The Buteyko method or Buteyko Breathing Technique is a form of complementary or alternative physical therapy that proposes chronic "breathing retraining" as a treatment for asthma as well as other conditions. The method takes its name from the late Ukrainian doctor Konstantin Pavlovich Buteyko (Ukrainian: Бутейко), who first formulated its principles during the 1950s. This method is based on the assumption that numerous medical conditions, including asthma, are caused by chronically increased respiratory rate (hyperventilation). However, this theory is not widely supported in the medical community due to the lack of evidence supporting either the theory behind the method or that it works in practice. This method purportedly retrains the breathing pattern through chronic repetitive breathing exercises to correct for the hyperventilation, which, according to the method's proponents, will therefore cure asthma as well as any other conditions purportedly caused by hyperventilation. At the core of the Buteyko method is a series of reduced-breathing exercises that focus on nasal-breathing, breath-holding and relaxation.
Research into the use of the Buteyko method has focused almost exclusively on the treatment of asthma, and have had methodological problems. Studies have not found objective measures to support its use such as improvement in lung function, though there are results showing it could possibly improve subjective measures such as asthma symptoms and quality of life. Reviews of this literature have generally concluded that the evidence is not strong enough to recommend its use for the treatment of asthma based on the available evidence. Those exceptions that have recommended considering its use have noted it should be used with traditional therapies (and not in place of mainstream treatment) and is unlikely to affect or cure the underlying cause of asthma. There is no support for the use of the Buteyko method in other diseases, such as diabetes mellitus or any of the over 150 diseases supporters of this method claim to treat.
Contents |
The Buteyko method was originally developed in the 1950s by physiologist Konstantin Buteyko in Russia.[1] The first official study into the effectiveness of the Buteyko Method on asthma was undertaken in 1968 at the Leningrad Institute of Pulmonology. The second, held at the First Moscow Institute of Pediatric Diseases in April 1980, eventually led to the head of the ministry of health to issue an order (No 591) for the implementation of the Buteyko method in the treatment of bronchial asthma.[2] Later, this method was introduced to Australia, New Zealand, Britain and the United States, where it has received increasing exposure.[1] Anecdotal reports of life-changing improvements attributed to the Buteyko method abound on the internet and in books.[3]
The Buteyko method is just one of a number of so-called breathing retraining methods in use for treating lung diseases, including conventional techniques such as physiotherapist led breathing exercises as well alternative medicine techniques like Buteyko such as yoga.[4]
The Buteyko method is based on the concept that "hidden" or undiagnosed hyperventilation is the underlying cause of numerous medical conditions, including asthma. It is known that hyperventilation can lead to low carbon dioxide levels in the blood (or hypocapnea), which can subsequently lead to disturbances of the acid-base balance in the blood and lower tissue oxygen levels. Advocates of this method believe that the effects of chronic hyperventilation would have even wider effects than is commonly accepted.[3] These effects include widespread spasms of the muscle in the airways (bronchospasm),[5] disturbance of cell energy production via the Krebs cycle, as well as disturbance of numerous vital homeostatic chemical reactions in the body. The Buteyko method is a purported method of "retraining" the body's breathing pattern to correct for the presumed chronic hyperventilation and hypocapnea, and thereby cure the body of these medical problems.[3]
The Buteyko method is not widely supported in the medical community, in part due to the fact that research has not supported this theory that hyperventilation and hypocapnea causes disease,[3] with one review noting that there is no convincing evidence to indicate that trying to change asthmatic's carbon dioxide level is either "desirable or achievable."[5] Studies that have looked for evidence to corroborate this theory, such as looking at the carbon dioxide levels in practitioners of Buteyko, have not found this evidence, leading some to propose alternate theoretical pathways for this method to improve symptoms.[3]
Although variations exist among teachers of the technique in different countries, the main objective is "normalization" of breathing and the three core principles of Buteyko remain the same: nasal breathing, reduced breathing and relaxation.
The Buteyko method emphasizes the importance of nasal breathing, which protects the airways by humidifying, warming, and cleaning the air entering the lungs. A majority of asthmatics have problems sleeping at night, and this is thought to be linked with poor posture or unconscious mouth-breathing. By keeping the nose clear and encouraging nasal breathing during the day, night-time symptoms can also improve. Other methods of encouraging nasal breathing are full-face CPAP machines - commonly used to treat sleep apnea - or using a jaw-strap or paper-tape to keep the mouth closed during the night. Strictly nasal breathing during physical exercise is another key element of the Buteyko method.
The core Buteyko exercises involve breath control; consciously reducing either breathing rate or breathing volume. Many teachers refer to Buteyko as 'breathing retraining' and compare the method to learning to ride a bicycle. Once time has been spent practicing, the techniques become instinctive and the exercises are gradually phased out as the condition improves.
Rather than using traditional peak flow measurements to monitor the condition of asthmatics, Buteyko uses a measurement called the Control Pause (CP), defined as the amount of time that an individual can comfortably hold breath after a normal exhalation. According to Buteyko teachers, with regular Buteyko reduced-breathing practice, asthmatics are expected to find that their CP gradually increases and their pulse rate decreases in parallel decreased asthma symptoms.
Dealing with asthma attacks is an important factor of Buteyko practice. The first feeling of an asthma attack is unsettling and can result in a short period of rapid breathing. By controlling this initial over-breathing phase, asthmatics can prevent a "vicious circle of over-breathing" from developing and spiraling into an asthma attack. This means that asthma attacks may be averted simply by breathing less.
Advocates of the Buteyko method report a wide range of other diseases (numbering up to 150), including diabetes, reproductive disorders and psychological disorders, which they believe is caused by hyperventilation and hypocapnea, and therefore are cured by use of the Buteyko method. However, research into the effectiveness of Buteyko have focused almost exclusively on asthma with a small amount of research on sleep apnea.[3] Members of the medical community have been skeptical of the efficacy of Buteyko due to the often "exaggerated and unsubstantiated claims" made by Buteyko practitioners.[4]
A review of the medical literature have found few high quality studies such as randomized controlled trials looking at the efficacy of treating asthma with "breathing retraining" methods in general, which include the Buteyko method, yoga training and other relaxation techniques.[6] Many of the studies that have evaluated breathing retraining have significant methodological flaws, including small sample sizes,[7] possible patient selection bias as well as heterogeneity in design that makes coming to a firm conclusion difficult.[8] These studies are also hampered by the difficulty in proper blinding and placebo control which could introduce more bias into these studies.[7]
The results from these studies have found trends of subjective improvement in factors such as asthma symptoms and measurement of quality of life with use of the Buteyko method and possible reduced rescue inhaler usage.[4] However, these studies have found no improvement in objective measures such as peak flow and FEV1 which are the typical measures for measuring the severity of asthma, or carbon dioxide level in the blood.[6]
Based on these results and the known methodological problems with these studies, most reviews have found the evidence is not strong enough to make firm conclusions about the efficacy of the Buteyko method, and have called for more research, including larger trials involving more patients.[6][7][8][9][10] One review did recommend breathing retraining techniques in general, which includes techniques such as physiotherapist led breathing exercises and yoga breathing in addition to Buteyko, with the caveats that they be used only as adjunct to the typical treatment with medications and for symptom control only as these techniques are unlikely to affect the underlying processes causing the asthma.[4] An expert guideline by the Global Initiative for Asthma noted that results from one study suggested that improvement in symptoms may have a basis in non-physiological factors such as the placebo effect.[11]
Expert guidelines have been split on the utility of the Buteyko method. The British Thoracic Society stated the Buteyko method "may be considered to help patients control the symptoms of asthma" based on the limited studies to date while recognizing the lack of data showing an objective improvement in prior studies.[12] However, the U.S. National Heart, Lung, and Blood Institute asthma guideline concluded "there is insufficient evidence to suggest that breathing techniques provide clinical benefit to patients who have asthma."[13]