International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article To Study the Effect of Buteyko Breathing Technique in Patients with Obstructive Airway Disease Rachna. D. Arora, Visalakshi. H. Subramanian PT School & Center, T.N.M.C. & B.Y.L. Nair Ch Hospital, Mumbai, India Corresponding Author: Rachna. D. Arora ABSTRACT Background: The Buteyko Method, a breathing technique, has been found to be effective in individuals with asthma and a range of other conditions. In the present study, an attempt was made to compare the effect of Buteyko Breathing Technique in patients with obstructive airway disease. Aim: To study the effect of Buteyko Breathing Technique in Obstructive Airway Disease Objectives: To assess the pre and post changes on outcome measures in control group & in experimental group respectively. To compare the effect on outcome measures in both the groups. Methodology: The subjects were screened to select 28 patients. The Control group received conventional Physiotherapy and Experimental group received Conventional Physiotherapy with Buteyko breathing technique. The treatment was given thrice a week for both the groups for 4 weeks. All the outcome measures i.e. Single Breath Count Test (SBCT), Resting Respiratory Rate (Resting RR) , Breath Holding Time (BHT), Percent Predicted Value of 6 Minute Walk Distance (%PV of 6MWD) & Peak Expiratory Flow Rate (PEFR)were recorded at baseline and post treatment in both the groups. Result: In control group, there was statistically significant increase in SBCT (p=0.001), BHT (p=0.000), PEFR (p=0.000), % PV 6MWD (P=0.006), reduction Resting RR (p=0.000) & Resting HR% (p=0.275). In Experimental Group, there was a statistically significant increase in SBCT (p=0.000), BHT (p=0.001), % PV 6MWD (p=0.001), PEFR (p=0.008), reduction Resting RR (p=0.000) & Resting HR% (p=0.000). On comparing the differences between both groups, statistically significant increase was found in BHT (p= 0.002), SBCT (p= 0.014), % PV 6MWD (p=0.097), PEFR (p=0.098) & significant reduction was found in Resting HR% (p=0.000) & Resting RR (p=0.005). Conclusion: Buteyko Breathing was effective in improving breathing control, breath holding and reducing the work of breathing in subjects with Obstructive Airway disease. Keywords: Obstructive Airway Disease, Bohr Effect, Buteyko Breathing Technique INTRODUCTION (V.K. VIjayan, 2013). It is generally Obstructive lung disease is a characterized by inflamed and easily category of respiratory disease characterized collapsible airways, obstruction to airflow, by airway obstruction. Many obstructive problems exhaling and frequent medical diseases of the lung result from narrowing clinic visits and hospitalizations. Types of of the smaller bronchi and larger obstructive lung diseases are asthma, bronchioles, often because of excessive COPD, bronchiectasis, obliterative contraction of the smooth muscle itself International Journal of Health Sciences & Research (www.ijhsr.org) 50 Vol.9; Issue: 3; March 2019 Rachna. D. Arora et.al. To Study the Effect of Buteyko Breathing Technique in Patients with Obstructive Airway Disease bronchiolitis (OB) (Shilpa P. Karande er al., through subsequent depletion of 2016). bicarbonate, pH disturbance, and reduced According to World Health tissue oxygen levels (Folgering, 1999; Organization estimates, 65 million people Gardner, 1995; Hardonk& Beumer, 1979). have moderate to severe COPD. More than However, Buteyko and his Russian 3 million people died of COPD in 2005 colleagues elaborated on the conventionally corresponding to 5% of all deaths globally accepted effects of hypocapnea. They and it is estimated to be the third leading argued that depletion of carbon dioxide cause of death by 2030.Airflow limitation is affected the core processes of energy usually progressive and is associated with production (Krebs cycle within the cell), an abnormal inflammatory response of vital chemical reactions requiring carbon lungs to noxious particles or gases. Patient compounds and other key homeostatic complains primarily of incapacitating processes. In Buteyko’s view, because dyspnoea and reduced Functional Capacity, carbon dioxide was so vital, the body leading to hyperventilation (Diagnosis and created a series of defence mechanisms to Assessment, updated 2013 & Christine retain carbon dioxide, including constriction milelsons, 2008). of airways and blood vessels, and gave rise The Buteyko Method, one of many to conditions such as asthma and health-promoting breathing techniques to hypertension (Buteyko, 1990; Stark & originate from Russia, made its way to Stark, 2002). According to the physiological Australia, Europe, and the United States in response of body, blood uses carbon dioxide the 1990s. The technique has been found to to improve oxygen distribution to cells (The be effective in individuals with asthma and Bohr Effect) (Bohr et al., 1997 & Olson JS a range of other conditions from anxiety to et al., 1972) sleep apnea (Ameisan, 1997; Stalmatski, In case of hyperventilation there is a 1999; Stark & Stark, 2002). The method is proportionate exhalation of carbon dioxide named after its originator, Dr. Konstantin as to the inhalation of oxygen, leading to a Pavlovich Buteyko, who claimed that his decline in the net amount of carbon dioxide program of breathing retraining could cure a in blood. Thus, there is less oxygen supply large number of the chronic ailments leading to weak health and chronic disease. affecting modern society. His early work in the 1960s centered on the use of breathing retraining for diseases of the circulatory system and the respiratory system. Over time, doctors working in Buteyko’s clinics in Moscow, Siberia, and the Ukraine also THE BOHR EFFECT claimed success in treating diabetes, psychological disorders, immune and metabolic disorders, and reproductive disorders. Buteyko’s method rests very much on his carbon dioxide theory of disease, and the primary aim of the breathing techniques is to raise carbon dioxide levels. Buteyko Figure 1: Illustration of Bohr Effect. claimed chronic hyperventilation to be a widespread, important, and generally METHODOLOGY unrecognized destabilizer of physiological Research Design: Experimental, parallel systems and psychological states. It is group, prospective study known that low carbon dioxide affects many Sample Population: Patients with moderate systems of the body either directly or to severe airflow limitation. International Journal of Health Sciences & Research (www.ijhsr.org) 51 Vol.9; Issue: 3; March 2019 Rachna. D. Arora et.al. To Study the Effect of Buteyko Breathing Technique in Patients with Obstructive Airway Disease Type Of Sampling: Purposive sampling. Resting Respiratory Rate (Resting Patients were randomly assigned to RR) experimental & control group with the help The number of breaths taken in a single of block randomization using block of four minute at rest was recorded against the Source Of Sampling: Chest medicine OPD sound of a metronome of tertiary health care hospital Breath Holding Time (BHT) Place of Study: Physiotherapy OPD The time for which a single breath can be Duration of Study: 18 Months (May 2016 held after complete exhalation was TO October 2017) recorded. Sample size: Percentage Predicted Value of 6 Minute The sample size was calculated using the walk distance (% PV of 6MWD) : previous study titled “Effect of singing a) 6MWD classes on quality of life and functional b) Reference equation was used to calculate capacity in subjects with mild to moderate PV of 6 MWD (Ramanathan Palaniappan, airflow limitation- A prospective 2014) experimental study”, the mean difference Male = 561.022 - (2.507 × age (yr)) + 1.505 and SD of primary outcome measure (Single × weight (kg)) - (0.055 × height (cm)) Breath Count Test) in intervention group Indian female = -30.425-(0.809×age(yr)) - was 4±1.7 with a large effect size. (2.074×weight(kg)) + (4.235×height(cm)) Conventional Physiotherapy showed no c) Percentage PV of 6MWD 6MWD change in Single Breath Count Test. % PV OF 6MWD= × 100 Considering that Buteyko Technique will Predicted value produce similar effect, minimal clinical Peak Expiratory Flow Rate effect size is calculated as (PEFR) In the upright sitting position the subjects 2 2 2 were given the cartoon mouth piece that was N = 2(Zα + Z1-β) σ / d The Sample size came as 28 including the adjusted to the mouth piece of the peak samples for dropouts. expiratory flow meter. The pointer is So, the Sample size for each group (n) = N/2 switched to zero. Instruction is given to the = 28/2 = 14 subjects to hold the peak flow meter level (horizontally) and to keep their fingers away from the pointer. The subjects are asked to Inclusion criteria: . Patients with FEV1/FVC ratio < 0.7 take a deep breath and close the lips firmly around the cartoon mouthpiece & blow as . 30% FEV1 < 79% of predicted. hard as they can as if blowing out candles. Resting Respiratory Rate ≥ 24. The reading over the peak flow meter is . Patients willing to participate. measured and the pointer is switched back to zero. The procedure is repeated for 3 Exclusion criteria: times and highest reading is recorded. Admission in any hospital due to acute exacerbation in the last 4 weeks PROCEDURE . Myocardial complications like acute The approval for the study was Hypertension & recent History of any sought from the local institution ethics cardiac disease committee. Block randomization method . Musculoskeletal pain using block of four was used for random allocation of patients to experimental OUTCOME MEASURES: (Buteyko and conventional) and control Single Breath Count Test (SBC) group (conventional). It was done prior to Score was taken as the number of count commencement of the study by an spoken in 1 breath independent person and sealed in separate, opaque, numbered envelops. International Journal of Health Sciences & Research (www.ijhsr.org) 52 Vol.9; Issue: 3; March 2019 Rachna. D. Arora et.al. To Study the Effect of Buteyko Breathing Technique in Patients with Obstructive Airway Disease 40 patients with airflow limitation Breathing control exercise coming to Chest Medicine OPD were screened out of which 28 were recruited.