Re: GPs practicing ortho

The Buteyko method or Buteyko Breathing Technique is a practice used for the treatment of asthma. The method takes its name from the late Ukrainian doctor Konstantin Pavlovich Buteyko (Ukrainian: Бутейко), who first formulated its principles during the 1960s. The method is a physical therapy and several small clinical trials have shown that it can safely reduce asthma symptoms and the need for rescue medication, as well as increasing quality of life scores.. However, improvement takes time and commitment, requiring daily exercises over a period of weeks or months.

At the core of the Buteyko method is a series of reduced-breathing exercises that focus on nasal-breathing, breath-holding and relaxation. Buteyko’s theory was that asthmatics “chronically overbreathe” and the exercises are designed to teach asthmatics to breathe less. The goal is to retrain breathing to a normal pattern, akin to certain forms of Yoga.

The British Guideline on the Management of Asthma 2008 grants permission for health professionals in the United Kingdom to recommend Buteyko, stating that the method “may be considered to help patients control the symptoms of asthma”, having noted of primary importance the Cochrane review meta-analysis which concluded that there is “no change in routine measures of lung function”, although some high quality trials have suggested benefits of reduced symptoms and bronchodilator use, but no effect on lung function.

The Method
Although variations exist among teachers of the technique in different countries, the three core principles of Buteyko remain the same: Reduced breathing, nasal breathing and relaxation.

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. A common theme in Buteyko exercise is to hold one’s breath until it is uncomfortable – producing a feeling of air hunger. This feeling mimics the feeling of breathlessness that asthmatics typically experience during an asthma attack.

Rather than using traditional peak flow measurements to monitor the condition of asthmatics, Buteyko uses an exercise called the Control Pause (CP), defined as the amount of time that an individual can comfortably hold breath after a normal exhalation. With regular Buteyko reduced-breathing practice, asthmatics tend to find that their CP gradually increases and in parallel their asthma symptoms decrease.

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. In addition, breathing through the nose helps the body to maintain higher concentrations of carbon dioxide and nitric oxide in 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 CPAP machines – commonly used to treat sleep apnea – or using a jaw-strap or paper-tape to keep the mouth closed during the night. However, a study in 2009 showed that nasal breathing alone was not enough to cause an improvement in asthma symptoms.
Strictly nasal breathing during physical exercise is another key element of the Buteyko method. A study in 2008 found that it made exercise safer for asthmatics.[8] While breathing through the nose-only, asthmatics could attain a work intensity great enough to produce an aerobic training effect.[9]

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.

Teachers note that the method is not a substitute for medical treatment and reliever medication should be kept handy at all times and used as required. Reduction of medication should be done under supervision of the doctor prescribing the medication, as some steroids and other drugs should not be ceased too quickly. This aspect of Buteyko is merely a change in lifestyle that can minimize the chance of an attack occurring and reduce the severity by remaining calm and in control of breathing.