Comparative Effectiveness Review Number 71 Breathing Exercises and/or Retraining Techniques in the Treatment of Asthma: Comparative Effectiveness Comparative Effectiveness Review Number 71 Breathing Exercises and/or Retraining Techniques in the Treatment of Asthma: Comparative Effectiveness Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10057-I Prepared by: Oregon Evidence-based Practice Center Kaiser Permanente Center for Health Research Portland, OR Investigators: Elizabeth O’Connor, Ph.D. Carrie D. Patnode, Ph.D., M.P.H. Brittany U. Burda, M.P.H. David I. Buckley, M.D., M.P.H. Evelyn P. Whitlock, M.D., M.P.H. AHRQ Publication No. 12-EHC092-EF September 2012 This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10057-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders. Persons using assistive technology may not be able to fully access information in the report. For assistance contact [email protected]. None of the investigators have any affiliations or financial involvement that conflict with the material presented in this report. Suggested citation: O’Connor E, Patnode CD, Burda BU, Buckley DI, Whitlock EP. Breathing Exercises and/or Retraining Techniques in the Treatment of Asthma: Comparative Effectiveness. Comparative Effectiveness Review No. 71. (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No. 12-EHC092-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to organize knowledge and make it available to inform decisions about health care. As part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Congress directed AHRQ to conduct and support research on the comparative outcomes, clinical effectiveness, and appropriateness of pharmaceuticals, devices, and health care services to meet the needs of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). AHRQ has an established network of Evidence-based Practice Centers (EPCs) that produce Evidence Reports/Technology Assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care. The EPCs now lend their expertise to the Effective Health Care Program by conducting Comparative Effectiveness Reviews (CERs) of medications, devices, and other relevant interventions, including strategies for how these items and services can best be organized, managed, and delivered. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews are useful because they define the strengths and limits of the evidence, clarifying whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about systematic reviews, see the Web site http://www.effectivehealthcare.ahrq.gov/reference/purpose.cfm. AHRQ expects that CERs will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. In addition, AHRQ is committed to presenting information in different formats so consumers who make decisions about their own and their family’s health can benefit from the evidence. Transparency and stakeholder input from are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input. CERs will be updated regularly. We welcome comments about this CER. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Carolyn M. Clancy, M.D. Stephanie Chang, M.D., M.P.H. Director, Agency for Healthcare Research Director, Evidence-based Practice Program and Quality Center for Outcomes and Evidence Agency for Healthcare Research and Quality Jean Slutsky, P.A., M.S.P.H. Director, Center for Outcomes and Evidence Christine Chang, M.D., M.P.H. Agency for Healthcare Research and Quality Task Order Officer Center for Outcomes and Evidence Agency for Healthcare Research and Quality iii Acknowledgments The authors gratefully acknowledge the following individuals for their contributions to this project: Daphne Plaut, M.L.S., Kevin Lutz, M.F.A., Christopher S. Peterson, and Sabrina Kosok, M.P.H.. In addition, we would like to thank all individuals who provided comments on our report. Key Informants Key Informants are the end users of research, including patients and caregivers, practicing clinicians, relevant professional and consumer organizations, purchasers of health care, and others with experience in making health care decisions. Within the EPC program, the Key Informant role is to provide input into identifying the Key Questions for research that will inform healthcare decisions. The EPC solicits input from Key Informants when developing questions for a systematic review or when identifying high-priority research gaps and future research needs. Key Informants are not involved in analyzing the evidence or writing the report and have not reviewed the report, except as given the opportunity to do so through the public review mechanism. Key Informants must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their role as end users, individuals are invited to serve as Key Informants, and those who present with potential conflicts may be retained. The Task Order Officer and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. Chris Coniaris, R.Ph., CSPI David Jacoby, M.D., Ph.D. Certified Yoga Instructor Chief, Division of Pulmonary and Critical Amrita Sanctuary for Yoga Care Medicine Portland, OR Oregon Health and Science University Portland, OR Susanna Czeranko, N.D. Licensed Naturopathic Physician and Sarahjoy Marsh, M.A. Instructor Certified Yoga Instructor National College of Natural Medicine The Sanctuary, A Center for Yoga, Dharma, Portland, OR and Health Arts Portland, OR Sandra Fusco-Walker Director, Patient Advocacy Nancy Sandler Allergy and Asthma Network Mothers of President, Allergy and Asthma Network Asthmatics Mothers of Asthmatics Fairfax, VA Fairfax, VA Elizabeth Holloway, Ph.D. Chartered Physiotherapist, Department of Epidemiology and Public Health University College London London, England iv Technical Expert Panel Technical Experts comprise a multidisciplinary group of clinical, content, and methodologic experts who provide input in defining populations, interventions, comparisons, or outcomes as well as identifying particular studies or databases to search. They are selected to provide broad expertise and perspective specific to the topic under development. Divergent and conflicted opinions are common and perceived as health scientific discourse that results in thoughtful, relevant systematic review. Therefore, study questions, design, and/or methodological approaches do not necessary represent the views of the individual technical or content experts. Technical Experts provide information to the EPC to identify literature search strategies and recommend approaches to specific issues as requested by the EPC. Technical Experts do not do analysis of any kind, do not contribute to the writing of the report, and have not reviewed the report, except as given