Clinical studies on Buteyko/breathing re-training
A large and increasing number of clinical studies and reviews have confirmed the efficacy of breathing re-education (re-training), and in particular, the Buteyko Breathing Method. The clinical studies are international in nature in that they have been carried out in several countries, including the United States, Australia, Canada, New Zealand, United Kingdom, Ireland, Egypt, India, Brazil, the Philippines, and of course Russia where the Buteyko method was developed.
A plethora of research studies on the Buteyko Method, involving a variety of medical conditions, have been carried out in Russia and consequently have been published in Russian. For readers who can read Russian, a list of 73 of these study papers may be accessed by clicking HERE. 27 of these study papers are downloadable.
In the Western world, the growing accumulation of research evidence has resulted in significant mentions concerning breathing re-education (breathing re-training) and in particular, the Buteyko Method, in documents produced by 3 high profile medical/healthcare organisations i.e. the British Thoracic Society/Scottish Intercollegiate Guidelines Network (SIGN), the Agency for Healthcare Research and Quality (AHRQ) in the United States, and the Global Initiative for Asthma (GINA). Outside of Russia, the majority of research studies on the Buteyko Method have focused on its effectiveness in the control of asthma.
British Thoracic Society/Scottish Intercollegiate Guidelines Network (SIGN)
The current ‘British guideline on the management of asthma’ (SIGN 153) published in September 2016 states:
“Behavioural programmes centred on breathing exercises and dysfunctional breathing reduction techniques (including physiotherapist-delivered breathing programmes such as the Papworth method, and the Buteyko method) can improve asthma symptoms, quality of life and reduce bronchodilator requirement in adults with asthma, although have little effect on lung function. These techniques involve instruction by a trained therapist in exercises to reduce respiratory rate, minute volume and to promote nasal, diaphragmatic breathing. Trials that include more than five hours of intervention appeared more likely to be effective. They can help patient’s experience of their condition and quality of life although do not affect lung function or airways inflammation. They should ideally be provided as part of integrated medical care. There is currently insufficient evidence relating to other breathing exercise methods, such as yoga breathing.”
This guideline gives behavioural programmes such as the Buteyko Method and the Papworth Method an ‘A’ recommendation. The grade of recommendation relates to the strength of the evidence on which the recommendation is based. An ‘A’ grade is the highest of 4 grades of recommendation. You may access the guideline here.
Although the quotation above, from the guideline, states that programmes such as the Buteyko Method and the Papworth Method “have little effect on lung function”, four fairly recent studies in the list at the bottom of this page, have demonstrated that the Buteyko Method did have a significant effect in improving lung function. These studies were:
Ravinder et al (2012), Prasanna et al (2015), Hassan et al (2012), and Elnaggara and Shanty (2016). Another study, awaiting publication, that was carried out by researchers at Universidade Federal do Rio Grande do Norte in Brazil, showed that the Buteyko method led to significant improvements in lung function in children with asthma.
The fact that the Papworth Method is given an ‘A’ recommendation is somewhat surprising in that only one clinical trial has been published on the Papworth Method (Holloway & West, 2007 – see list below) and its conclusions were rather cautious. These conclusions were:
“The Papworth Method appears to ameliorate respiratory symptoms, dysfunctional breathing and adverse mood compared with usual care. Further controlled trials are warranted to confirm this finding, assess the effect in other patient groups and determine whether there is some effect on objective measures of respiratory function.”
In addition, although the Papworth Method was developed in the UK, there is no professional organisation in the UK for people who teach the Papworth Method. The main breathing re-education professional organisation in the UK is the Buteyko Breathing Association (BBA). The majority of BBA’s members are Chartered Physiotherapists.
Agency for Healthcare Research and Quality (AHRQ) United States
In 2012, the Agency for Healthcare Research and Quality (AHRQ) in the United States published a comprehensive review of 22 studies of breathing techniques and concluded that the Buteyko breathing technique achieves “medium to large improvements in asthma symptoms and reductions in reliever medications.”
The review also noted that:
“Available evidence suggests that selected intensive behavioural approaches that include breathing retraining exercises may improve asthma symptoms and reduce reliever medication use in motivated adults with poorly controlled asthma.”
You may access the AHRQ report via the link below:
Click here to access the AHRQ report.
Global Initiative for Asthma (GINA)
In May 2014, the Global Initiative for Asthma (GINA) published a report titled ‘Global Strategy for Asthma Management and Prevention 2014 (Revision)’. On page 40 of that report, GINA assigned ‘Breathing Techniques’ (Buteyko and Papworth) an evidence level rating of ‘A’. For an evidence level ‘A’, the sources of evidence are: (a) randomised controlled trials (RCTs) and meta-analyses, and (b) a rich body of data. GINA defined evidence level ‘A’ as:
“Evidence is from end-points of well designed RCTs or meta-analyses that provide a consistent form of findings in the population for which the recommendation is made. Category ‘A’ requires substantial numbers of studies involving substantial numbers of participants.”
Since their May 2015 report, GINA has used the very broad term “breathing exercises” and has not differentiated between the strength of evidence of different types or techniques of “breathing exercises”.
Clinical studies, reviews and articles
The vast majority of the clinical studies that have been carried out on the efficacy of breathing re-education have investigated the Buteyko Method (also known as the Buteyko Breathing Technique). The fact that such a large number of studies have been conducted is quite remarkable given that the Buteyko Method is not a drug treatment and Buteyko Method clinical studies are not funded by pharmaceutical companies.
A total of 16 of the studies listed at the bottom of this page (including 3 of the 4 completed, but yet to be published ones), were randomised controlled trials (RCTs). Of these 16 studies, 15 were on the Buteyko Method/Buteyko Breathing Technique and 1 was on the Papworth Method. A number of the Buteyko studies listed were not RCTs. However, Professor Sir Michael Rawlins, Chair of the Medicines and Healthcare Products Regulatory Agency (UK) has argued that a new approach is needed to analyse clinical evidence. According to Rawlins, randomised controlled trials (RCTs), long regarded at the ‘gold standard’ of evidence, have been put on an undeserved pedestal. In his view, their appearance at the top of “hierarchies” of evidence is inappropriate; and hierarchies, themselves, are illusory tools for assessing evidence. In his opinion, they should be replaced by a diversity of approaches that involve analysing the totality of the evidence-base.
Before listing the pertinent studies, reviews, and articles, quotations from some of these studies are now provided.
Quotations from study papers
“Even though no study has indicated exactly why Buteyko is so effective at controlling asthma, if a drug could show these results, then it is likely that it would be widely used in asthma control.”
(Hassan et al, 2012)
“This study demonstrated that the BBT (Buteyko Breathing Technique) and the TLPT (thoracic lymphatic pump technique) can effectively improve the total serum IgE, the ventilatory function in terms of FVC, FEV1, PEF, FEF25–75% and FEV1/FVC, and C-ACT scores in children with bronchial asthma. However, Buteyko breathing was more significantly effective compared with the TLPT.”
“The results of this study revealed a significant decrease in asthma daily symptoms, a significant improvement in PEFR, and Control pause test in group A (Buteyko Breathing Technique (BBT)), while there was insignificant change in group B (no BBT, just their prescribed medications).”
(Hassan et al, 2012)
“There was an increase in peak expiratory flow rate (PEFR) with 51% in group A (Buteyko Breathing Technique) and an increase of 3.6% in group B (no BBT, just their prescribed medications).”
(Hassan et al, 2012)
“There was a statistically significant improvement of daily Asthma Control and PEFR (peak expiratory flow rate) in the group who did the Buteyko breathing exercise for 2 months over the control group”.
(Prasanna et al, 2015)
“Group – Buteyko Breathing Technique (BBT) group-A showed significant improvement in the FEV1 and PEFR, and a significant decrease in the levels of dyspnea, where PLBE with DE Group – B showed no significant changes in any of the three measurements.”
(Ravinder et al, 2012)
“Buteyko Breathing Technique has given a logical treatment for reversing hyperventilation disorders which is responsible for recurrent asthmatic attack, so it can be concluded that Buteyko Breathing exercise when done regularly and properly can stop or reverse the decline in the lung function and reduce dyspnea in asthmatic patients.”
(Ravinder et al, 2012)
“In addition to reduction in medication there were improvements in measures of quality of life scores, symptom scores, and also reduced number of courses of oral steroids.”
(McHugh et al, 2006)
“In conclusion, we found that those practising the Buteyko breathing technique (BBT) reduced hyperventilation and their use of beta2-agonists. A trend toward reduced inhaled steroid use and better quality of life was observed in these patients without changes in objective measures of airway calibre.”
(Bowler et al, 1998)
“This randomised clinical trial showed that both the Buteyko and control (physiotherapy) interventions produced a favourable outcome in that over 70% of the participants enjoyed asthma control 6 months after completing the intervention. In addition, the subjects in the Buteyko group were able to significantly reduce their daily doses of inhaled corticosteroid.’”
Cowie et al (2008)
List of clinical studies and reviews
In the list of studies, reviews, and articles below, where possible, a link to the study/review/article is provided.
Adelola OA. et al. 2013, Role of Buteyko Breathing Technique in asthmatics with nasal symptoms, Clinical Otolaryngology April; 38(2):190-191
Afle GM and Grover SK To study the effectiveness of Buteyko Breathing Technique versus diaphragmatic breathing in asthmatics I J Physiother, Vol 1 (3) 116-119, August 2014
Arden-Close E et al. Patients’ experiences of breathing re-training for asthma: a qualitative process analysis of participants in the intervention arms of the BREATHE trial, Primary Care Respiratory Medicine, 27, Article number: 56 (2017)
Austin G. et al. 2009. Buteyko Breathing Technique Reduces Hyperventilation Induced Hypocapnia and Dyspnoea after Exercise in Asthma, Pulmonary Rehabilitation B58 A3409. Abstract
Birch M (2012) Clinical Review: Sleep Apnoea – A survey of breathing retraining, Australian Nursing Journal, October, Vol 20, No. 4, pp. 40-41,
Bruton A et al. Physiotherapy breathing retraining for asthma: a randomised controlled trial, THE LANCET Respiratory Medicine, Vol 6 January 2018
Bowler SD. et al. (1998) Buteyko breathing techniques in asthma: a blinded randomized controlled trial. MJA, Dec 7-21; 169 (11-12). Abstract
Burges J et al. (2011) Systematic review of the effectiveness of breathing retraining in asthma management, Expert Rev. Respir. Med. 5(6), 789–807
Chavda MV and Shah HM. (2016) To compare the efficacy of pursed lip breathing and Buteyko breathing technique to reduce the symptoms of exercise induced asthma in obese children, International Journal of Current Research, Vol. 8, Issue 07, pp. 35058-35064
Cooper S. et al (2003) Effect of Two Breathing Exercises (Buteyko and Pranayama) in asthma: A Randomised Controlled Trial. Thorax, Vol. 58, No. 8, pp. 649-659 Thorax
Courtney R. Dysfunctional Breathing: Its Parameters, Measurement and Relevance: A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy, School of Health Sciences, Science and Technology Portfolio, RMIT University, February 2011
Cowie RL et al. 2008 A randomized controlled trial of the Buteyko technique as an adjunct to conventional management of asthma, Respiratory Medicine; May; 102(5):726-32. Full text
Elnaggara RK and Shendy MA (2016) Efficacy of non-invasive respiratory techniques in the treatment of children with bronchial asthma: a randomized controlled trial, Bulletin of Faculty of Physical Therapy, 21:1–10
Hassan ZM. et al. (2012) Effect of Buteyko breathing technique on patients with bronchial asthma, Egyptian Journal of Chest Diseases and Tuberculosis, 61, 235–241. Full text
Holloway, EA and West RJ (2007) Integrated breathing and relaxation training (the Papworth method) for adults with asthma in primary care: a randomised controlled trial, Thorax, Dec; 62 (12): 1039-1042
Huidrom K. et al, 2016, Effectiveness of Buteyko breathing technique on respiratory physiological parameters among patients with bronchial asthma, International Journal of Recent Scientific Research, Vol. 7, Issue 5, pp. 11328-11331
Lina, RC. et al. (2014) Effectiveness of Buteyko Method in Asthma Control and Quality of Life of School-age Children, academia.edu Full text
Mendonca KMPP et al (2017) Buteyko Method for children with asthma, American Journal of Respiratory and Critical Care Medicine, 2017; 195: A2203
Mendonca KMPP et al (2017) Buteyko Method for children with asthma and mouth breathing: a randomised controlled trial, American Journal of Respiratory and Critical Care Medicine, 2017; 195: A2204
McGowan, J. 2003. Health Education: Does the Buteyko Institute Method make a difference? Thorax Vol 58, Suppl III, page 28, December.
McHugh P. et al (2003) Buteyko Breathing Technique for Asthma: An Effective Intervention. Vol. 116, No. 1187 New Zealand Medical Journal
McHugh P et al (2006) Buteyko breathing technique and asthma in children: a case series, New Zealand Journal of Medicine, Vol. 119. No. 1234
O’Connor E et al. Breathing Exercises and/or Retraining Techniques in the Treatment of Asthma: Comparative Effectiveness, Comparative Effectiveness Reviews, No. 71, Agency for Healthcare Research and Quality (US) 2012
Opat AJ et al. (2000) A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video Journal Asthma, 37(7):557-64. Abstract
Prasanna KB. et al 2015 Effect of Buteyko breathing exercise in newly diagnosed asthmatic patients International Journal of Medicine and Public Health; Jan-Mar, Vol 5, Issue 1
Prem V. et al (2013) Comparison of the Effects of Buteyko and Pranayama Breathing Techniques on Quality of Life in Patients with Asthma- A Randomised Controlled Trial. Clinical Rehabilitation Vol. 27, No.2, pp.133-141
Rai RH et al. A Study on Immediate Effect of Buteyko Breathing Technique on Cardio-Respiratory Parameters in Young Adults, International Journal of Health Sciences and Research, Vol.8; Issue: 7; July 2018
Ravinder N. et al. 2012, A Study of effects of Buteyko Breathing Technique on Asthmatic Patients. Indian Journal of Physiotherapy and Occupational Therapy – An International Journal 6(2), 224 228
Schmid T et al. Buteyko technique (BT) as an adjunct in pulmonary rehabilitation (PR) in patients with asthma and dysfunctional breathing – First results of an ongoing prospective controlled study, European Respiratory Journal 2012 40: P3527
Slader CA. et al (2006) Double Blind Randomised Controlled Trial of Two Different Breathing Techniques in the Management of Asthma. Thorax Vol. 61, pp. 651-656.
Thomas M and Bruton A (2014) Breathing exercises for asthma, Breathe, December 1, Vol. 10, No.4 pp 312-322
Villareal, M C et al. (2014) Effect of Buteyko Method on Asthma Control and Quality of Life of Filipino Adults with Bronchial Asthma, Journal of Macro Trends in Health and Medicine, Vol 2, Issue 1 Full text