Last May 6, 2014, the Global Initiative for Asthma (GINA), launched the latest update of their famous guidelines for asthma. The latest update was made to be easier to read and understand. The update included changes in the definition of asthma, emphasis on confirming the asthma diagnosis, and updated strategies in asthma care. Notable in this year’s GINA guidelines is the publication of a separate Appendix.
Breathing Exercises (such as Buteyko Method) was given an Evidence Level “A”, which is the highest grade of evidence GINA assigns.
GINA 2014 now recommends for healthcare practitioners to consider the use of non-pharmaceutical strategies and interventions for asthma patients with one or more risk factors. These risk factors include having 1 or more severe exacerbation in the last year, exposure to tobacco smoke, low FEV1, obesity, major psychological problems, major socioeconomic problems, confirmed food allergy, allergen exposure if sensitized, sputum eosinophilia, and any patient with 1 or more risk factors for exacerbation.
The Buteyko Method has been included as a non-pharmaceutical intervention. Referred to as “breathing exercises”, it has been advised as a useful supplement to conventional asthma management. It was given an Evidence Level “A”, which is the highest grade of evidence GINA assigns to any form of treatment.
This development perhaps mean that studies on breathing exercises including the Buteyko Method have sufficiently convinced the authors of GINA. Studies which can do this usually consist of high quality Randomized Controlled Trials (RCTs) and Metanalysis. Although the main document merely mentioned “breathing exercises”, the separate appendix clarified that the “breathing exercises” included the Buteyko Method and the Papworth Method.
Also notable in the document was the mention of hyperventilation and dysfunctional breathing which can occur with asthma for people as young as 12 years old. The symptoms of these 2 entities are dizziness, paresthesia, and sighing. The Buteyko Method as a form of breathing retraining is the treatment of choice for dysfunctional breathing according to the British Thoracic Society (BTS) Guidelines. It is also mentioned in the BTS asthma guidelines.
STRENGTHS AND WEAKNESSES OF THE NEW GINA RECOMMENDATIONS
The GINA guidelines’ now promotes the breathing exercises as a mainstream “non-pharmaceutical” option. It is lamenting to note that the authors have decided to call the Buteyko Method (along with the Papworth Method) as “Breathing Exercises” in the main document. In previous documents, they mentioned the Buteyko Method by name (See article Buteyko and GINA). This connotes that although they have noted a high level of evidence for breathing exercises, they avoid endorsing a particular “brand” of program.
Beyond breathing, the Buteyko Method promotes a healthy diet, stress management, and allergen avoidance.
Merely being called “Breathing Exercises” can lead to specific dangers. Other forms of breathing exercises which lack evidence may be mistakenly recommended as well. Although, the document’s appendix did not state which other breathing programs are recognized, only the Buteyko Method and the Papworth Method are mentioned by name. It is doubtful too that many health care workers will read through the appendix thoroughly.
Being included in “breathing exercises” also does not give complete justice to the Buteyko Method. Beyond breathing, the Buteyko Method also promotes a healthy diet, stress management, and allergen avoidance. Healthy diet, stress management, and allergen avoidance are also included in GINA as possible non-pharmaceutical interventions.
The new GINA guidelines broadens the indications for physicians and health care workers to recommend the Buteyko Method. Previous GINA versions state that the Buteyko Method was recommended for those overusing their medications. The 2014 version now states that it can be recommended for any asthma patient with a risk factor. This of course can be almost any one with asthma.
We hope that in the future, the Buteyko Method and other breathing exercises may be cited for indications such as exercise-induced bronchoconstriction, hyperventilation, dysfunctional breathing, rhinitis, and other problems which they may have potential for. We hope too that further studies into breathing retraining programs may delineate their differences and highlight the strengths of each one.
For the history of GINA click here
For the history of Buteyko in GINA click here
The GINA guidelines is available at http://www.ginasthma.org/documents/4
The GINA guildelines appendix can be downloaded at http://www.ginasthma.org/local/uploads/content/files/GINA_Appendix_2014.pdf
The BTS guidelines on dysfunctional breathing can be found here: https://www.brit-thoracic.org.uk/portals/0/guidelines/physiotherapy/physiotherapyguideline/physiofullguideline.pdf
Breathing Expert blog: http://www.breathingexpert.com/blog
Dr. Charles Edward G. Florendo is a family medicine and health optimization medicine specialist. He is also probably the first hyperventilation and dysfunctional breathing specialist in Southeast Asia. He has taught breathing retraining to patients and healthcare workers in Africa, United States, and the Philippines. He holds an advanced certificate in Buteyko from the Buteyko Breathing Association (UK). He is presently the medical adviser of the Buteyko Clinic International and a consultant at Mary Chiles General Hospital (Philippines) and the Clinica Salutare (Philippines).
You may email him at email@example.com
Disclaimer: This article is a review of the GINA guidelines and reflects the opinion of its author. This article does not represent, not intended to be, and does not constitute medical advice. The mention of the Buteyko Method, Papworth Method, and other breathing exercises by the Global Initiative for Asthma guidelines does not constitute an endorsement of any of the said programs by the Global Initiative for Asthma committee, or its participating bodies. Copyrights and trademarks mentioned or displayed in this article belong to their respective owners. The author is not affiliated with the Global Initiative for Asthma.