Breathing Exercises in Asthma Targeting Dysfunctional Breathing
- Conditions
- Dysfunctional Breathing in Asthma
- Interventions
- Other: Usual careOther: Breathing Exercises
- Registration Number
- NCT03127059
- Lead Sponsor
- Naestved Hospital
- Brief Summary
Dyspnoe can disable patients with asthma. Dysfunctional breathing (DB), resulting in dyspnoe, can mimic or exaggerate asthma. Around every forth patient with asthma have DB. Breathing exercises (BrEX) can improve asthma-related quality of live (QOL) in less severe asthma. No study has investigated the effect of BrEX on QOL neither on level of physical activity in severe asthma.
A randomised controlled multicentre trial will include 190 adults with poor asthma control (Asthma Control Questionnaire (ACQ6)-score≥0.8) from seven outpatient departments and one specialized private clinic. Patients will be allocated to either usual care (no intervention) or breathing exercises (BrEX)-treatment consisting of 12-week intervention including three physiotherapist-sessions focusing on breathing pattern modification (Papworth Method; Buteyko technique) in rest and activity and 10 minutes home-exercise twice daily. Primary outcome is change in Mini Asthma Quality of Life Questionnaire (MiniAQLQ) at six-months follow-up.
- Detailed Description
In Denmark around 300,000 suffer from asthma. Dyspnoe can disable patients with asthma. Dysfunctional breathing (DB), resulting in dyspnoe, can mimic or exaggerate asthma. Around 20-29% of asthmatic patients have DB. Breathing exercises (BrEX) can improve asthma-related quality of life (QOL) and control of asthma symptoms in less severe asthma. No study has investigated the effect of BrEX on QOL neither on level of physical activity in severe asthma.
A randomised controlled multicentre trial will include 190 adults with poor asthma control (Asthma Control Questionnaire (ACQ6)-score≥0.8) from seven outpatient departments and one specialized private clinic. After optimizing of inhalation technique, patients will be allocated to either usual care (no intervention) or BrEX-treatment consisting of 12-week intervention including three physiotherapist-sessions focusing on breathing pattern modification (Papworth Method; Buteyko technique) in rest and activity and 10 minutes home-exercise twice daily. Primary outcome is change in Mini Asthma Quality of Life Questionnaire (MiniAQLQ) at six-months follow-up. Secondary outcomes are changes in ACQ6, Nijmegen Hyperventilation Questionnaire (NQ), Hospital Anxiety and Depression Scale (HAD), accelerometry (physical activity level, number of steps), 6 minutes walk distance, and forced expiratory volume in first second (FEV1), besides response of Global perceived effect rate (GPE) in asthma-related QOL and asthma control.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 190
- Referred from GP to a secondary, out-patient respiratory clinic for lack of asthma control
- Pulmonologist-diagnosed asthma
- ≥ 2 consultations at a pulmonologist-lead asthma clinic
- ACQ6 ≥0.8
- Able to provide written informed consent.
- Trained in breathing exercises by physiotherapist last 6 months
- Aged <18
- Pregnancy
- Not able to speak, read or understand Danish
- Any severe disease as judged by the responsible physician
- Participating in another pulmonary interventional research-project.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Usual care Usual care Individual instruction from a nurse at baseline aimed at knowledge on pharmacological treatment and optimized inhalation techniques. The participants will be encouraged to use online video instruction. Besides the individual instruction described above, patients will receive only short information given initially at recruitment. They are allowed to receive instruction in positive expiratory pressure-treatment and physiotherapy targeting other problems than dysfunctional breathing (DB). Breathing Exercises Breathing Exercises Individual instruction from a nurse at baseline aimed at knowledge on pharmacological treatment and optimized inhalation techniques. The participants will be encouraged to use online video instruction. Three physiotherapist-sessions of Breathing Exercises (BrEX) with duration of 60 minutes (the initial) and 30 minutes (other sessions) at week 1, 4, and 9. The participant is expected to do 10 minutes of home exercise twice daily. The entire intervention combines elements of the Papworth method, and the Buteyko technique.
- Primary Outcome Measures
Name Time Method Mini Asthma Quality of Life Questionnaire (MiniAQLQ) Primary endpoint: Change from baseline to 6 months follow up. Secondary endpoints will be 3 and 12 months follow up. MiniAQLQ is a disease-specific patient-reported outcome on experiences during the previous two weeks. The original version of AQLQ (32 items) is recommended for clinical use, whereas this shortened version is suggested for research. In moderate to severe asthma cohorts, MiniAQLQ has good reliability (ICC 0.83-0.86) and strong validity (criteria validity to AQLQ, r≥0.80; construct validity against ACQ, r=0.69). MiniAQLQ has 15 items in four domains (symptoms, activity limitation, emotions, environment), which are answered using a 7-point Likert scale (1=maximum impairment; 7=no impairment).
- Secondary Outcome Measures
Name Time Method Asthma Control Questionnaire (ACQ6) Change from baseline to 3, 6, and 12 months follow up Asthma Control Questionnaire (ACQ6) will be used in the 6 sub-score version omitting FEV1 % of predicted. The outcome-score is the mean of 6 sub-scores (5 questions about symptoms, 1 question in use of reliever medication (beta2-agonist)) using a 7-point Likert scale (0=fully controlled; 6=severely uncontrolled)
Accelerometry (PAL, number of steps) Change from baseline to 3 and 6 months follow up. Physical activity level (PAL) and numbers of steps will be measured by an accelerometer (BodyMedia SenseWear®) monitoring during 5 days
Hospital Anxiety and Depression Scale (HAD) Change from baseline to 3, 6, and 12 months follow up Hospital Anxiety and Depression Scale (HAD) uses a 0-21 scale; a low score indicates least mental health problems.
Nijmegen Questionnaire (NQ) Change from baseline to 3, 6, and 12 months follow up A Nijmegen Questionnaire (NQ)-score \> 23 suggests symptomatic hyperventilation, but is typically used to define DB.
Global perceived effect rate (GPE) At 3, 6, and 12 months follow up Global perceived effect rate (GPE) will be used as a retrospective evaluation of effect in asthma-related QOL as well as in asthma control on a 7-point Likert scale. GPE will only be measured at the follow ups.
6 Minutes Walk Distance (6MWD) Change from baseline to 6 months follow up. 6 Minutes Walk Distance (6MWD); 6MWD is the most typically used function-score in pulmonary research.
Spirometry (FEV1) Change from baseline to 6 months follow up. Spirometry (MedikroPro) will be used to measure forced expiratory volume in first second in liter (FEV1).
Trial Locations
- Locations (2)
Dep. of Physiotherapy and Dep. of Pulmonology
🇩🇰Roskilde, Region Zealand, Denmark
Allergi og Lungeklinikken Helsingør
🇩🇰Helsingør, Danish Capital Region, Denmark