Breathing exercises as adjunct therapy in adult asthma: a systematic review.
4 affiliations
- 1Department of Respiratory Medicine and Allergy, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.
- 2Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- 3Department of Respiratory Medicine, Fundació Hospitalàries Barcelona, Barcelona, Spain.
- 4Respiratory Rehabilitation Unit. Department of Respiratory Medicine and Allergy and Department of Physical Therapy-Rehabilitation, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain.
Abstract
Background
Despite optimal pharmacological treatment, a substantial proportion of adult asthma patients remain symptomatic. Breathing exercises have emerged as a non-pharmacological adjunct specifically targeting dysfunctional breathing patterns (chronic hyperventilation, tachypnea, and aberrant ventilatory mechanics) that pharmacotherapy does not adequately address. Evidence for their efficacy across outcomes and delivery formats warrants systematic evaluation.Methods
We searched five databases (Cochrane Library, PubMed/MEDLINE, Scopus, Web of Science, PEDro) for RCTs, controlled quasi-experimental studies, and uncontrolled pre-post pilot studies in which breathing exercises were the primary intervention for adults with confirmed asthma, published between January 2013 and March 2025. Methodological quality was assessed using the PEDro scale; risk of bias was assessed using the Cochrane RoB 2 tool for randomised trials and descriptively for non-randomised studies. A narrative synthesis was performed due to significant clinical, methodological, and statistical heterogeneity.Results
Six primary studies (n = 1,098; PEDro scores 3-6) were included: four randomised controlled trials (RCTs) and two uncontrolled pre-post/pilot studies. Several included studies reported significant improvements with breathing retraining in health-related quality of life (AQLQ, Mini-AQLQ, SGRQ) and asthma control scores (ACT, ACQ). Among the modalities studied, the Buteyko method showed relatively consistent benefits, including a ~ 20% reduction in rescue bronchodilator and inhaled corticosteroid use. In one large RCT, digital self-guided delivery was equivalent to face-to-face physiotherapist instruction. Static spirometric volumes (FEV₁, FVC) and airway inflammation markers (FeNO) were not significantly modified. Severe exacerbation rates were unchanged.Conclusions
Available evidence suggests that structured breathing exercises are safe and potentially effective adjunctive interventions in adult asthma, improving patient-reported outcomes (health-related quality of life and asthma control) by correcting dysfunctional breathing patterns, without altering the underlying airway inflammatory process. Breathing exercises may be considered as part of multidisciplinary asthma management for adults who remain symptomatic despite optimised pharmacological therapy.
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BibTeX
@article{crespolessmann2026breathing,
title = {{Breathing exercises as adjunct therapy in adult asthma: a systematic review.}},
author = {Astrid Crespo-Lessmann and Eduardo Vélez-Segovia and Luis Paz and Vicente Plaza},
journal = {F1000Research},
year = {2026},
month = jun,
doi = {10.12688/f1000research.180230.1},
url = {https://europepmc.org/article/MED/42959049},
note = {CC BY},
}
RIS
TY - JOUR
TI - Breathing exercises as adjunct therapy in adult asthma: a systematic review.
AU - Astrid Crespo-Lessmann
AU - Eduardo Vélez-Segovia
AU - Luis Paz
AU - Vicente Plaza
PY - 2026
DA - 2026/06/23
JO - F1000Research
DO - 10.12688/f1000research.180230.1
UR - https://europepmc.org/article/MED/42959049
AB - Background Despite optimal pharmacological treatment, a substantial proportion of adult asthma patients remain symptomatic. Breathing exercises have emerged as a non-pharmacological adjunct specifically targeting dysfunctional breathing patterns (chronic hyperventilation, tachypnea, and aberrant ventilatory mechanics) that pharmacotherapy does not adequately address. Evidence for their efficacy across outcomes and delivery formats warrants systematic evaluation.Methods We searched five databases (Cochrane Library, PubMed/MEDLINE, Scopus, Web of Science, PEDro) for RCTs, controlled quasi-experimental studies, and uncontrolled pre-post pilot studies in which breathing exercises were the primary intervention for adults with confirmed asthma, published between January 2013 and March 2025. Methodological quality was assessed using the PEDro scale; risk of bias was assessed using the Cochrane RoB 2 tool for randomised trials and descriptively for non-randomised studies. A narrative synthesis was performed due to significant clinical, methodological, and statistical heterogeneity.Results Six primary studies (n = 1,098; PEDro scores 3-6) were included: four randomised controlled trials (RCTs) and two uncontrolled pre-post/pilot studies. Several included studies reported significant improvements with breathing retraining in health-related quality of life (AQLQ, Mini-AQLQ, SGRQ) and asthma control scores (ACT, ACQ). Among the modalities studied, the Buteyko method showed relatively consistent benefits, including a ~ 20% reduction in rescue bronchodilator and inhaled corticosteroid use. In one large RCT, digital self-guided delivery was equivalent to face-to-face physiotherapist instruction. Static spirometric volumes (FEV₁, FVC) and airway inflammation markers (FeNO) were not significantly modified. Severe exacerbation rates were unchanged.Conclusions Available evidence suggests that structured breathing exercises are safe and potentially effective adjunctive interventions in adult asthma, improving patient-reported outcomes (health-related quality of life and asthma control) by correcting dysfunctional breathing patterns, without altering the underlying airway inflammatory process. Breathing exercises may be considered as part of multidisciplinary asthma management for adults who remain symptomatic despite optimised pharmacological therapy.
SN - 2046-1402
ER -