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Breathing Techniques

Breathing techniques are one of the most popular complementary therapies for asthma.1 There are several different types of breathing exercises. They can be grouped as:2,3

  • Breath retraining.
  • Exercises to strengthen the muscles that help you breathe.
  • Yoga breathing techniques.

Guidelines from the National Heart, Lung, and Blood Institute say that there is not enough evidence to know whether breathing techniques help people with asthma.4 Studies of breathing techniques are generally small. Most studies have very different designs. This makes it hard to compare the results. In contrast, the Global Initiative for Asthma states that breathing techniques may be useful.5 They should be used in addition to asthma medications, not in place of medication. According to these guidelines, this recommendation is based on high quality evidence.

How do breathing techniques work?

Breath retraining. Breath retraining is also called “hyperventilation reduction techniques.” Hyperventilation is also called overbreathing. When you hyperventilate, you breathe more quickly or deeply than normal.6 This leads to low carbon dioxide levels in your blood. Low carbon dioxide causes symptoms such as dizziness.

The goal of breath retraining is to normalize your breathing pattern. Another goal is to increase the amount of carbon dioxide in your blood.2,7 Some people say this reduces breathlessness and reverses airway narrowing.7 However, the role of hyperventilation in causing asthma symptoms is not clear.3

Examples of breath retraining techniques are Buteyko breathing, the Papworth method, and capnometry-assisted respiratory training.7,8 These techniques focus on:2,3

  • Shallow breathing.
  • Breathing through your nose.
  • Holding your breath after exhaling.
  • Using abdominal (core) muscles for breathing.

Inspiratory muscle training. Other breathing exercises strengthen the muscles that help you breathe. Having asthma may change the way that your chest muscles work. Some people with asthma have constantly overinflated lungs.9 This causes the chest muscles to shorten up. Eventually, the muscles do not work as well.

Breathing devices are used for breathing muscle training. Just as dumbells provide resistance for building arm muscle, these devices provide resistance to build the breathing muscles.9

Yoga. Yoga is another breathing technique for managing asthma. Yoga practice may include deep breathing exercises, postures, and meditation.7 Yoga encourages slow, regular breathing using abdominal muscles. You learn to breathe out slowly and fully.3 Yoga may lower anxiety and emotional overreaction to asthma symptoms.7

What are the benefits of using breathing techniques?

Improvement in quality of life. Most studies show that breathing techniques improve your quality of life.3,7 Yoga also improves asthma-related quality of life compared with usual care.10

Fewer asthma symptoms. Another fairly consistent finding is that people who use breathing techniques or yoga have fewer asthma symptoms.3,7,10

Stronger breathing muscles. Inspiratory muscle training makes the breathing muscles stronger.9 However, it is not clear what other benefits that leads to.

Less rescue medications. One study showed that people who used breathing techniques used less rescue medications.1 People in this study were taught one of two different techniques. They were told to try the technique for three to five minutes if asthma symptoms flared up. If the techniques did not help, they were told to use their inhaler. Both techniques reduced the amount of rescue medications used. This result suggests that breathing techniques may be effective because they help you to relax and feel more in control of your care.5 However, this was a very small study that has not been repeated in a large trial.4 It can be risky to delay necessary medical care when asthma symptoms flare up.4

Do breathing techniques improve lung function?

It is not clear whether breathing techniques improve lung function. In one review paper, there was no improvement in five of 11 studies. However, the other six studies showed a benefit.7 Compared with usual care or psychological interventions, yoga seems to improved lung function.10

What are the risks of using breathing techniques?

Breathing techniques are generally considered safe,7 but should not be used in place of conventional medical care during a severe asthma attack. Controlled breathing may help you to stay calm during an asthma attack, but it does not improve lung function.4 Using breathing techniques should not delay medical care during an asthma attack.

Who teaches breathing techniques?

You can ask a respiratory therapist or physical therapist to teach you breathing techniques. They often teach people with asthma how to breathe from their diaphragm or through pursed lips. Your diaphragm is a large muscle at the bottom of your chest cavity. As the diaphragm tightens and relaxes, you breathe in and out. Breathing exercises train your diaphragm to work better.11

Pursed lip breathing is used to slow breathing down and keep the airways open longer during exhalation. To do this, you take a breath in and exhale slowly through tightly puckered lips, similar to the way you blow out when you whistle.

Written by: Sarah O'Brien | Last Reviewed: September 2019.
  1. Slader CA, Reddel HK, Spencer LM, et al. Double blind randomised controlled trial of two different breathing techniques in the management of asthma. Thorax. 2006;61:651-656.
  2. Thomas M, Bruton A. Breathing exercises for asthma. Breathe. 2014;10:312-322. http://breathe.ersjournals.com/content/10/4/312.full
  3. O’Connor E, Patnode CD, Burda BU, et al. Breathing Exercises and/or Retraining Techniques in the Treatment of Asthma: Comparative Effectiveness [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Sep. Available from http://www.ncbi.nlm.nih.gov/books/NBK109355/
  4. National Heart, Lung, and Blood Institute. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma - Full Report 2007. Accessed 11/12/14 at: http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf
  5. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2014. Online Appendix. Accessed 2/26/15 at: http://www.ginasthma.org/local/uploads/content/files/GINA_Appendix_2014.pdf.
  6. Meuret AE, Ritz T. Hyperventilation in panic disorder and asthma: empirical evidence and clinical strategies. Int J Psychophysiol. 2010;78:68-79. http://www.ncbi.nlm.nih.gov/pubmed/20685222
  7. Freitas DA, Holloway EA, Bruno SS, et al. Breathing exercises for adults with asthma. Cochrane Database Syst Rev. 2013;10:CD001277.
  8. Ritz T, Rosenfield D, Steele AM, et al. Controlling asthma by training of Capnometry-Assisted Hypoventilation (CATCH) vs slow breathing: a randomized controlled trial. Chest. 2014;146:1237-1247.
  9. Silva IS, Fregonezi GA, Dias FA, et al. Inspiratory muscle training for asthma. Cochrane Database Syst Rev. 2013;9:CD003792.
  10. Cramer H, Posadzki P, Dobos G, Langhorst J. Yoga for asthma: a systematic review and meta-analysis. Ann Allergy Asthma Immunol. 2014;112:503-510.
  11. Agache I, Ciobanu C, Paul G, Rogozea L. Dysfunctional breathing phenotype in adults with asthma - incidence and risk factors. Clin Transl Allergy. 2012;2:18.
  12. Medline Plus. Hyperventiliation. Accessed 2/2/15 at: http://www.nlm.nih.gov/medlineplus/ency/article/003071.htm