CHEST Guidelines-Controlling-Asthma-by-Breathing-Techniques

Controlling-Asthma-by-Breathing-Techniques_chest

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In a letter to the editor published in <em>CHEST</em> in March 2015, Sahajal Dhooria and Ritesh Agarwal discussed the findings of a study by Ritz et al., published in November 2014, which showed that respiratory training can significantly improve asthma management. This includes better asthma control, reduced peak flow variability, improved lung function, decreased bronchodilator use, less airway hyperreactivity, and enhanced quality of life. The study specifically compared capnometry-assisted respiratory training (CART) with slow breathing and awareness training. The findings suggested that CART resulted in a greater reduction of respiratory impedance and decreased distress during methacholine challenges, possibly due to improved tolerance to elevations in carbon dioxide (P co2).

Dhooria and Agarwal point out an important aspect overlooked in the study—the role of anxiety. They highlight that anxiety is often associated with asthma symptoms and can contribute to airway hyperresponsiveness. Moreover, breathing techniques are known to reduce anxiety. They propose that the effectiveness of CART might also have been due to better anxiety reduction through biofeedback, suggesting that the improvements observed might have both physiological and psychological underpinnings. This leaves unanswered questions about whether the benefits stemmed purely from physiological changes or were influenced by psychological factors.

The authors, affiliated with the Department of Pulmonary Medicine at the Postgraduate Institute of Medical Education and Research in India, emphasize that a thorough assessment of anxiety as part of the study could have clarified these aspects. There were no reported conflicts of interest. The letter encourages further exploration of the psychological impacts of respiratory training on asthma management, pointing to a potential combined effect of physiological and psychological benefits.

Keywords

respiratory training

asthma management

capnometry-assisted respiratory training

anxiety

biofeedback

lung function

airway hyperreactivity

psychological factors

asthma symptoms

CHEST journal