Physiotherapy breathing retraining for asthma

a randomised controlled trial

Anne Bruton, Amanda Lee, Lucy Yardley, James Raftery, Emily Arden-Close, Sarah Kirby, Shihua Zhu, Manimekalai Thiruvothiyur, Frances Webley, Lyn Taylor, Denise Gibson, Guiqing Yao, Mark Stafford-Watson, Jenny Versnel, Michael Moore, Steve George, Paul Little, Ratko Djukanovic, David Price, Ian D. Pavord & 2 others Stephen T. Holgate, Mike Thomas*

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Citations (Scopus)
7 Downloads (Pure)

Abstract

Background Despite effective pharmacotherapy, asthma continues to impair quality of life for most patients. Non-pharmacological approaches, including breathing retraining, are therefore of great interest to patients. However, clinicians rarely advocate breathing retraining and access to this intervention is restricted for most patients due to the limited availability of suitable physiotherapists and poor integration of breathing retraining into standard care. We aimed to assess the effectiveness of a digital self-guided breathing retraining intervention. Methods In this randomised controlled trial, we recruited patients from 34 general practices in the UK. Eligibility criteria for patients with asthma were broad, comprising a physician diagnosis of asthma, age of 16–70 years, receipt of at least one anti-asthma medication in the previous year, and impaired asthma-related quality of life (Asthma Quality of Life Questionnaire [AQLQ] score of <5·5). We developed a self-guided intervention, which was delivered as a DVD plus a printed booklet (DVDB). Participants were randomly assigned to receive either the DVDB intervention, three face-to-face breathing retraining sessions, or standard care, in a 2:1:2 ratio, for 12 months. Randomisation was achieved using the Southampton Clinical Trials Unit telephone randomisation service by use of random number generators. The primary outcome was the AQLQ score in the intention-to-treat population at 12 months. The trial was powered to show equivalence between the two active intervention groups, and superiority of both intervention groups over usual care. Secondary outcomes included patient-reported and physiological measures of asthma control, patient acceptability, and health-care costs. This trial was registered with International Standard Randomised Controlled Trial Number registry, number ISRCTN88318003. Findings Between Nov 5, 2012 and Jan 28, 2014, invitations to participate in the study were sent to 15 203 patients with general practitioner-diagnosed asthma, of whom 655 were recruited into the study. AQLQ scores at 12 months were significantly higher in the DVDB group (mean 5·40, SD 1·14) than in the usual care group (5·12, SD 1·17; adjusted mean difference 0·28, 95% CI 0·11 to 0·44), and in the face-to-face group (5·33, SD 1·06) than in the usual care group (adjusted mean difference 0·24, 95% CI 0·04 to 0·44); AQLQ scores were similar between the DVDB group and the face-to-face group (0·04, 95% CI −0·16 to 0·24). There were no significant differences between the randomisation groups in FEV1 or fraction of exhaled nitric oxide. 744 adverse events occurred in 272 patients: 101 (39%) of 261 patients in the DVDB group, 55 (42%) of 132 patients in the face-to-face group, and 132 (50%) of 262 in the usual care group, with patients reporting one or more event. 11 (4%) patients in the DVDB group, four (3%) patients in the face-to-face group, and 20 (8%) patients in the usual care group had a serious adverse event. Interpretation Breathing retraining programmes improve quality of life in patients with incompletely controlled asthma despite having little effect on lung function or airway inflammation. Such programmes can be delivered conveniently and cost-effectively as a self-guided digital audiovisual programme, so might also reduce health-care costs. Funding UK National Institute of Health Research.

Original languageEnglish
Pages (from-to)19-28
Number of pages10
JournalThe Lancet Respiratory Medicine
Volume6
Issue number1
Early online date14 Dec 2017
DOIs
Publication statusPublished - 1 Jan 2018

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Respiration
Asthma
Randomized Controlled Trials
Quality of Life
Random Allocation
Health Care Costs
Patient Acceptance of Health Care
Pamphlets
Physical Therapists
National Institutes of Health (U.S.)
Telephone
General Practice
General Practitioners
Registries
Nitric Oxide
Clinical Trials
Inflammation
Physicians
Costs and Cost Analysis
Drug Therapy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Physiotherapy breathing retraining for asthma : a randomised controlled trial. / Bruton, Anne; Lee, Amanda; Yardley, Lucy; Raftery, James; Arden-Close, Emily; Kirby, Sarah; Zhu, Shihua; Thiruvothiyur, Manimekalai; Webley, Frances; Taylor, Lyn; Gibson, Denise; Yao, Guiqing; Stafford-Watson, Mark; Versnel, Jenny; Moore, Michael; George, Steve; Little, Paul; Djukanovic, Ratko; Price, David; Pavord, Ian D.; Holgate, Stephen T.; Thomas, Mike.

In: The Lancet Respiratory Medicine, Vol. 6, No. 1, 01.01.2018, p. 19-28.

Research output: Contribution to journalArticle

Bruton, A, Lee, A, Yardley, L, Raftery, J, Arden-Close, E, Kirby, S, Zhu, S, Thiruvothiyur, M, Webley, F, Taylor, L, Gibson, D, Yao, G, Stafford-Watson, M, Versnel, J, Moore, M, George, S, Little, P, Djukanovic, R, Price, D, Pavord, ID, Holgate, ST & Thomas, M 2018, 'Physiotherapy breathing retraining for asthma: a randomised controlled trial', The Lancet Respiratory Medicine, vol. 6, no. 1, pp. 19-28. https://doi.org/10.1016/S2213-2600(17)30474-5
Bruton, Anne ; Lee, Amanda ; Yardley, Lucy ; Raftery, James ; Arden-Close, Emily ; Kirby, Sarah ; Zhu, Shihua ; Thiruvothiyur, Manimekalai ; Webley, Frances ; Taylor, Lyn ; Gibson, Denise ; Yao, Guiqing ; Stafford-Watson, Mark ; Versnel, Jenny ; Moore, Michael ; George, Steve ; Little, Paul ; Djukanovic, Ratko ; Price, David ; Pavord, Ian D. ; Holgate, Stephen T. ; Thomas, Mike. / Physiotherapy breathing retraining for asthma : a randomised controlled trial. In: The Lancet Respiratory Medicine. 2018 ; Vol. 6, No. 1. pp. 19-28.
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abstract = "Background Despite effective pharmacotherapy, asthma continues to impair quality of life for most patients. Non-pharmacological approaches, including breathing retraining, are therefore of great interest to patients. However, clinicians rarely advocate breathing retraining and access to this intervention is restricted for most patients due to the limited availability of suitable physiotherapists and poor integration of breathing retraining into standard care. We aimed to assess the effectiveness of a digital self-guided breathing retraining intervention. Methods In this randomised controlled trial, we recruited patients from 34 general practices in the UK. Eligibility criteria for patients with asthma were broad, comprising a physician diagnosis of asthma, age of 16–70 years, receipt of at least one anti-asthma medication in the previous year, and impaired asthma-related quality of life (Asthma Quality of Life Questionnaire [AQLQ] score of <5·5). We developed a self-guided intervention, which was delivered as a DVD plus a printed booklet (DVDB). Participants were randomly assigned to receive either the DVDB intervention, three face-to-face breathing retraining sessions, or standard care, in a 2:1:2 ratio, for 12 months. Randomisation was achieved using the Southampton Clinical Trials Unit telephone randomisation service by use of random number generators. The primary outcome was the AQLQ score in the intention-to-treat population at 12 months. The trial was powered to show equivalence between the two active intervention groups, and superiority of both intervention groups over usual care. Secondary outcomes included patient-reported and physiological measures of asthma control, patient acceptability, and health-care costs. This trial was registered with International Standard Randomised Controlled Trial Number registry, number ISRCTN88318003. Findings Between Nov 5, 2012 and Jan 28, 2014, invitations to participate in the study were sent to 15 203 patients with general practitioner-diagnosed asthma, of whom 655 were recruited into the study. AQLQ scores at 12 months were significantly higher in the DVDB group (mean 5·40, SD 1·14) than in the usual care group (5·12, SD 1·17; adjusted mean difference 0·28, 95{\%} CI 0·11 to 0·44), and in the face-to-face group (5·33, SD 1·06) than in the usual care group (adjusted mean difference 0·24, 95{\%} CI 0·04 to 0·44); AQLQ scores were similar between the DVDB group and the face-to-face group (0·04, 95{\%} CI −0·16 to 0·24). There were no significant differences between the randomisation groups in FEV1 or fraction of exhaled nitric oxide. 744 adverse events occurred in 272 patients: 101 (39{\%}) of 261 patients in the DVDB group, 55 (42{\%}) of 132 patients in the face-to-face group, and 132 (50{\%}) of 262 in the usual care group, with patients reporting one or more event. 11 (4{\%}) patients in the DVDB group, four (3{\%}) patients in the face-to-face group, and 20 (8{\%}) patients in the usual care group had a serious adverse event. Interpretation Breathing retraining programmes improve quality of life in patients with incompletely controlled asthma despite having little effect on lung function or airway inflammation. Such programmes can be delivered conveniently and cost-effectively as a self-guided digital audiovisual programme, so might also reduce health-care costs. Funding UK National Institute of Health Research.",
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TY - JOUR

T1 - Physiotherapy breathing retraining for asthma

T2 - a randomised controlled trial

AU - Bruton, Anne

AU - Lee, Amanda

AU - Yardley, Lucy

AU - Raftery, James

AU - Arden-Close, Emily

AU - Kirby, Sarah

AU - Zhu, Shihua

AU - Thiruvothiyur, Manimekalai

AU - Webley, Frances

AU - Taylor, Lyn

AU - Gibson, Denise

AU - Yao, Guiqing

AU - Stafford-Watson, Mark

AU - Versnel, Jenny

AU - Moore, Michael

AU - George, Steve

AU - Little, Paul

AU - Djukanovic, Ratko

AU - Price, David

AU - Pavord, Ian D.

AU - Holgate, Stephen T.

AU - Thomas, Mike

N1 - Funding UK National Institute of Health Research.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background Despite effective pharmacotherapy, asthma continues to impair quality of life for most patients. Non-pharmacological approaches, including breathing retraining, are therefore of great interest to patients. However, clinicians rarely advocate breathing retraining and access to this intervention is restricted for most patients due to the limited availability of suitable physiotherapists and poor integration of breathing retraining into standard care. We aimed to assess the effectiveness of a digital self-guided breathing retraining intervention. Methods In this randomised controlled trial, we recruited patients from 34 general practices in the UK. Eligibility criteria for patients with asthma were broad, comprising a physician diagnosis of asthma, age of 16–70 years, receipt of at least one anti-asthma medication in the previous year, and impaired asthma-related quality of life (Asthma Quality of Life Questionnaire [AQLQ] score of <5·5). We developed a self-guided intervention, which was delivered as a DVD plus a printed booklet (DVDB). Participants were randomly assigned to receive either the DVDB intervention, three face-to-face breathing retraining sessions, or standard care, in a 2:1:2 ratio, for 12 months. Randomisation was achieved using the Southampton Clinical Trials Unit telephone randomisation service by use of random number generators. The primary outcome was the AQLQ score in the intention-to-treat population at 12 months. The trial was powered to show equivalence between the two active intervention groups, and superiority of both intervention groups over usual care. Secondary outcomes included patient-reported and physiological measures of asthma control, patient acceptability, and health-care costs. This trial was registered with International Standard Randomised Controlled Trial Number registry, number ISRCTN88318003. Findings Between Nov 5, 2012 and Jan 28, 2014, invitations to participate in the study were sent to 15 203 patients with general practitioner-diagnosed asthma, of whom 655 were recruited into the study. AQLQ scores at 12 months were significantly higher in the DVDB group (mean 5·40, SD 1·14) than in the usual care group (5·12, SD 1·17; adjusted mean difference 0·28, 95% CI 0·11 to 0·44), and in the face-to-face group (5·33, SD 1·06) than in the usual care group (adjusted mean difference 0·24, 95% CI 0·04 to 0·44); AQLQ scores were similar between the DVDB group and the face-to-face group (0·04, 95% CI −0·16 to 0·24). There were no significant differences between the randomisation groups in FEV1 or fraction of exhaled nitric oxide. 744 adverse events occurred in 272 patients: 101 (39%) of 261 patients in the DVDB group, 55 (42%) of 132 patients in the face-to-face group, and 132 (50%) of 262 in the usual care group, with patients reporting one or more event. 11 (4%) patients in the DVDB group, four (3%) patients in the face-to-face group, and 20 (8%) patients in the usual care group had a serious adverse event. Interpretation Breathing retraining programmes improve quality of life in patients with incompletely controlled asthma despite having little effect on lung function or airway inflammation. Such programmes can be delivered conveniently and cost-effectively as a self-guided digital audiovisual programme, so might also reduce health-care costs. Funding UK National Institute of Health Research.

AB - Background Despite effective pharmacotherapy, asthma continues to impair quality of life for most patients. Non-pharmacological approaches, including breathing retraining, are therefore of great interest to patients. However, clinicians rarely advocate breathing retraining and access to this intervention is restricted for most patients due to the limited availability of suitable physiotherapists and poor integration of breathing retraining into standard care. We aimed to assess the effectiveness of a digital self-guided breathing retraining intervention. Methods In this randomised controlled trial, we recruited patients from 34 general practices in the UK. Eligibility criteria for patients with asthma were broad, comprising a physician diagnosis of asthma, age of 16–70 years, receipt of at least one anti-asthma medication in the previous year, and impaired asthma-related quality of life (Asthma Quality of Life Questionnaire [AQLQ] score of <5·5). We developed a self-guided intervention, which was delivered as a DVD plus a printed booklet (DVDB). Participants were randomly assigned to receive either the DVDB intervention, three face-to-face breathing retraining sessions, or standard care, in a 2:1:2 ratio, for 12 months. Randomisation was achieved using the Southampton Clinical Trials Unit telephone randomisation service by use of random number generators. The primary outcome was the AQLQ score in the intention-to-treat population at 12 months. The trial was powered to show equivalence between the two active intervention groups, and superiority of both intervention groups over usual care. Secondary outcomes included patient-reported and physiological measures of asthma control, patient acceptability, and health-care costs. This trial was registered with International Standard Randomised Controlled Trial Number registry, number ISRCTN88318003. Findings Between Nov 5, 2012 and Jan 28, 2014, invitations to participate in the study were sent to 15 203 patients with general practitioner-diagnosed asthma, of whom 655 were recruited into the study. AQLQ scores at 12 months were significantly higher in the DVDB group (mean 5·40, SD 1·14) than in the usual care group (5·12, SD 1·17; adjusted mean difference 0·28, 95% CI 0·11 to 0·44), and in the face-to-face group (5·33, SD 1·06) than in the usual care group (adjusted mean difference 0·24, 95% CI 0·04 to 0·44); AQLQ scores were similar between the DVDB group and the face-to-face group (0·04, 95% CI −0·16 to 0·24). There were no significant differences between the randomisation groups in FEV1 or fraction of exhaled nitric oxide. 744 adverse events occurred in 272 patients: 101 (39%) of 261 patients in the DVDB group, 55 (42%) of 132 patients in the face-to-face group, and 132 (50%) of 262 in the usual care group, with patients reporting one or more event. 11 (4%) patients in the DVDB group, four (3%) patients in the face-to-face group, and 20 (8%) patients in the usual care group had a serious adverse event. Interpretation Breathing retraining programmes improve quality of life in patients with incompletely controlled asthma despite having little effect on lung function or airway inflammation. Such programmes can be delivered conveniently and cost-effectively as a self-guided digital audiovisual programme, so might also reduce health-care costs. Funding UK National Institute of Health Research.

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