Breathing exercises for asthma – Importance of addressing biochemical, biomechanical and psycho-physiological dimensions of dysfunctional breathing

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Background: Several systematic reviews have concluded that breathing retraining (BRT) is beneficial for patients with asthma. BT protocols vary in their therapeutic aims, and techniques used although most target either biochemical, biomechanical or psychophysiolgical dimensions of dysfunctional breathing (DB). The relative importance of each of these three dimensions of DB for breathing retraining is still unclear. This review looks at evidence for the importance of each of these dimensions of breathing dysfunction for breathing retraining protocols for asthma. Aims: This study reviews relevant literature with the aim of determining (1) the rationale for targeting biochemical, biomechanical and psychophysiological dimensions of DB in asthma, (2) the response of each of these dimensions of DB to specific BRT protocols and 3. evidence suggesting ideal BRT protocols. Methods: Data bases Medline, Scopus Proquest, Cinhahl and the Cochran Library were searched for articles discussing dysfunctional breathing, breathing therapy, breathing training and asthma. Additional relevant articles were sourced from reference lists. Discussion: Breathing retraining for asthma is likely to be most successful when it is integrative and when all the key dimensions of breathing dysfunction are taken into account. Ideal breathing retraining protocols need to be comprehensive and sufficiently intensive to produce measurable improvements in biochemical, biomechanical and psycho physiological dimensions of health. Results:There is evidence for the importance of all 3 dimensions of DB in asthma. Hyperventilation, breathing pattern disorders and psychophysiological factors such as conditioned behaviors, sense of congruence and perceived control contributes to pathophysiology, symptoms and lower perceived health. Breathing retraining protocols can beneficially impact on many of these factors. However, it appears that the best results are achieved when BRT is sufficiently intensive and appropriately targeted.