Buteyko Children

Vol 119 No 1234 ISSN 1175 8716
Buteyko breathing technique and asthma in children: a case

series
Asthma is a common disorder in New Zealand, with estimates of prevalence as high
as one in six of the population affected.1 The annual cost of asthma drugs is high—in
2005, approximately NZ$34 million was spent on inhaled corticosteroids and β2-
agonists.2
The use of β2-agonist in chronic asthma is itself contentious, with a recent meta-
analysis concluding that regular use of β2-agonist resulted in tolerance within 1–3
weeks as well as being pro-inflammatory to the airways.3 Interventions that have the
potential to reduce β2-agonist insult to the airways of people with chronic asthma are
deserving of further investigation.
The Buteyko breathing technique (BBT) is an intervention for asthma that is
associated with significant reductions in medication use as well as improvements in
other indices such as symptom scores and quality of life in adults.4–7
Previous work demonstrates the effectiveness of BBT in adults.4,6 To date, there has
been no published work looking at the impact in children.
We report a case series that considers the place of BBT in children.
Methods
To find suitable participants (Table 1), we approached local general practices and
advertised in the local (Gisborne) newspaper. Twenty-six children were identified of
whom 8 (aged 7–16 years) were eligible for inclusion; being previously diagnosed
with asthma by their GP and using medication for asthma for at least 6 months with
significant use of medication for asthma in the 2 weeks prior; no prior instruction in
BBT; and no significant unstable medical condition.
Intervention
Participants underwent training in BBT (by a representative of the Buteyko Institute
of Breathing and Health) over five sessions of 60–90 minutes held over 5 consecutive
days. BBT consists of a series of exercises promoting nasal breathing and periods of
hypoventilation.8
Outcome measures
Prior to tuition, and at 3 months following instruction in BBT, participants (along
with their parent/guardian) self completed a questionnaire ascertaining:
• Medication use over the previous 2 weeks;
• Symptom scores over the previous 2 weeks;
• Courses of oral steroids over the previous 3 months; and
NZMJ 19 May 2006, Vol 119 No 1234 Page 1 of 4

URL: http://www.nzma.org.nz/journal/119-1234/1988/ © NZMA
• Absences from school due to asthma over the previous 3 months and admissions
to hospital over the previous 3 months.
At 3 months, participants were also asked whether BBT had been helpful or not in the
management of their asthma. Any changes in medication after instruction were to be
in association with their own general practitioner.
Results
Table 1. Characteristics of participants at end of run-in
Variable BBT Group

(n=8)
Gender (male : females) 4:4
Mean age (range) in years 11.1 (8–14)
Ethnicity (European : Maori) 4:4
Mean years with asthma (range) 7.5 (4–12)
Mean daily adjusted β2-agonist dose in mcg equiv salbutamol (standard deviation) 742 (624)
Mean daily adjusted inhaled steroid dose in mcg equiv fluticasone (standard deviation) 137 (119)
BBT=Buteyko breathing technique.
Changes in medication use

Average β2-agonist use reduced from 743 mEq of salbutamol per day to 254
mEq/day, a drop of 66%. Inhaled steroid use reduced from 138 mEq of fluticasone per
day to 81 mEq/day, a drop of 41% (Figure 1).
Figure 1. Medication use (mEq) by participants before and after training in

Buteyko breathing technique
M edication Use
800
700
600
500
Before
400
After
300
200
100
0
Inhaled Beta Agonist Inhaled Corticosteroid

Qualitative measures
There were no admissions to hospital in the 3 months before or after instruction in
BBT for any of the participants. In the 3 months prior to instruction in BBT, 8 days of
school were missed by three participants. There were 4 days missed by two
participants in the 3 months after BBT tuition. The post-instruction period of 3
months did, however, include 6 weeks of school holidays.
In the 3 months prior to tuition in BBT, three participants had 11 courses of oral
steroids, and in the 3 months post-tuition, one participant had one course of oral
steroids. Average symptom scores in the 3 months before tuition in BBT went from
1.5 to 0.875 in the 3 months post-tuition (where 0=no symptoms, 1=mild,
2=moderate, and 3=severe).
Of the eight participants, one reported “no change” in his/her asthma, six reported
“slightly improved”, and one reported “markedly improved”. There were no reports of
“slightly deteriorated” or “marked deteriorated”.
Discussion
There have been several published randomised controlled trials involving the use of
BBT in adults with asthma.4,6,7 These trials have all shown positive results with
marked reductions in inhaled β2-agonist along with reductions in inhaled
corticosteroids without negative impact on measures of lung function and with no
apparent adverse effect. There is, however, no data for BBT in a paediatric setting.
In this study we used accepted diagnostic criteria for asthma.9 We recognise that this
has the potential to include a broad group, including dysfunctional breathing.10
In this series, we have identified that BBT is associated with change in medication in
children that mirrors results found in adults (Table 2).
Table 2. Comparison of medication reductions in BBT trials to date
Brisbane3 Gisborne5 Nottingham6 This series

Beta-agonist reduction 95% * 85% 100% * 66%
Inhaled steroid reduction 49% 50% 41.5% ** 41%
BBT=Buteyko breathing technique; *Results are reported as mean unless marked with * in which case are median;
**Nottingham did not attempt reductions in inhaled steroid use until assessment of airways hyper-reactivity was
finished.
In addition to reduction in medication there were improvements in measures of

quality of life scores, symptom scores, and also a reduced number of courses of oral
steroids.
The small size and self-selection of the patient group in this case series limits any
more meaningful commentary on the results.
However given the association between BBT and medication reduction in this group
of children, and the similarity with adults, we suggest that BBT would merit
exploration by a randomised controlled trial in children. In addition, we agree with a

recent review of BBT which states that further research is necessary to establish
whether BBT is effective, and if so, how it may work.11
Acknowledgements: This study was funded by grants from the JN Williams Memorial Trust and The
Tairawhiti Complementary and Traditional Therapies Research Trust. We also thank BIBH for
providing an instructor (Russell and Jennifer Stark) and teaching the BBT as well as the GPs and
practice nurses for participating in the study.
Patrick McHugh
Clinical Director, Emergency Department
Gisborne Hospital, Gisborne
([email protected])
Bruce Duncan
Public Health Physician
Tairawhiti District Health, Gisborne
Frank Houghton
Assistant Lecturer (and Health Geographer), Department of Humanities
Limerick Institute of Technology, Limerick, Ireland
References:
1. Crane J, Lewis S, Slater T, et al. The self reported prevalence of asthma symptoms amongst
adult New Zealanders. N Z Med J 1994;107:417–21.
2. PHARMAC. Annual Review 2005: Improving Health. Wellington: PHARMAC; 2005.
Available online. URL: http://www.pharmac.govt.nz/pdf/ARev05.pdf Accessed May 2006.
3. Salpeter SR, Ormiston TM, Salpeter EE. Meta-analysis: Respiratory tolerance to regular
beta2-agonist use in patients with asthma. Ann Intern Med 2004; 140:802–13.
4. Bowler SD, Green A, Mitchell CA. Buteyko breathing technique in asthma: a blinded
randomised controlled trial. Med J Aust. 1998;169:575–8. Available online. URL:
http://www.mja.com.au/public/issues/xmas98/bowler/bowler.html Accessed May 2006.
5. Opat AJ, Cohen MM, Bailey MJ, Abramson MJ. A clinical trial of the Buteyko Breathing
Technique in asthma as taught by a video. J Asthma. 2000;37:557–64.
6. McHugh P, Aitcheson F, Duncan B, Houghton F. Buteyko breathing technique for asthma: an
effective intervention. N Z Med J. 2003;116(1187). URL:
http://www.nzma.org.nz/journal/116-1187/710/
7. Cooper S, Oborne J, Newton S, et al. Effect of two breathing exercises (Buteyko and
pranayama) in asthma: a randomised controlled trial. Thorax. 2003;58:674–9.
8. Buteyko Method: Butyeko Institute of Breathing and Health, Manuka, Australia. Available
online. URL: http://www.buteyko.info/ Accessed May 2006.
9. Holt S, Kljakovic M, Reid J; POMS Steering Committee. Asthma morbidity, control and
treatment in New Zealand: results of the Patient Outcomes Management Survey (POMS),
2001. N Z Med J. 2003;116(1174). URL: http://www.nzma.org.nz/journal/116-1174/436/
10. Thomas M, McKinley RK, Freeman E, Foy C. Prevalence of dysfunctional breathing in
patients treated for asthma in primary care: cross sectional survey. BMJ. 2001;322:1098–100.
11. Bruton A, Lewith GT. The Buteyko breathing technique for asthma: a review. Complement
Ther Med. 2005;13:41–6.


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Vol 119 No 1234 ISSN 1175 8716

Buteyko breathing technique and asthma in children: a case

NZMJ 19 May 2006, Vol 119 No 1234 Page 1 of 4

Variable BBT Group

Changes in medication use

Figure 1. Medication use (mEq) by participants before and after training in

NZMJ 19 May 2006, Vol 119 No 1234 Page 2 of 4

Table 2. Comparison of medication reductions in BBT trials to date

Brisbane3 Gisborne5 Nottingham6 This series

In addition to reduction in medication there were improvements in measures of

NZMJ 19 May 2006, Vol 119 No 1234 Page 3 of 4

NZMJ 19 May 2006, Vol 119 No 1234 Page 4 of 4

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