NEW YORK TIMES NOVEMBER 2 2009
A Breathing Technique Offers Help for People With Asthma
By JANE E. BRODY
Published: November 2, 2009
I don’t often write about alternative remedies for serious medical conditions. Most have little more than anecdotal support, and few have been found effective in well-designed clinical trials. Such trials randomly assign patients to one of two or more treatments and, wherever possible, assess the results without telling either the patients or evaluators who received which treatment.
Now, however, in describing an alternative treatment for asthma that does not yet have top clinical ratings in this country (although it is taught in Russian medical schools and covered by insurance in Australia), I am going beyond my usually stringent research criteria for three reasons:
¶The treatment, a breathing technique discovered half a century ago, is harmless if practiced as directed with a well-trained therapist.
¶It has the potential to improve the health and quality of life of many people with asthma, while saving health care dollars.
¶I’ve seen it work miraculously well for a friend who had little choice but to stop using the steroid medications that were keeping him alive.
My friend, David Wiebe, 58, of Woodstock, N.Y., is a well-known maker of violins and cellos, with a 48-year history of severe asthma that was treated with bronchodilators and steroids for two decades. Ten years ago, Mr. Wiebe noticed gradually worsening vision problems, eventually diagnosed as a form of macular degeneration caused by the steroids. Two leading retina specialists told him to stop using the drugs if he wanted to preserve his sight.
He did, and endured several terrifying trips to the emergency room when asthma attacks raged out of control and forced him to resume steroids temporarily to stay alive.
Nothing else he tried seemed to work. “After having a really poor couple of years with significantly reduced quality of life and performance at work,” he told me, “I was ready to give up my eyesight and go back on steroids just so I could breathe better.”
Treatment From the ’50s
Then, last spring, someone told him about the Buteyko method, a shallow-breathing technique developed in 1952 by a Russian doctor, Konstantin Buteyko. Mr. Wiebe watched a video demonstration on YouTube and mimicked the instructions shown.
“I could actually feel my airways relax and open,” he recalled. “This was impressive. Two of the participants on the video were basically incapacitated by their asthma and on disability leave from their jobs. They each admitted that keeping up with the exercises was difficult but said they had been able to cut back on their medications by about 75 percent and their quality of life was gradually returning.”
A further search uncovered the Buteyko Center USA in his hometown, newly established as the official North American representative of the Buteyko Clinic in Moscow.
“When I came to the center, I was without hope,” Mr. Wiebe said. “I was using my rescue inhaler 20 or more times in a 24-hour period. If I was exposed to any kind of irritant or allergen, I could easily get a reaction that jeopardized my existence and forced me to go back on steroids to save my life. I was a mess.”
But three months later, after a series of lessons and refresher sessions in shallow breathing, he said, “I am using less than one puff of the inhaler each day — no drugs, just breathing exercises.”
Mr. Wiebe doesn’t claim to be cured, though he believes this could eventually happen if he remains diligent about the exercises. But he said: “My quality of life has improved beyond my expectations. It’s very exciting and amazing. More people should know about this.”
Ordinarily, during an asthma attack, people panic and breathe quickly and as deeply as they can, blowing off more and more carbon dioxide. Breathing rate is controlled not by the amount of oxygen in the blood but by the amount of carbon dioxide, the gas that regulates the acid-base level of the blood.
Dr. Buteyko concluded that hyperventilation — breathing too fast and too deeply — could be the underlying cause of asthma, making it worse by lowering the level of carbon dioxide in the blood so much that the airways constrict to conserve it.
This technique may seem counterintuitive: when short of breath or overly stressed, instead of taking a deep breath, the Buteyko method instructs people to breathe shallowly and slowly through the nose, breaking the vicious cycle of rapid, gasping breaths, airway constriction and increased wheezing.
The shallow breathing aspect intrigued me because I had discovered its benefits during my daily lap swims. I noticed that swimmers who had to stop to catch their breath after a few lengths of the pool were taking deep breaths every other stroke, whereas I take in small puffs of air after several strokes and can go indefinitely without becoming winded.
The Buteyko practitioners in Woodstock, Sasha and Thomas Yakovlev-Fredricksen, were trained in Moscow by Dr. Andrey Novozhilov, a Buteyko disciple. Their treatment involves two courses of five sessions each: one in breathing technique and the other in lifestyle management. The breathing exercises gradually enable clients to lengthen the time between breaths. Mr. Wiebe, for example, can now take a breath after more than 10 seconds instead of just 2 while at rest.
Responses May Vary
His board-certified pulmonologist, Dr. Marie C. Lingat, told me: “Based on objective data, his breathing has improved since April even without steroids. The goal now is to make sure he maintains the improvement. The Buteyko method works for him, but that doesn’t mean everyone who has asthma would respond in the same way.”
In an interview, Mrs. Yakovlev-Fredricksen said: “People don’t realize that too much air can be harmful to health. Almost every asthmatic breathes through his mouth and takes deep, forceful inhalations that trigger a bronchospasm,” the hallmark of asthma.
“We teach them to inhale through the nose, even when they speak and when they sleep, so they don’t lose too much carbon dioxide,” she added.
At the Woodstock center, clients are also taught how to deal with stress and how to exercise without hyperventilating and to avoid foods that in some people can provoke an asthma attack.
The practitioners emphasize that Buteyko clients are never told to stop their medications, though in controlled clinical trials in Australia and elsewhere, most have been able to reduce their dependence on drugs significantly. The various trials, including a British study of 384 patients, have found that, on average, those who are diligent about practicing Buteyko breathing can expect a 90 percent reduction in the use of rescue inhalers and a 50 percent reduction in the need for steroids within three to six months.
The British Thoracic Society has given the technique a “B” rating, meaning that positive results of the trials are likely to have come from the Buteyko method and not some other factor. Now, perhaps, it is time for the pharmaceutically supported American medical community to explore this nondrug technique as well.
This is the first of two columns. Next week: The pros and cons
of steroid treatments.
THE PLAIN DEALER (CLEVELAND) JAN 26, 2010
Shallow-breathing technique can fight asthma: an Alternative Paths column
By Brie Zeltner, The Plain Dealer
January 26, 2010, 9:15AM
Evan Gillespie's asthma was so severe in his adolescence that pre-dawn attacks landed him in the emergency room more than 30 times. He was often in respiratory failure after rescue inhalers failed, his lips turning blue from lack of oxygen as he struggled to take in enough air.
Gillespie, of Chagrin Falls, felt completely helpless.
At 23, his heart stopped beating briefly in the intensive care unit after Gillespie received an accidental overdose of steroid medication to get his breathing under control.
Enough, he decided.
Gillespie, now 31, no longer takes any medication and considers himself cured.
His life changed a year ago, he says, when he discovered the Buteyko breathing method, a shallow-breathing technique developed by Russian physician Konstantin Buteyko in the 1950s.
After searching the Internet for alternative remedies and trying chiropractic and acupressure treatments that didn't offer any relief, Gillespie found YouTube videos of people demonstrating Buteyko.
He decided to give it a try and was surprised to find Carol Baglia, a licensed respiratory therapist and Buteyko instructor, in Cleveland.
"There aren't a lot of people who are certified or qualified to teach it here," says Baglia, despite the method's success in Russia and increasing use in countries including Australia, New Zealand, England and Ireland.
Baglia's involvement with the breathing method started after she developed adult-onset asthma during a high-stress home renovation in 2000. She stumbled upon it the same way Gillespie did, by searching the Internet.
She was so floored by the results -- she has not had any asthma symptoms since starting the Buteyko method -- that she left her accounting career and went back to school to learn respiratory therapy.
Buteyko theory turns conventional thinking about asthma on its head, so the method -- taking fewer small, measured, shallow breaths through the nose -- seems counterintuitive.
During an asthma attack, the airways narrow because of inflammation and muscle spasm, and the normal response is to breathe more heavily, deeply and quickly to pull in more oxygen. In the traditional view of asthma, the inflammation of the airways and muscle spasm cause hyperventilation.
Konstantin Buteyko believed the opposite, that it was chronic hyperventilation that led to asthma.
Buteyko noticed that hyperventilation leads to a lower level of carbon dioxide in the body, because more of the gas is breathed out in every exhalation.
Low carbon dioxide in the tissues can cause muscle spasms, including the ones in the smooth muscles lining the airways that occur during an asthma attack. For Buteyko, hyperventilation caused asthma, not the reverse.
To break the cycle this sets up, the Buteyko method instructs people to take small, slow shallow breaths through the nose only, reducing the amount of carbon dioxide lost. It also teaches users how to increase the amount of time, called a "pause," between breaths.
The goal of the method is to avoid hyperventilation by "resetting" the breathing rate at a naturally lower pace, Baglia says.
"If the breathing is normal all the time, they don't go off into the berserk stage that leads them into feeling suffocated and unable to breathe," Baglia says. "You can't possibly have an asthma attack when you're breathing this way."
Angelo Capistrano, 55, of Cleveland, had his first asthma attack in 2006 after a lung infection. A devoted cyclist, he could no longer ride his bike and was constantly coughing despite using steroid inhalers, Advair and eventually a portable nebulizer.
Three months after starting the Buteyko method and rigorously sticking to only nasal breathing, he started to notice a change in his symptoms.
Nasal breathing, Baglia says, naturally limits the amount of air you can bring in at one time, warms the air and filters it before it enters the lungs.
"Asthmatics have irritable airways, so if you open your mouth and breathe a huge breath and it's cold and dry and dirty, right there the airways are going to spasm," she says. "That's not the way your body was meant to breathe."
Capistrano is now able to ride his bike up to 10 hours a week and still breathes only through his nose. He is also medication-free.
"It's a very amazing tool," he says. "It's the most natural, simple thing, as simple as changing your breathing pattern."
In addition to teaching the prevention of hyperventilation, the Buteyko method also teaches techniques to help calm asthma attacks should they happen.
The night after Gillespie had his first two-hour session with Baglia, he had an asthma attack and was able to breathe his way free of it without using his rescue inhaler.
Six months later, he felt comfortable enough to get rid of all his medications.
Baglia never tells anyone to stop using medications, and Buteyko practitioners recommend that anyone using the technique or making any changes in medications do so in consultation with a doctor.
Don't expect an enthusiastic response, however. The Buteyko method only made it out of Russia, where it is part of the medical school curriculum, in the 1990s, Baglia says.
But compared to most complementary medical therapies, there is a veritable glut of evidence to support its use.
The common thread through most of the trials, many of them randomized and controlled (considered the gold standard for clinical trials) is a significant improvement in asthma symptoms while using less medication, despite no or only small changes in markers of physiology like lung capacity or airway inflammation.
A recent Canadian trial found that the number of patients who achieved good control of their asthma increased from 40 percent at baseline to 79 percent at six months, with a statistically significant reduction in the use of inhaled steroid medications.
The Mayo Clinic recently listed Buteyko as one of the most promising alternative treatments for asthma, and the British Thoracic Society includes the technique in its national guidelines for doctors and gives it a "B" rating, indicating that the current evidence for its use comes from high-quality studies, and is consistent and applicable.
Still, Gillespie's allergist told him that the technique was potentially dangerous because asthma is a potentially lethal disorder and has no cure. He said he didn't support its use.
After sending the doctor some of the studies supporting the safety and efficacy of the method, Gillespie fired him.
"I've been so insecure with my health throughout my life because I've been on so much medication and my asthma still wasn't controlled," he says. "All of a sudden I can not only not have asthma, but it's under my control. I'm not worried about having another asthma attack, ever."
Contact Brie Zeltner: firstname.lastname@example.org or 216-999-4283.
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Posted by dwgnk
January 26, 2010, 10:14AM
Great interesting and informative article, Brie.
What a shame some doctors are so entrenched in traditional "drug" thinking that they refuse to explore and support non-drug therapies that can empower and heal their patients, often for free. Medicine is indeed in bed with monied interest.
Good for you, Mr. Gillespie!
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Posted by itzamre
January 26, 2010, 9:44PM
I took Carol's course several years ago and have been asymptomatic for asthma ever since. No more colds. Runny noses. And...I'm off the dreaded Advair, sprays, drops, etc. Took almost six months of Buteyko practice...but my doctor agreed there is no longer a need for medication. As a side note...the second week of our class two of the sleep apnia types indicated they had stored their masks. They were no longer snoring. Carol puts her course on throughout the region. Suggest her future schedule be published. I will forever thank her for helping me live smarter!
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