Speech-guided breathing retraining in asthma: a randomised controlled crossover trial in real-life outpatient settings

Dietrich Von Bonin,Ursula Wolf,Oliver Avianus,Jörg Salomon,Sabine D Klein,Christian Grah,Eva Streit,Jana Würker

doi:10.1186/s13063-018-2727-z

Abstract

BackgroundBreathing retraining techniques have received increased attention in the management of asthma, because there is growing evidence of the usefulness of such methods in improving quality of life, reducing symptoms and reducing bronchodilator use. Our study investigated the effect of anthroposophic therapeutic speech (ATS), which uses sounds and syllabic rhythm to improve articulation, breathing and cardiorespiratory interaction, in patients with asthma in a real-life outpatient setting.MethodsIn a randomised controlled crossover trial, patients with asthma in three centres in Switzerland and Germany were randomised to either receive 11 ATS sessions or to wait. Subsequently, patients changed either to wait or to receive ATS. Primary outcomes were changes from the beginning to the end of each phase in the Asthma Quality of Life Questionnaire (AQLQ) and spirometry parameters. Secondary outcomes were changes in inhaled glucocorticoids, the Asthma Control Test (ACT), peak flow and asthma exacerbations.ResultsAltogether, 63 patients were randomised, of which 56 were enrolled and 49 completed the study. Statistically significant differences between the ATS groups and waiting control groups were found for the overall AQLQ score (d = 0.86, p = 0.001) and the domain scores for symptoms, activity limitation and emotional function as well as ACT score (d = 0.53, p = 0.048). No significant differences were observed in spirometry parameters, inhaled glucocorticoids, peak flow and days without asthma exacerbation per week. No serious adverse events occurred during ATS sessions.ConclusionsATS significantly improves asthma control and quality of life in patients with asthma. Whether ATS may improve lung function remains to be shown.Trial registrationClinicalTrials.gov NCT02501824. Retrospectively registered on 8 July 2015.

Highlights

Breathing retraining techniques have received increased attention in the management of asthma, because there is growing evidence of the usefulness of such methods in improving quality of life, reducing symptoms and reducing bronchodilator use
The most consistent results favouring the intervention group have been found for quality of life (e.g. SF-36) and asthma related quality of life (e.g. Asthma Quality of Life Questionnaire, AQLQ) as well as in Asthma Control Test (ACT) scores [4]
The AQLQ score increased by 0.63 points after anthroposophic therapeutic speech (ATS) compared to 0.07 points after waiting, resulting in a 0.56-point difference between the two phases

Summary

Introduction

Breathing retraining techniques have received increased attention in the management of asthma, because there is growing evidence of the usefulness of such methods in improving quality of life, reducing symptoms and reducing bronchodilator use. Our study investigated the effect of anthroposophic therapeutic speech (ATS), which uses sounds and syllabic rhythm to improve articulation, breathing and cardiorespiratory interaction, in patients with asthma in a real-life outpatient setting. Breathing retraining techniques have received increased attention in the management of asthma, because there is growing evidence for the safety and usefulness of such methods. An innovative recent study investigating physiotherapy-based breathing retraining demonstrated significant effects for end tidal CO2, breathing rate and predicted forced expiratory volume for the experimental group versus no additional treatment. There is insufficient evidence for the efficacy of breathing methods in the context of yoga, biofeedback and respiratory muscle training [2, 4, 6, 7]

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Conclusion