pranayama and the Buteyko Breathing Technique

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Question for [N-]: why don't RRTs and others empirically try alternate
nostril breathing on patients in respiratory distress? What about
ethics? Regards, Richard Friedel


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Back in the early 90's when I did practice as RRT in the ER, breathing techniques with nasal breathing was a part of what was done for the patient admitted with acute respiratory distress. In conjunction with medical evaluation, treatment, and medication, we did whatever to comfort the patient, and tone-down and calm the environment. From speech and mannerism, to curtains, lights, and sounds. Depending on the circumstance, the patient was coached different ways to make the exhalation phase longer, or use diaphragm instead of shoulders and intercostals to breath. I never felt like I was sneaking in Yoga meditation rites, or preaching a vague "CO2 theory" supporting treatment.

I know there's a new fad with measuring exhaled NO in asthma, but I had not heard of "Decreased pulmonary vascular resistance during nasal breathing: modulation by endogenous nitric oxide from the paranasal sinuses", but I don't doubt it. This study contributes to the growing research we have on NO, but I'm still waiting for the practical utility that NO treatment studies seem to promise.

On the topic of nasal airway resistance in asthma, I stumbled on the following that, based on the abstract, doesn't find anything we wouldn't already expect:

Duggan CJ, Watson RA, Pride NB. Postural changes in nasal and pulmonary resistance in subjects with asthma. J Asthma. 2004 Oct;41(7):701-7.
"...DISCUSSION: Values of airflow resistance are 2-3 times higher in both normal and asthmatic subjects when breathing via the nose and supine than under normal laboratory conditions of oral breathing and seated."

I went out to the Internet for a quick review on the status of breathing retraining for asthma, including pranayama and the Buteyko Breathing Technique in clinical medicine:

http://en.wikipedia.org/wiki/Buteyko_method

Holloway E, Ram FSF. Breathing exercises for asthma (Cochrane Review). In: The Cochrane Library,Issue 1, 2001. Oxford: Update Software.
"...The researchers concluded that breathing re-training might be helpful as part of the treatment of asthma, but that the data available are insufficient to prove it, due to the small number of studies, the small number of patients studied, the different types of interventions employed, and the inability to obtain further data from the authors."

http://www.mja.com.au/public/issues/xmas98/bowler/bowler.html
e-Medical Journal of Australia review

http://www.jr2.ox.ac.uk/bandolier/booth/alternat/breathexasthma.html
Bandolier 2000 review

Gyorik SA, Brutsche MH. Complementary and alternative medicine for bronchial asthma: is there new evidence? Curr Opin Pulm Med. 2004 Jan;10(1):37-43. Review.
"...Strategies influencing breathing technique or perception, such as breathing or retraining exercises, need to be studied over the next few years to establish their additive role in the treatment of asthma..."

Bruton A, Lewith GT. The Buteyko breathing technique for asthma: a review. Complement Ther Med. 2005 Mar;13(1):41-6. Epub 2005 Apr 18.
"...The BBT 'package' is complex, as it also includes advice and education about medication use, nutrition and exercise, and general relaxation. This makes it difficult, and possibly inappropriate, to attempt to tease out a single mechanism."



Yours,N-, RRT