Buteyko

Just found this while surfing, confirms what you said about Buteyko, I tried it and it was a waste of money, in fact I ended up in hospital, quite soon after

-- Barbara

From Mike:
Thanks, Barbara.

Buteyko is a form of endogenous breathing. Try it. It works for some, not all. But also realize that you may well have developed a non optimal breathing habit and someday it will begin to restrict your ability to breathe and probably so slowly you will never realize it until it is too late: Unless someone has shown you how to breathe fully and in balance without limiting your air supply. From what I have seen, Buteyko controls your responses and conditions you to use more of the same oxygen supply or have less need for oxygen. I believe it does too little to develop your breathing volume (FEV1) to the max. The Framingham Study USA clearly proved it was breathing volume that is the primary market for longevity. I will add efficiency of exhalation to reduce the oxygen cost of breathing + support in rebalancing the nervous system. It is NOT about CO2. Excessive CO2 is a byproduct of bad breathing, but it is not the root cause.

Environment, stress, allergies, nutrition, immune system dysfunction are very relevant factors but poor mechanics and coordination of the breathing are I believe what sets up the tendency towards asthma in the first place. Also, there is a HUGE emotional factor in asthma. See breath holding.

I have developed hands on and breathing exercise training techniques that have been very successful in reducing or eliminating inhaler and steroid usage. Sometimes in a matter of hours.

"There are people who "compensate" or are able to tolerate lower levels than that because of their lung disease process" quoted from an e-mail to me from a department head respiratory therapist connected with the Mayo clinic. mgw

The alt.support.asthma news group debates its virtues and downfalls ad nauseum. Its proponents tout it as a cure/treatment for everything from Asthma to Migraine, Hay Fever, Sinus and Allergies, Emphysema and COPD, Severe Snoring and Sleep Apnea. Its critics call it "Quack" Medicine, "Snake Oil," or worse, a money-making pyramid scheme to cheat desperate people out of their earnings. My opinion happens to agree with the critics.

According to Buteyko Breathing Page, "...asthma is simply your body's way of helping to restrict the amount of air you are breathing, so that more carbon dioxide is trapped in, and a possibly fatal event is avoided. It is just like plumbing -- if you want to reduce the flow through a pipe, simply make it smaller or clog it up." Buteyko is a technique of slowing respirations and decreasing Tidal Volume in an attempt to raise Alveolar CO2 (PACO2). They state that CO2 is an important factor in determining the pH of the blood, which is quite true, but they neglect taking into account the buffering effects of hemoglobin and bicarb, effects of hypoxia on breathing and PACO2, or account for the actions of asthma triggers.

This is in direct opposition to the National Institute of Health's definition found in the newest 1997 Asthma Treatment Guidelines: "Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli (NHLBI 1995). Moreover, recent evidence indicates that subbasement membrane fibrosis may occur in some patients with asthma and that these changes contribute to persistent abnormalities in lung function (Roche 1991)."

There was a study, The Brisbane Trials, done on the effects, or lack there of, of Buteyko. The study is flawed by losing its double blind component due to leaking the information of which group was receiving which therapy. A quote from the study: "This loss of blinding might have favorable influenced Buteyko subject's self assessment of asthma control and adversely affected the control group." The study also incorporates a great deal of subjective data, which is always suspect. In addition to that, the Buteyko subjects received more follow-up phone calls as to their conditions (seven as opposed to one), further skewing the subjective data. The only definitive data returned by this study was that steroid use was reduced to a greater extent in the Buteyko group. Interestingly at the end of 8 months, there were 4 Buteyko patients on oral Prednisone and 2 in the control group, and an equal number participants (3) were admitted to the hospital with acute asthma exacerbation.

Even the reduction of steroid use was not credited to the technique. Rather, the researchers stated that it was possible that the patient where already taking more steroids than needed before testing, quote: "Although during the run-in phase subjects were exhorted to use beta2 agonist therapy strictly on an as-required basis, it is likely that in many subjects, the use of these medications and of inhaled steroids was excessive."

The most crucial data to prove or disprove the technique, End Expiratory CO2, was unchanged. The whole basis of the technique was to raise this value. On top of this, there were no significant changes in PFT values (FEV1 and PEFR), thus no evidence that there was any improvement in the patient's asthma.

Let's look at a couple of facts dealing with Carbon Dioxide, Oxygen, Hyperventilation, and Asthma seen from the traditional medical point of view.

First off, Carbon Dioxide (CO2), is a poison, a biproduct of metabolism. The respiratory system eliminates CO2 and provides Oxygen (O2) for the bloodstream. CO2 levels effect our rate of breathing, but so does Oxygen levels.

When Asthma Triggers or allergic reactions cause an attack to start, the airways respond with inflammation and bronchospasm. Some of the alveoli become closed off and oxygen levels drop. Once enough alveoli stop taking part in gas exchange, oxygen levels reach a point that causes hypoxemia (low blood oxygen levels), see the article on arterial blood gases (ABGs) for explanation of changes in blood gas values during an asthma attack. Hypoxemia will cause the respiratory rate to increase. This increase will effect oxygen and carbon dioxide levels. Carbon dioxide levels will fall and the pH to rise. The drop in CO2 levels is the result, not the cause of an asthma attack.

I challenge the proponents of Buteyko to prove me wrong, not by rhetoric or flawed studies, but by proven, double blind, objective, and published data. I'd love to be proven wrong on this one guys, anything to add to the arsenal we have for this disease.

John Neal Rhodes, About.com

From Mike:
Unless infancy is plagued by abuse, poor nutrition (allergies from dairy, etc.) and extremely bad air, asthma is largely a mechanical issue. Abuse and fear of abandonment often the source. Even with poor nutrition, then the mechanical breathing coordination probably must be optimized to eliminate or minimize emergency drug intervention. I suspect that if you put 100 people in a room with bad air and you will have little to no asthma. Put 100 people together having eaten allergy-causing food, and the asthma symptoms will increase. Put 100 people together with bad air, bad food and poor breathing coordination, and you will have MANY people with asthma symptoms. I strongly suspect that the drugs and steroids group would like to keep it as a strictly non-mechanical issue so that people keep supporting the pharmaceutical industry. When you are a hammer, everything looks like a nail.

The people that advocate excessive drugs and steroids argue against Buteyko for what I deem the wrong reasons as below.

Dateline: 09/15/97

Continuing with the subject of Pulmonary Function Testing (PFT), we will look at some of the most basic terms, concepts, and how they relate to asthmatics.

Medical science divides our breathing pattern into a few basic components, these basic findings are important in assessing overall lung function. Understanding these findings and how they change during an asthma attack, helps in understanding some of the major lung changes that take place during an attack.

Below is an illustration of a basic Lung Sub test. Starting from the left, a patient is breathing normally for three breaths, takes as deep a breath as possible, then exhales as much as possible, and then returns to normal breathing. Click on the right hand side boxes for definitions of these major lung divisions.

From Mike:
This was not a proper Buteyko procedure, and I could not copy the graph, so please disregard it.

• TV, Tidal Volume, while at rest our normal breath is called the Tidal Volume. Stress, exercise, and illness (including asthma) will cause this volume to increase or decrease.

• IRV, Inspiratory Reserve Volume, IRV represents the amount of air you can breathe in after a resting inspiration. This is the amount of air volume your body can call upon when a deeper breath is needed during exercise or when your body is under stress. Your body increases respiratory volume when it needs more oxygen and needs to blow off excess carbon dioxide.

• ERV, Expiratory Reserve Volume, like the IRV, represents the reserve volume of air you can exhale after you have exhaled normally during a resting respiration (TV). Again, your body can call upon this reserve to increase the amount of air exchange.

• IC, Inspiratory Capacity, IC equals the total amount of air you can inhale from a resting exhalation. Another way of looking at IC: TV+IRV=IC

• FRC, Functional Reserve Capacity, FRC is the amount of air remaining in the lungs after a normal exhalation. FRC cannot be measured directly as with TV, IRV, ERV, IC, and VC. FRC is the sum of the ERV and RV (Reserve Volume) (FRC=ERV+RV). This is an important number as it relates to the increase and decrease of RV.

• VC, Vital Capacity, represents the total amount of air exhaled from a maximal inhalation to a maximal exhalation. The VC is similar to the FVC in Flow Volume Loops except for the "F". The "F" stands for Forced, so in the VC we do not want the patient to exhale forcefully as in the Flow Volume Loop. VC tend to be a little larger than FVC, especially in asthmatics, since the act of forcing the air out, as in FVC, causes the very small airways to collapse, trapping or slowing the flow of air. The more relaxed technique allows these small airways to remain open and more air exhaled.

• RV, Reserve Volume, the RV is the amount of air left in the lung after you blow out as much air as possible. This volume of air must be measured indirectly by use of gas diffusion or a Body Plethysmograph (also known as the "Body Box"). This is a very important value for asthmatics and one of the most critical. During an asthma attack the RV increases as a result of air trapping and extended incomplete exhalations due to airway collapse and constriction.

  Air trapping is caused by airways that totally close down trapping the air behind it. Since trapped air does not take part in gas exchange (the exchange of oxygen rich air for carbon dioxide laden air at the alveolar level), you don't get as much oxygen or get rid of as much carbon dioxide with each breath.

  As the blood levels of oxygen fall and carbon dioxide rise, your body tries to increase the depth (TV) and rate of breathing. But there is a catch, increasing RV also impacts on your reserve volumes (IRV and ERV), making them smaller. The physical sensation of this invasion of the other reserve volumes, the decreasing oxygen, and increasing carbon dioxide is shortness of breath. Prompt and appropriate treatment at this point usually halts the attack and symptoms are reversed.

  If left untreated and the asthmatic attack worsens, the increasing RV and incomplete exhalations eat away at your reserve volumes and can get to the point were you don't have enough reserves to keep up with your respiratory demand. Add to this muscle fatigue from increased work of breathing and increasing oxygen demands of respiratory muscles and you have a classic downward spiral. Blood levels of carbon dioxide continues to rise and oxygen fall, this is where asthma becomes respiratory failure. Respiratory failure can result in intubation and being placed on a ventilator, it can also result in death when treatment is delayed.

• TLC, Total Lung Capacity, TLC is the total maximum amount of air your lungs can hold. It is the total of all lung volumes or lung capacities (IRV+TV+ERV+RV) or (IC+FRC).

Decreasing peak flow meters (an aside about peak flow meter dangers from Mike) readings can give us an early warning to trouble. Stick to your asthma plan, don't delay treatment, and stay in contact with your asthma specialist. Follow your physician's advise for action to be taken for Peak Flow readings in the Green, Yellow, and Red Zone!

The Brisbane trial is the best western study of the Buteyko Method. The trial results indicated asthmatics using the Buteyko Method reduced use of beta-agonists (relievers) by 96% and steroids by 49%.

The trials were sponsored by the Australian Association of Asthma Foundations and lead by Professor Charles Mitchell, and Doctor Simon Bowler.

Bronchodilator Reduction

At the 12 week mark the group practicing Buteyko exercises had reduced their bronchodilator (reliever) medication by 96%, whereas the control group had no significant improvement.

Inhaled Steroid Reduction

The Buteyko Breathing Method allowed asthmatics to reduce their anti-inflammatory medication by 49% over three months, whereas the control group had no reduction.

Breathing Rates

The initial clinical testing demonstrated that all participants at rest hyperventilated. The Buteyko techniques teach asthma sufferers to reduce their breathing to normal levels.

Buteyko subjects reduced their hyperventilation by an average of 31% in their minute volume at twelve weeks. There was no significant change in the control group.

There was a correlation between the relative reduction in need for bronchodilators and the proportionate reduction in minute volumes in Buteyko subjects; that is, the subject's need for bronchodilator medication was related to the volume of air they breathed. The more air an individual breathed, the more bronchodilator that person needed.

This research supports:

• Known link between hyperventilation and asthma
• Effectiveness of the Buteyko Method in normalising breathing
• Relationship between the normalisation of breathing and the reduced need for medication

The outcome of the Brisbane trial has led the Australian National Asthma Campaign to include Buteyko in their next doctor's asthma Management Handbook, giving official blessing to the Buteyko Method.

At present, similar trials are planned in New Zealand, Australia, and the UK. The Victorian Asthma Foundation has made AUD$20,000 available for further research into Buteyko.

Click here to read a full version of the trial published in the Australian Medical Journal.

From Mike:
All the alt.support.asthma above seems to direct one toward the western medical model of drugs and steroids.

So. I would sum it up to say that Buteyko can be a good emergency medical approach for some. I believe it is inherently misleading towards the healthiest way to breathe. It has a distinct western medical "illness model" bias. Shallow breathing eventually will cause the rib cage to be unable to expand as it should. Shallow breathing also inhibits the natural massage of the internal organs. Making the body better efficient to use less oxygen is I believe sub-optimal. Making an organism more efficient such as endogenous respiration (compressing intra lung pressure to make oxygen more concentrated in the blood) is good (more efficient) up to a point. Efficiency does not beget ease if it is very much smaller in volume. Efficiency can only compensate for volume up to a certain point.

Also, there is a nervous system aspect that has to do with the parasympathetic depth and its relationship to the relaxation/rest/digest/heal response. Without volume and rib cage expansion there is loss of deepest rest. The ultimate for relaxation, healing, oxygenation would be volume AND efficiency. Then the optimal capacity becomes reachable. Otherwise volume and ease are slowly lost to efficiency. Efficiency also has a stress component to it. Volume does not. The larger car engine runs slower and smoother. The smaller one faster and less smooth.

Take careful note of the oxygen information on the upper left of this page. Judge for yourself whether you believe CO2 is more important or is oxygen the primary focus for a long, healthy and vibrant life. Note the information on hyperbaric oxygen chambers. If the CO2 theory were accurate, then having massive amounts of O2 would cause massive wheezing, and clearly it does not. Educate yourself, and make your choice.

Newspaper interview.

I also need to mention the fact that I as interviewed for the Daily Mirror in London about an article they were doing on "breathing". It sells 8 million daily and I was very happy about doing the interview. The interviewer spent around 4 hours over 2 days in transatlantic phone calls asking me many, many questions. When I finally saw the article I was aghast to see that it was really about Buteyko. This fact had never been mentioned. I was set up and quoted completely out of context as I had no idea the article was being written about Buteyko.

That said... I have developed a simple way to change the mechanics of the breath that begins to reduce need for excessive inhaler usage. I call it the Squeeze and Breathe. I have purposefully linked this page the OXYGEN menu above and to the left. It is part of my Rapid Breathing Development self-help program. Or begin with it or http://www.breathing.com/tips-asthma.htm and go from there.

See also how this "Beginning" is used by accessing the TIPS at www.breathing.com/tips-asthma.htm

Med J Aust. 2001 Jan 15;174(2):64-5.

The effects of carbon dioxide on exercise-induced asthma: an unlikely explanation for the effects of Buteyko breathing training.

Al-Delaimy WK, Hay SM, Gain KR, Jones DT, Crane J.

Wellington School of Medicine, New Zealand.

OBJECTIVES: To examine the effect of breathing 3% CO2 on exercise-induced asthma (EIA), as a raised airway CO2 level is suggested to mediate the effects of Buteyko breathing training (BBT).

DESIGN: Double-blind crossover study, using a standard laboratory-based exercise challenge, with EIA defined as a fall of 15% or greater in the forced expiratory volume in one second (FEV1) within 30 minutes of completing a standard exercise protocol. SUBJECTS: 10 adults with confirmed EIA.

INTERVENTION: Air enriched with 3% CO2 during and for 10 minutes after exercise.

OUTCOME MEASURES: Maximum percentage fall in FEV1 after exercise. Area under curve (AUC) of the decrease in FEV1 with time.

RESULTS: Mean maximum fall in FEV1 was similar: 19.9% with air, and 26.9% with 3% CO2 (P = 0.12). The mean AUC for the total 30-minute post-exercise period was 355 for air and 520 for 3% CO2 (P = 0.07). After discontinuing the 3% CO2 at 10 minutes after exercise, there was a further and sustained fall in FEV1. Mean AUC for the period 10-30 minutes post-exercise was significantly greater for CO2 than air (275 and 137, respectively [P = 0.02]). Mean minute ventilation was increased when subjects exercised breathing 3% CO2: 77.5 L/min for 3% CO2, compared with 68.7 L/min for air (P = 0.02).

CONCLUSION: Breathing 3% CO2 during exercise does not prevent EIA. The shape of the FEV1 response curve after 3% CO2 suggests that a greater degree of EIA (because of increased minute ventilation during exercise) was opposed by a direct relaxant effect of CO2 on the airway. Increased airway CO2 alone is an unlikely mechanism for the reported benefits of BBT; nevertheless, further study of the effects of voluntary hypoventilation in asthma is warranted.

Publication Types:

• Clinical Trial
• Randomized Controlled Trial

From Mike:
In closing, the bottom line is that asthma symptoms have been reduced with improved diet, environment, breath holding, catharsis and rebalancing one's breathing. None of these involve drugs or steroids. Try them all. Better breathing is possible for everyone.

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