A study led by the University of Southampton has found that people who continue to get problems from their asthma, despite receiving standard treatment, experience an improved quality of life when they are taught breathing exercises. The majority of asthma patients have some degree of impaired quality of life.
Researchers, funded by the National Institute for Health Research (NIHR), also found that the benefits of the breathing exercises were similar, whether they were taught in person by a physiotherapist in three face-to-face sessions, or delivered digitally for use in their own home (in this study via DVD). Their findings are published in a paper in the journal The Lancet Respiratory Medicine.
The controlled trial recruited 655 UK adults who reported impaired asthma-related quality of life. Participants were randomised to receive a breathing exercise intervention delivered via DVD (261 people), or face to face with a physiotherapist (132 people). A third 'control' group received 'usual care' (262 people), continuing to take normal asthma medication, with no further intervention.
Both the DVD and face to face physiotherapy programmes improved patients' asthma-related quality of life scores (over 12 months) compared with those receiving usual care, with improvements that are comparable to those achieved by increasing medication. Neither of the breathing retraining interventions (exercises) improved lung function or airway inflammation, suggesting they were not affecting the underlying biology of the disease. The programmes did not 'cure' asthma, despite improving people's experience of having it. The number of asthma attacks was lower in the breathing retraining groups, but the reductions were not at a level of statistical significance.
The NHS healthcare costs were lower for both breathing retraining groups than for the usual care control group, and were lowest when access was provided digitally.1 Savings made by delivering the programme in this way outweigh any technology provision costs. The team has made the contents of the DVD and the supporting booklet freely available through the website http://www.breathestudy.co.uk/.
Asthma affects more than five million people in the UK and costs the NHS and social care (including disability payments) more than £1 billion each year. It led to at least 6.3 million primary care consultations, and 1,160 asthma deaths in 2012. While asthma medications can provide full symptom control for some, a recent European survey suggests this isn't the case for most.
First author on the paper, Professor Anne Bruton, of the University of Southampton, comments: "Our study provides valuable evidence to show that not only can these breathing exercises be of help to people with asthma, they can also be cost-effective - with teaching by DVD much cheaper than in person. Many patients have concerns about taking medicines long-term, so non-drug approaches to control asthma, like these exercises, can be of particular interest."
The NIHR was receptive to calls from patients, carers and clinicians to fund studies looking into ways that could help asthmatics manage their condition. Professor Hywel Williams, Director of the NIHR's Health Technology Assessment (HTA) Programme, says: "We are delighted to have funded this study in an area of research that is important to the public and medical professionals.
"The need for more research into the possible benefits of breathing exercises as a physical therapy for asthma was identified by the James Lind Alliance (JLA) after patients, carers and clinicians highlighted it among their top 10 questions for research into asthma.
"It is important that we continue to fund research in technologies that help people manage their conditions."
Dr Samantha Walker, Director of Research & Policy at the charity Asthma UK, says: "Excitingly, this study shows that video can be just as effective as face-to-face support in communicating with people with asthma and encouraging them to better manage their symptoms.
"It demonstrates how important technology can be in transforming healthcare and potentially the lives of the 5.4 million people in the UK with asthma. We're urging researchers and innovators to work together to develop ways to help people with asthma through digital means, whether that is through video, SMART inhalers that can monitor the effectiveness of treatment, or apps to help patients manage their symptoms."
Notes to Editors
1) Costs for the physiotherapy face to face intervention was £83.45 per patient compared with £2.85 for the DVD (printing the discs and documentation).
2) For a copy of The Lancet Respiratory Medicine paper Physiotherapy breathing retraining for asthma - a randomised control trial, access under embargo at: http://www.thelancet-press.com/embargo/breathing.pdf or contact Peter Franklin, Media Relations, University of Southampton. Tel: 023 8059 5457 Email: email@example.com,
3) Anne Bruton is funded by a National Institute for Health Research Senior Research Fellowship.
4) More information on the study has been published in the NIHR Journals Library. For a summary of the study see the NIHR Signal. More information on the James Lind Alliance is available on their website.
5) The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world's challenges. We are among the top one per cent of institutions globally. Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 24,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 200,000 alumni. http://www.southampton.ac.uk
6) Asthma UK's mission is to stop asthma attacks and cure asthma. We do this by funding world leading research, campaigning for improved care and supporting people to reduce their risk of a potentially life-threatening asthma attack. The Asthma UK Helpline is open weekdays from 9am to 5pm on 0300 222 5800.For more information about asthma please visit http://www.asthma.org.uk
7) The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research.
Established by the Department of Health, the NIHR:
- - funds high quality research to improve health
- trains and supports health researchers
- provides world-class research facilities
- works with the life sciences industry and charities to benefit all
- involves patients and the public at every step
For further information, visit the NIHR website: http://www.nihr.ac.uk
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The Lancet Respiratory Medicine