Breathing exercises for asthma: panacea or placebo?

Breathing is easy—we all do it all of the time from the moment we are born. So why should it be necessary to teach people how to breathe? How is it possible to get something wrong when it appears so simple? And, if it is wrong, can it be corrected?

In this issue of Thorax Holloway and West1 report a randomised trial of adding the Papworth technique—a combination of breathing and relaxation exercises first introduced for hyperventilation syndromes—to usual care in patients with asthma (see p 1039). They recruited 85 volunteers with asthma from a primary care asthma register, 72 of whom completed the parallel group study and were followed up for 12 months. The group had relatively mild asthma with mean forced expiratory volume in 1 s (FEV₁) >90% predicted and thus, unsurprisingly, there were no significant improvements in the conventional physiological measures. However, the actively managed group who received five sessions of the Papworth technique, each lasting 1 h, had significant improvements in the St George’s Respiratory Questionnaire (SGRQ), symptoms and anxiety and depression scores.

This study raises as many questions as it answers. Why might breathing be amenable to change? Most homeostatic mechanisms (such as body temperature, hormonal cycles, blood sugar levels) are automatic and impervious to voluntary control. But breathing is different. The body’s automatic “settings” can be overridden by voluntary control. It is possible to breath hold and, with training, to do so for prolonged periods (eg, several minutes as exemplified by the extreme diving sport). It is equally possible and easier to hyperventilate, so inducing hypocapnia and alkalosis. Alkalosis alters the levels of ionised calcium, nerve conduction …