Non pharmacological approaches to asthma: Physiotherapy. Claire Hepworth Specialist Respiratory Physiotherapist

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1 Non pharmacological approaches to asthma: Physiotherapy Claire Hepworth Specialist Respiratory Physiotherapist

2 Good breathing control Buteyko therapy & research How to clear the nose effectively Managing dry, irritating cough Exercise Relaxation

3 Good breathing Slow Mouth closed Quiet Relaxed Relatively shallow Pauses after expiration Stomach rises on inspiration Expiration is longer Poor breathing Fast Mouth open Noisy Upper chest rises, neck muscles active Large volume of air in & out No pauses between breaths Stomach pulled in during inspiration Inspiration is longer (Buteyko, 2015)

4 Diaphragm Fatigue resistant Affected by posture and position

5 Breathing control exercises Dr Butyeko observed ill patients had high respiratory rates Improve breathing, improve illness First study taught Buteyko to children with asthma State Medical system approved Buteyko Buteyko is a holistic, non pharmacological adjunct to treating asthma with the main aim to improve quality of life (Buteyko Breathing Association) (Buteyko, 2015)

6 Reduced β 2 agonist usage (Bowler et al, 1998; McHugh et al, 2003; Opat et al, 2009; Cooper et al, 2003) Improved quality of life (Opat et al, 2009; Burgess et al, 2011) Reduce asthma symptoms (Cooper et al, 2003; Hassan et al, 2012) Recommended in the BTS guidelines for adults with asthma (BTS, 2009 & 2014) 1++ classification But these are all in adults...

7 One case series in 8 children with asthma Reduced β 2 agonist usage Reduced asthma symptoms Reduced courses of oral steroids Reduced Inhaled corticosteroid (dropped down gradually) Reduced days missed off school (Mugh et al, 2006)

8 Based on the principle that people with asthma over breathe 5 sessions for 1 hour of breathing exercises at rest & with activity Many exercises i.e. mini pauses (Buteyko, 2015)

9 Many children with asthma mouth breathe (Venetikdou et al, 1993) (Buteyko, 2015)

10 Nose filters, warm, moisten the air (Amitrano & Tortora, 2012) Produces nitric oxide that can kill bacteria and viruses (Honl, 2013) Asthmatics often switch from nose to mouth breathing at lower flow rates (Hallani et al, 2008) Nose designed for breathing

11 Nodding 10 times Tipping 3-6 times Hold & blow 6 times Advanced nose clearance Alternate nostril breathing Apply small piece of tape to the mouth (over 8 years with supervision) Sinus nasal irrigation Consider obstruction in nose i.e. Polyps (Buteyko, 2015)

12 Coughing dries, irritates & inflames the airways To control dry, tickly cough (not for productive coughs) Hand over mouth Swallow Stop coughing (internal) Small breaths for 30 seconds Repeat as needed (Buteyko, 2015)

13 Teenage boy Asthma Frequent hospital admissions Poor breathing control at rest and with exercise Taught nose breathing and breathing control at rest and with exercise Excellent response

14 (Williams et al, 2008)

15 Many asthmatics feel that normal breathlessness is an asthma symptom (Goodwin et al, 2004) (Buteyko, 2015)

16 The benefits of good asthma & breathing control... Encourage children with asthma to exercise, ensuring good breathing and asthma control

17 Spirometry before exercise Exercise what brings on these symptoms Observation Spirometry post exercise

18 - Poor asthma control - Poor breathing control - Panicking (from parent or patient) - Combination of factors - Education

19 Drink enough water Differentiate between asthma symptoms and normal breathlessness Teaching to control breathing If mouth breathing, stop and regain breathing control Exercise comfortably without provoking symptoms Exercise 30 minutes every day (asthma UK, 2015) Gain confidence exercising at school/home

20 16 year old girl Mum concerned dropping oxygen with exercise Stopped exercising Assessment Open mouth breathing throughout Poor fitness levels No bronchoconstriction Sats 97% in air post exercise Treatment Breathing control emphasised with exercise Reassured family

21 Stress causes increased respiratory rate as part of flight or fight response Over-breathing Relaxed breathing in buteyko Deep muscle relaxation Identify own relaxation music, read Postural/stretching exercises yoga/ tai chi Important to find time to relax

22 Many non-pharmacological treatments for children with asthma Individual approach Treatment underpinned by Buteyko theory holistic Importance of clearing the nose, breathing control at rest and with activity & relaxation

23 Please refer children with asthma to physiotherapy

24

25 Asthma UK (2015) Amitrano, R & Tortora, G. (2012) Anatomy & physiology laboratory manual. 7 th edition Bowler SD et al. Buteyko breathing techniques in asthma: a blinded randomised control trial. Medical Journal of Australia. 1998, Vol. 169, pp BTS/SIGN British guideline on the management of asthma. (2014) BTS/SIGN British guidline on the management of asthma. (2009) Burgess, J et al. Systematic review of the effectiveness of breathing retraining in asthma management. Expert review in Respiratory Medicine. 201, 2011, Vol. 5, 6, pp Buteyko. Buteyko Breathing Techniques. Teacher training manual. 5 th Edition. Buteyko Breathing Association. J L Brindley (2015) Cooper, S et al. Effect of two breathing exercises (Buteyko and pranayama) in asthma: a randomised controlled trial. Thorax. 2003, Vol. 58, 8, pp Hassan, Z M, Riad N M and Ahmed, F H. Effect of buteyko breathing technique on patients with bronchial asthma. Egyptian journal of chest diseases and tuberculosis. 2012, Vol. 61, pp Hallani M, Wheatley JR, Amis TC (2008) Eur Respir J Apr;31(4): Initiating oral breathing in response to nasal loading: asthmatics versus healthy subjects. Honl, T (2013) Chronic Mouth Breathing A Serious Health Concern (Mouth vs. Nasal Breathing) Stevens Point Journal

26 LaBella, C R et al. Athletic trainers experience and comfort with evaluation and management of asthma: a pilot study. Journal of Asthma. Feb 2009, Vol. 46,1, pp Mchugh, P et al. Buteyko breathing technique for asthma: an effective intervention. New Zealand Medcial Journal. 2003, Vol. 116 Mchugh P, Duncan B, Houghton F Buteyko breathing technique and asthma in children: a case series. New Zeal Med Jour 2006 May 19;119 Opat, A J, et al. A clinical trial of the buteyko breathing technique in asthma as taught by a video. Journal of asthma. 37, 2000, Vol. 7, pp Thomas, M et al The prevalence of dysfunctional breathing in adults in the community with and without asthma. Primary Care Respiratory Journal (2005), Vol. 14, 2 pp Thomas, M et al. Prevalence of dysfunctional breathing in patients treated for asthma in primary care: Cross sectional survey. BMJ. 2001, Vol. 322, 7294, pp Thomas, M et al. Breathing exercises for asthma. Thorax. 2009, Vol. 64, 1, pp Traister, RS et al. A retrospective analysis comparing subjects with isolated and coexistent vocal cord dysfunction and asthma. Allergy Asthma Proc. Venetikidou, A et al. Incidence of malocclusion in asthmatic children. Clinical Paediatric Dentistry. 1993, Vol. 17, 2, pp Williams, B et al. Exploring and explaining low participation in physical activity among children and young people with asthma. BMC Family Practice, June 2008, Vol. 30, 9, p.40

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