question

We wanted to look at the evidence for the effects of breathing exercises in children with asthma.

Key results

We found three studies involving 112 children with mild to severe asthma. All the included studies compared breathing exercises as part of a more complex treatment (inspiratory muscle training, relaxation exercises, endurance exercises, rhythmic mobilization exercises, vibrations, percussion, forced expiration technique) versus control. The studies varied in size from 28 to 60 children. Samples consisted of inpatients and outpatients. The control groups received different treatments: one received placebo (pretend) treatment, one an educational programme and doctor appointments, and one was not described. We found no primary outcomes (measures of quality of life, asthma symptoms and side effects of treatment) that were reported as comparisons between the treatment and control groups.

Quality of the evidence

The included studies had an overall small number of participants and sessions. No included study compared breathing exercises alone versus a control. Instead, breathing exercises were part of a package of treatments and were compared to a control. The methods used to conduct the studies were not as well reported as we would like and so were unclear about the quality of the trials. Overall, we judged the included studies as being at an unclear risk of bias and the quality of the evidence included in the review was low.

Conclusion

We could draw no reliable conclusions concerning the use of breathing exercises for children with asthma in clinical practice.

Authors' conclusions: 

We could draw no reliable conclusions concerning the use of breathing exercises for children with asthma in clinical practice. The breathing exercises were part of a more comprehensive package of care, and could not be assessed on their own. Moreover, there were methodological differences among the three small included studies and poor reporting of methodological aspects and results in most of the included studies.

Read the full abstract...
Background: 

Asthma is the most common chronic disease in childhood. Breathing exercise techniques have been widely used by researchers and professionals in the search for complementary therapies for the treatment of asthma.

Objectives: 

To assess the effects of breathing exercises in children with asthma.

Search strategy: 

We searched for trials in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL and AMED and handsearched respiratory journals and meeting abstracts. We also consulted trial registers and reference lists of included articles.

The literature search was run up to September 2015.

Selection criteria: 

We included randomised controlled trials of breathing exercises alone versus control or breathing exercises as part of a more complex intervention versus control in children with asthma.

Data collection and analysis: 

Two review authors independently assessed trial quality and extracted data. The primary outcomes were quality of life, asthma symptoms and serious adverse events. The secondary outcomes were reduction in medication usage, number of acute exacerbations, physiological measures (lung function (especially low flow rates) and functional capacity), days off school and adverse events.

Main results: 

The review included three studies involving 112 participants. All the included studies performed the comparison breathing exercises as part of a more complex intervention versus control. There were no trials comparing breathing exercises alone with control. Asthma severity of participants from the included studies varied. The studies measured: quality of life, asthma symptoms, reduction in medication usage, number of acute exacerbations and lung function. Breathing exercise techniques used by the included studies consisted of lateral costal breathing, diaphragmatic breathing, inspiratory patterns and pursed lips. One study included in the review did not specify the type of breathing exercise used. The control groups received different interventions: one received placebo treatment, one an educational programme and doctor appointments, and one was not described. There were no reported between-group comparisons for any of the primary outcomes. We judged the included studies as having an unclear risk of bias.

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