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Physiotherapy breathing retraining for asthma: a randomised controlled trial

Physiotherapy breathing retraining for asthma: a randomised controlled trial
Physiotherapy breathing retraining for asthma: a randomised controlled trial

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.

2213-2600
19-28
Bruton, Anne
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Lee, Amanda
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Yardley, Lucy
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Raftery, James
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Arden-Close, Emily
0e18e0ef-cde3-447e-a593-e3bce3920226
Kirby, Sarah
9be57c1b-5ab7-4444-829e-d8e5dbe2370b
Zhu, Shihua
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Thiruvothiyur, Manimekalai
c3de44c0-564b-48e5-a287-84e3d4b20a8e
Webley, Frances
143f965b-866b-4455-89a5-d187f52e1cde
Taylor, Lyn
e548e5d1-ac6b-4243-b389-58ca751bd773
Gibson, Denise
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Yao, Guiqing
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Stafford-Watson, Mark
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Versnel, Jenny
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Moore, Michael
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George, Steve
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Djukanovic, Ratko
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Price, David
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Pavord, Ian D.
ee414b70-d199-4271-be4f-408da5bcad8f
Holgate, Stephen T.
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Thomas, Mike
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Bruton, Anne
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Lee, Amanda
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Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Raftery, James
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Arden-Close, Emily
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Kirby, Sarah
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Zhu, Shihua
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Thiruvothiyur, Manimekalai
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Webley, Frances
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Taylor, Lyn
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Gibson, Denise
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Yao, Guiqing
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Stafford-Watson, Mark
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Versnel, Jenny
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Moore, Michael
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George, Steve
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Little, Paul
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Djukanovic, Ratko
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Price, David
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Pavord, Ian D.
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Holgate, Stephen T.
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Thomas, Mike
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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. and Thomas, Mike (2018) Physiotherapy breathing retraining for asthma: a randomised controlled trial The Lancet Respiratory Medicine, 6, (1), pp. 19-28. (doi:10.1016/S2213-2600(17)30474-5).

Record type: Article

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.

Text Physiotherapy breathing retraining for asthma - Accepted Manuscript
Restricted to Repository staff only until 14 June 2018.
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More information

Accepted/In Press date: 7 November 2017
e-pub ahead of print date: 14 December 2017
Published date: January 2018
Additional Information: Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC-BY NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Identifiers

Local EPrints ID: 416517
URI: https://eprints.soton.ac.uk/id/eprint/416517
ISSN: 2213-2600
PURE UUID: 98e631f4-cceb-4efa-b7d2-b9050a0fdc7f
ORCID for Anne Bruton: ORCID iD orcid.org/0000-0002-4550-2536
ORCID for Sarah Kirby: ORCID iD orcid.org/0000-0003-1759-1356
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Ratko Djukanovic: ORCID iD orcid.org/0000-0001-6039-5612

Catalogue record

Date deposited: 21 Dec 2017 17:30
Last modified: 15 Feb 2018 17:31

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Contributors

Author: Anne Bruton ORCID iD
Author: Amanda Lee
Author: Lucy Yardley
Author: James Raftery
Author: Emily Arden-Close
Author: Sarah Kirby ORCID iD
Author: Shihua Zhu
Author: Manimekalai Thiruvothiyur
Author: Frances Webley
Author: Lyn Taylor
Author: Denise Gibson
Author: Guiqing Yao
Author: Mark Stafford-Watson
Author: Jenny Versnel
Author: Michael Moore ORCID iD
Author: Steve George
Author: Paul Little
Author: David Price
Author: Ian D. Pavord
Author: Mike Thomas

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