Thomas and colleagues reported breathing training leading to improvements in asthma-specific health status and other patient-centred measures.1 These included Asthma Quality of Life Questionnaire (AQLQ) scores, Hospital Anxiety and Depression (HAD) anxiety, HAD depression, Nijmegen scores and Asthma Control Questionnaire (ACQ) scores. The significant improvement in all the above stated scores except the last one at 6 months after the intervention could be due to a few inherent biases. This was discussed in our weekly journal club.

First, most of the population studied were hyperventilating subjects, as evidenced by the mean Nijmegen scores in both groups of >23. Breathing training might therefore have helped these hyperventilating subjects. Second, as stated in the article, most subjects with chronic disease would like to try alternative forms of treatment.2 If this “alternative form” was mentioned during the invitation to take part in the study (which is not stated in the article), then all the subjects could have been self-motivated, which is not representative of the general population and hence the results cannot be generalised. Last, the subjects who underwent breathing training were encouraged to do the breathing exercises throughout the 6-month period whereas the control group had three sessions of asthma education with no such ongoing “controlling effect”.

A significant improvement in forced expiratory volume in 1 s and a significant fall in exhaled nitric oxide 1 month after the intervention in the control group shows the beneficial effect of patient education. Hence, effective pharmacotherapy with asthma education continues to be the core of asthma treatment. The role of breathing training is possibly present in subjects who have a tendency to hyperventilate, which need not be due just to asthma but to any cause.