Buteyko method
Encyclopedia
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.
and in books.
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
.
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. These effects include widespread spasms of the muscle in the airways (bronchospasm
), 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.
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, 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." 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.
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.
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.
. 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.
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. Many of the studies that have evaluated breathing retraining have significant methodological flaws, including small sample size
s, possible patient selection bias
as well as heterogeneity in design that makes coming to a firm conclusion difficult. These studies are also hampered by the difficulty in proper blinding and placebo
control which could introduce more bias into these studies.
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. 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.
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. 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. 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
.
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. 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."
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
as well as other conditions. The method takes its name from the late Ukrainian doctor Konstantin Pavlovich Buteyko
Konstantin Buteyko
Konstantin Pavlovich Buteyko was the creator of the Buteyko method for the treatment of asthma and other breathing disorders.-Early life:Konstantin Pavlovich Buteyko was born on 27 January 1923 into a farming family in Ivanitsa, near Kiev, Ukraine. His father was a keen mechanic and he followed...
(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
Respiratory rate
Respiratory rate is also known by respiration rate, pulmonary ventilation rate, ventilation rate, or breathing frequency is the number of breaths taken within a set amount of time, typically 60 seconds....
(hyperventilation
Hyperventilation
Hyperventilation or overbreathing is the state of breathing faster or deeper than normal, causing excessive expulsion of circulating carbon dioxide. It can result from a psychological state such as a panic attack, from a physiological condition such as metabolic acidosis, can be brought about by...
). 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
Methodology
Methodology is generally a guideline for solving a problem, with specificcomponents such as phases, tasks, methods, techniques and tools . It can be defined also as follows:...
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
Quality of life
The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...
. 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
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
or any of the over 150 diseases supporters of this method claim to treat.
History
The Buteyko method was originally developed in the 1950s by physiologist Konstantin Buteyko in Russia. 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. Later, this method was introduced to Australia, New Zealand, Britain and the United States, where it has received increasing exposure. Anecdotal reports of life-changing improvements attributed to the Buteyko method abound on the internetInternet
The Internet is a global system of interconnected computer networks that use the standard Internet protocol suite to serve billions of users worldwide...
and in books.
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
Yoga
Yoga is a physical, mental, and spiritual discipline, originating in ancient India. The goal of yoga, or of the person practicing yoga, is the attainment of a state of perfect spiritual insight and tranquility while meditating on Supersoul...
.
Theory
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 dioxideCarbon dioxide
Carbon dioxide is a naturally occurring chemical compound composed of two oxygen atoms covalently bonded to a single carbon atom...
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
Oxygenation (medical)
Oxygenation occurs when oxygen molecules enter the tissues of the body. For example, blood is oxygenated in the lungs, where oxygen molecules travel from the air and into the blood...
. Advocates of this method believe that the effects of chronic hyperventilation would have even wider effects than is commonly accepted. These effects include widespread spasms of the muscle in the airways (bronchospasm
Bronchospasm
Bronchospasm or a bronchial spasm is a sudden constriction of the muscles in the walls of the bronchioles. It is caused by the release of substances from mast cells or basophils under the influence of anaphylatoxins...
), 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.
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, 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." 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.
Description
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.Nasal breathing
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 CPAPCPAP
CPAP may stand for:* Continuous positive airway pressure, a particular type of ventilation therapy* The Center for Public Administration and Policy, an academic department at Virginia Tech...
machines - commonly used to treat sleep apnea
Sleep apnea
Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...
- 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.
Reduced breathing exercises
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.
Relaxation
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.Effectiveness
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 apneaSleep apnea
Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...
. 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.
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
Yoga
Yoga is a physical, mental, and spiritual discipline, originating in ancient India. The goal of yoga, or of the person practicing yoga, is the attainment of a state of perfect spiritual insight and tranquility while meditating on Supersoul...
training and other relaxation techniques. Many of the studies that have evaluated breathing retraining have significant methodological flaws, including small sample size
Sample size
Sample size determination is the act of choosing the number of observations to include in a statistical sample. The sample size is an important feature of any empirical study in which the goal is to make inferences about a population from a sample...
s, possible patient selection bias
Selection bias
Selection bias is a statistical bias in which there is an error in choosing the individuals or groups to take part in a scientific study. It is sometimes referred to as the selection effect. The term "selection bias" most often refers to the distortion of a statistical analysis, resulting from the...
as well as heterogeneity in design that makes coming to a firm conclusion difficult. These studies are also hampered by the difficulty in proper blinding and placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...
control which could introduce more bias into these studies.
The results from these studies have found trends of subjective
Subjectivity
Subjectivity refers to the subject and his or her perspective, feelings, beliefs, and desires. In philosophy, the term is usually contrasted with objectivity.-Qualia:...
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. 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.
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. 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. An expert guideline by the Global Initiative for Asthma
Global Initiative for Asthma
The Global Initiative for Asthma is a medical guidelines organisation which works with public health officials and health care professionals globally to reduce asthma prevalence, morbidity, and mortality....
noted that results from one study suggested that improvement in symptoms may have a basis in non-physiological factors such as the placebo effect
Placebo effect
Placebo effect may refer to:* Placebo effect, the tendency of any medication or treatment, even an inert or ineffective one, to exhibit results simply because the recipient believes that it will work...
.
Expert guidelines
Guideline (medical)
A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare...
have been split on the utility of the Buteyko method. The British Thoracic Society
British Thoracic Society
The British Thoracic Society was formed in 1982 by the amalgamation of the British Thoracic Association and the Thoracic Society. It is a registered charity and a company limited by guarantee.-Function:...
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. However, the U.S. National Heart, Lung, and Blood Institute
National Heart, Lung, and Blood Institute
The National Heart, Lung, and Blood Institute is a division of the National Institutes of Health, located in Bethesda, Maryland...
asthma guideline concluded "there is insufficient evidence to suggest that breathing
techniques provide clinical benefit to patients who have asthma."