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The Buteyko Method, or Buteyko Breathing Technique (BBT) is part of a holistic health philosophy that includes a set of breathing exercises developed by the Ukrainian born, Russian doctor, Konstantin Pavlovich Buteyko (Russian: Бутейко). '''

The Buteyko method has been scientifically proven to be a safe, highly effective and complementary technique for treating asthma. It is widely believed to be effective in a number of other ailments, although clinical evidence is lacking for these.

The exercises are believed to work by retraining, or correcting, breathing patterns. At present it is mainly used for asthma, sleep apnea, anxiety and panic attacks. Given the long list of symptoms attributed to poor breathing patterns by BBT's proponents, (ref.1,5,7,13,15,20,23,24,25) its application is growing world-wide, despite scepticism from the mainstream medical community. Some of this scepticism stems from the lack of an effective physiological mechanism to explain why Buteyko exercises work. Buteyko's own physiological mechanism, the "CO2 theory", is popular but has more opposing than supporting clinical evidence.

Up to date theories, including Nitric Oxide balancing and ANP production, have been proposed and studies continue.

Chronic hyperventilation has been discussed in the medical literature over most of the last century. (ref. 1,2,13,15,23,24).

Buteyko has developed breathing exercises akin to certain forms of Yoga in order to normalise breathing patterns.

Advocates of the technique claim that asthmatics can eliminate the need for inhalers and live a medication-free life. Sceptics claim that the causal relation is flawed and there is little evidence there is any effect other than placebo, although this has now been ruled out by a number of controlled clinical trials. (See Clinical Trial list at end.)

Theory

Central to the method is the theory that respiratory illnesses are a subset of illnesses caused by habitually breathing excessive volumes of air - what Buteyko calls "hidden hyperventilation". In particular, Buteyko claimed that the lungs of asthmatics contained too little carbon dioxide. One of the effects of low CO2 is a tightening of the Oxy-hemoglobin bond, which prevents proper oxygenation of the tissues. This well established physiological principle is known as the "Bohr effect"(ref.5,7,15,23,25). Buteyko also supported the view of others (ref.14) that chronic hyperventilation was attributable largely to the sedentary modern life style.

Practice

The technique revolves around reduced breathing exercises designed to increase the 'control pause' - the amount of time the individual can survive comfortably between exhaling and having to breath in again.

Typically, asthmatics are measured to have control pauses of less than 15 seconds. Using reduced breathing exercises, people are able to increase their control pause. As a person's control pause increases, so their symptoms decrease.

Buteyko also reminded us of the physiological importance of breathing through the nose rather than the mouth. Apart from protecting the airways by humidifying, warming, cleaning and sterilizing air entering the lungs, breathing through the nose also reduces the tendency to hyperventilate.

Asthma Attack

Under the Buteyko model, the first feeling of an asthma attack results in a short period of over-breathing. By controlling this initial over-breathing phase the asthmatic can stop a vicious circle of over-breathing developing.

This means that asthma attacks can often be stopped simply by breathing less. Many asthmatics chronically overbreathe (ref.4,16), causing (or providing a catalyst for) various physiological symptoms, asthma attacks among them (ref.4,20,23). There's also the fact that, by practice of reduced volume breathing, the control pause can be lengthened significantly so something on a physiological level is clearly being changed or retrained. It has been demonstrated that blood CO2 levels do increase during the practice of reduced volume breathing.

Note that the method isn't designed to be primarily a treatment for an asthma attack. It's effectively a change in lifestyle which is designed to minimise or stop attacks occurring in the first place.

The technique is very popular in Australia and is starting to get a foothold in the UK. It's normally learned via short courses from teachers trained in the technique. It's widely agreed that it must be learned from a teacher and that students may cause harm by attempting to self-teach, since they can easily make their breathing worse instead of better.

By the end of Buteyko treatment, most asthma and even emphysema suffers are able to reduce their medication, such as inhalers (ref.2).

What Critics say

Critical analysis

Buteyko courses are considered by some to be expensive and attendees are discouraged from teaching the technique to others. Additionally, many both inside and outside the medical community consider it to be another example of quack medicine. This situation isn't helped by the great many medical conditions, many unrelated to respiratory complaints, which the technique claims to alleviate.

Advocates say the profound impact of low carbon dioxide on the biochemistry of the body is well established. (Ref. 7,12,13,15,20,23,25). Such biochemical disturbances could disrupt any of the normal body functions and systems, such as the immune system, one of the major problems in asthma.

Furthermore the claimed success against asthma is supposed to be the increased CO2 concentration, yet asthma sufferers are noted for increased levels of CO2 during attacks. This is a side effect of the inability to exhale fully. Critics suggest that making the CO2 problem even worse one is unlikely to improve the condition.

On the other hand, the Buteyko argument holds that since high blood CO2 is only seen in severe asthma attacks (ref.4,16), when there is already significant damage to the lungs, the functioning parts of the lungs are over-ventilated to compensate and will therefore have low CO2. Studies have, in fact shown, that during mild asthma attacks, before there is significant damage to the lungs, the blood CO2 is extremely low with oxygen still in the normal range (ref.4,16). This is considered an important pointer to the cause of asthma.

Others suggest that asthma is greatly affected by general mental state, and relaxation of any form is known to be fairly effective, which is readily explained by Buteyko's hyperventilation theory. Early claims that no scientific evidence has been presented to suggest this is anything but placebo, have been rebuffed by the clinical studies into Buteyko.

Clinical studies

In 1995 a randomized double blind placebo controlled study on the technique was run in Brisbane, Australia (ref.2).

People in the test were taught either the Buteyko method or a placebo breathing method involving standard physiotherapy relaxation and breathing, and changes in behavior noted. The results of the test showed no improvement in lung function such as forced expiratory volume in one second or peak flow, of Buteyko compared with the placebo technique. However, since these tests involve a hyperventilation maneuver, the effect of which is to increase specific airway resistance by around 70% in asthmatics (ref.5,9,25), the scientific validity of these tests for assessing asthma should be questioned.

Additionally, the tests also showed no statistically significant increase in actual CO2 paradoxically in spite of statistically significant reduction in minute volume (Ref 2).

However, the study detected statistically significant changes in drug use, with the Buteyko group showing a decrease in inhaler use. To quote the summary of the trial: "Those practising Buteyko technique reduced hyperventilation and their use of beta2-agonists. A trend toward reduced inhaled steroid use and better quality of life was observed in these patients without objective changes in measures of airway calibre."

From the data given the reduction in beta2 agonists (e.g.: Ventolin) was 96% and the reduction in steroids 49%

The results were also clouded because it was later learned that the Buteyko group was, according to normal Buteyko practice, being telephoned by the Buteyko teacher during the trial, something that was happening to a lesser extent with the control group. However, this theory was dismissed by another double blind controlled trial in New Zealand in 2003, that particularly sought to address this question. (See clinical trials: 4)

Other interesting findings from the Brisbane trial were: 1. Asthmatics do, indeed, have higher minute volumes and lower CO2 than healthy people. 2. Medication reduction was statistically significantly related to reduction in minute volume. 3. Quality of life scores increased significantly. An earlier report of a reduction in symptom score by 71% was not reported in the MJA paper.

Other double blind studies, such as the 2003 New Zealand study, have shown repeated favourable results under more controlled conditions (clinical trials:4).

It is so far clear that there has to be more research on both the method and the theory to satisfy both advocates as sceptics of the Buteyko-method. Since there is more knowledge of the role of Nitric-oxide on respiration, the theory as described above should be revised to be up to date. (Maybe someone can write something about research on the role of NO in respiration?)

Literature

External links

Clinical Trials

1. See Reference 2

2. Cooper S, Oborne J, Newton S, Harrison V, Thompson-Coon J, Lewis S, Tattersfield A, "Effect of two breathing exercises (Buteyko and Pranayama) in asthma: a randomized controlled trial.", Thorax, VOL 58, 2003, 674-679

3. McGowan J, "Health Education: Does the Buteyko Institute Method make a difference?", Thorax, VOL 58/Sup3, December 2003, p28

4. McHugh P, Aitcheson F, Duncan B, Houghton F, "Buteyko Breathing Technique for Asthma: an effective intervention.", The Medical Journal of New Zealand, VOL 116, 12 December 2003,

5. Opat AJ, Cohen MM, Bailey MJ, Abramson MJ, "A Clinical Trial of the Buteyko Breathing Technique in Asthma as Taught by Video", J. of Asthma, VOL 37(7), 2000, 557-564

6. McHugh P, Duncan B, Houghton F, "Buteyko breathing technique and asthma in children: a case series.", The New Zealand Medical Journal, VOL 119 No1234, May 2006

References

References:

1. Bass C, "The hyperventilation syndrome", Respiratory Diseases in Practice, Oct/Nov 1990, 13-16

2. Bowler S, Green A, Mitchell C, "Buteyko breathing and asthma: a controlled trial", Medical J. of Australia, VOL 169, December 1998, 575-578

3. Brasher RE, "Hyperventilation Syndrome", Lung, VOL 161, 1983, 257-273

4. Clarke PS, Gibson J, "Asthma, hyperventilation and emotion", Australian Family Physician, VOL 9, 1980, 715-719

5. Cluff RA, "Chronic Hyperventilation and its treatment by physiotherapy: discussion paper", J of the Royal Society of Medicine, VOL 77, September 1984, 855- 861

6. DaCosta JM, "On irritable heart: a clinical study of a form of functional cardiac disorder and its consequences.", Am J Med Sci, VOL 61, 1871, 17-53

7. Demeter SL, Cordasco EM, "Hyperventilation syndrome and asthma", The American Journal of Medicine, VOL 81, December 1986, 989-994

8. Donnelly PM, "Exercise induced asthma: The protective role of CO2 during swimming", The Lancet, VOL 337, 19 January 1991, 179-180

9. Gayrard P, Orhek J, Grimaud C, Charpin J, "Bronchoconstrictor effects of deep inspiration in patients with asthma", Am Rev Respir Dis, VOL 111, 1975, 433-439

10. Guyton AC, Hall JE, "Textbook of medical physiology", Chemical control of respiration, PUBLISHER: WB Saunders; ISBN 0-7216-5944-6; 1996; EDITION: 9; PAGES: 527-528.

11. Hibbert GA, Pilsbury DJ, "Demonstration and Treatment of Hyperventilation Causing Asthma", British J. of Psychiatry, VOL 153, 1988, 687-689

12. Kazarinov VA, "Buteyko Method: The experience of implementation in medical practice", The biochemical basis of KP Buteyko's theory of the diseases of deep respiration, EDITOR: Buteyko KP; PUBLISHER: Patriot Press Moscow; 1990; PAGES: 198-218. available from http://members.westnet.com.au/pkolb/biochem.htm

13. Lum LC, "Hyperventilation: The tip and the iceberg", J Psychosom Res, VOL 19, 1975, 375-383 http://members.westnet.com.au/pkolb/Lum.pdf

14. Magarian GJ, "Hyperventilation syndrome: infrequently recognized common expressions of anxiety and stress.", Medicine, VOL 61, 1982, 219-36

15. Magarian GJ, Middaugh DA, Linz DH, "Hyperventilation Syndrome: a diagnosis begging for recognition", West J Med, VOL 138, 1983, 733-736 http://members.westnet.com.au/pkolb/Magarian.htm

16. McFadden WR, Lyons HA, "Arterial-Blood Gas Tension in Asthma", The New England Journal of Medicine, VOL 278:19, 9 May 1968, 1027-1032

17. Mck Jefferies,MD FACP "Safe uses of Cortisol." PUBLISHER: Charles C.Thomas - Springfield. ISBN 0-398-06621-3; 1996; EDITION: 2;

18. Morgan WP, "Hyperventilation Syndrome: a review", Am Ind Hyg Assoc J, VOL 44:9, 1983, 685-689

19. Neill WA, Hattenhauer M, "Impairment of Myocardial O2 supply due to Hyperventilation", Circulation, VOL 52, November 1975, 854-858

20. Nixon PGF, "Hyperventilation and cardiac symptoms", Internal Medicine, VOL 10:12, December 1989, 67-84

21. Pfeffer JM, "Hyperventilation and the hyperventilation syndrome", Postgrad Med, VOL 60(Sup.2), 1984, 12-15

22. Pfeffer JM, "The etiology of the hyperventilation syndrome", Psychother Psychosom, VOL 30, 1978, 47-55

23. Sher TH, "Recurrent chest tightness in a 28-year-old woman", Annals of allergy, VOL 67, Sept. 1991, 310-314

24. Tavel ME, "Hyperventilation syndrome - Hiding behind pseudonyms?", Chest, VOL 97, 1990, 1285-1288

25. Waites TF, "Hyperventilation - chronic and acute", Arch Intern Med, VOL 138, 1978, 1700-1701

26. Wheatley CE, "Hyperventilation syndrome: A frequent cause of chest pain", Chest, VOL 68:2, August 1975, 195-199

Bibliography of Russian texts

(from the paper by Kazarinov VA, reference 12)

1. Buteyko K.P. Oscillogtaphs and Hypertonia. Is "Enhanced" Breathing Beneficial? Izobretatell I Ratsionalizator. 1962. No.5.

2. Buteyko K.P. Shurgaya Sh.I.Functional Diagnosis of Coronary Disease. Thesis from Symposium on Surgical Treatment of Coronary Disease, Moscow, 1962.

3. Buteyko K.P., Demin D.V. Cross-correlational Analysis of Physiological Functions. Izv.Sib.Otd. AN SSSR. 1963, No.6. Ser.biol.med.nauk.Vypusk Issue) 2.

4. Buteyko K.P., Odintsova M.P., Demin D.V. The Influence of Hyper and Hypoxaemia on the Tonus of Peripheral Vessels. Proceeding of the Second Siberia Scientific Conference of Therapists, Irkutsk, 1964.

5. Buteyko K.P., Demin D.V., Odintsova M.P. The Application of Regressive Analysis for Differentiation of the Influence of Gaseous Components of the Arterial Blood on the Functional State of Fine Peripheral Arteries. Materialy Vtoroy sib. Nauchnoy Konf. Terapevtov. Irkutsk, 1964.

6. Buteyko K.P., Demin D.V.,, Odintsova M.P. The Mathematical Analysis of Interreaction of Physiological tigation Factors. Physics-Mathematical Methods for Inves in Biology and Medicine. Materialy Pervoy Novosib- Conf., Novosibirsk/, 1965.

8. Buteyko K.P., Demin Dove,, Odintsova M.P. The Relationship between the Ventilation of the Lungs and the Tone of Arterial Vessels in Patients with Hypertonic Disease and Stenocardia. Fiziologichni Zhurnal, 1965. Vol.II, No.5 (in Ukrrainian).

9. Buteyko K.P., Demin D.V., Odintsova M.P. The Relationship between the Carbon Dioxide in Alveoles, Arterial Pressure and Cholesterol in Blood in Patients with Hypertonic Disease and Stenocardia. Materialy Tretley Sib. Nauchn. Conf. Terapevtov. irkutsk, 1965. (Proceedings of the Third Siberian Sci. Conference of Therapists).

10. Buteyko K.P. The Cross-Correlational Technique of Analysis of Physiological Regulations. Materialy VII Vsesoyuzn. Conf. po Avtomat. Kontrolyu i Metodam Elektr. Izmereniy. Novosibirsk, 1965, (Proc. of the VII-Union Conference on Automatic Control and Methods for Electrical Measurements).

11. Buteyko K.P. The Complex Investigations into Functional Systems in Biology and Medicine. (Reports of the Medical Electronics Section of the 9th Regional Sci.-Tech. Conference Dedicated to the Day of. Radio). Dokl. Sektsii Med. Elektroniki 9-oy Obl. Nauchn.-Tekhn. Conf. Posvyashchennoy Dnyu Radio, Novosibirsk, 1966.

12. Buteyko K.P., Demin D.V., Odintsova M.P. The Relationship between the Partial Pressure in Alveolar Air and the Tone of Peripheral Arteries in Patients with Hypertonic Disease and Stenocardia. Zdravookhranenie Turkmenistana. 1966. No.2 (Public Health of Turkmenistan. 1966, No.2).

13. Buteyko K.P., Demin D.V., Odintsova M.P. The Effect of Carbon Dioxide on the Coronary Efferent Arteries in Patients with Hypertonic Disease and Atherocardiosclerosis. Zdravookhranenie Kazakhranenie Kazakhstana. 1966. No. 6 (The Kazakhstan Public Health, 1966, No.6).

14. Buteyko K.P., Demin D.V., Odintsova M.P. A Linear Model for Regulation of Vascular Tone by Gaseous Components of Arterial Blood. Dokl. 9-oy Obl. Nauchn.-Tekhn. Conf., Posvyashchennoy Dnyu Radio. Novosibirsk, 1966.

15. Buteyko K.P. et al. The Influence of Intentional Regulation of Respiration on Some Physiological Functions at Altitude. Voprosy Aviatsionnoy Meditsiny (Problems of Aviation Medicine). Moscow, 1966.

16. Buteyko K.P., Chasovskikh S.F.,, Demin D.V. An Indirect Determination of the Degree of Hypertension of Pulmonary Circulation According to the Data of Calibrated Phonocardiography. Materialy 4-oy Povolzhskoy Conf. Fiziologov, Biokhimikov i Farmakologov- Saratov, 1966. T.l. (Proceedings of the 4th Volga River Conference of Physiologists, Biochemists and Pharmacologists. Saratov, 1966, Vol.1).

17. Buteyko K.P., Odintsova M.P., Demin D.V. The Influence of Hyper- and Hypoxaemia on the Tone of Arterial Vessels. Sovetskaya Meditsina. 1967. No.3 (Soviet Medicine, 1967. No3)-

18. Murakhtanova Z.M., Buteyko K.P. et al. Concerning Characteristic of External Respiration in Patients with Scoliosis. Sbornik Rabot Novosib. Instituta Travmatologii i Ortopedii. Novosibirsk, 1967. (Collection of Reports of the Novosibirsk Institute of Traumatology and Orthopedics. Novosibirsk, 1967).

19. Buteyko K.P. et al. The Use of Correlation Methods for Investigation of Cardiovascular System. Mat. Metody v Aviatsionnoy i Kosmicheskoy Meditsine. - Moscow, 1967 (Mathematical Methods in Aviation and Cosmic Medicine).

20. Buteyko K.P., Demin D.V., Odintsova M.P. The Mutual Information of Heartrhythm and Other Physiological Human Functions according to the Data of Cross-Correlative Analysis. Mat. Metody Analiza Sergechnogo Ritma. Moscow, 1968 (Mathematical Methods for Analysis of Heart Rhythm. M., 1968).

21. Buteyko K.P., Odintsova M.P., Nasonkina P.S. The Ventilation Test for Patients -with Bronchial Asthma. Vrachebnoe Delo, 1968, No.4 (Medical Treatment. 1968, No.4).

22. Buteyko K.P., Odintsova M.P. Hyperventilation as One of the Reasons for the Spasm of Nonstriated Musculature of the Bronchi and Arterial Vessels. Materialy 4-oy Nauchn.-Praktich. Conf. po Vrachebn- Kontrolyu i Lechebnoy Fizkulture. Sverdlovsk, 1968 (Proceedings of the 4th Scientific-Practical Conference on Medical Control and Medical Physical Culture. Sverdlovsk, 1968).

23. Buteyko K.P. Complex Methods for Investigation of Cardiovascular System and Respiration. Voprosy Funktsionallnoy Diagnostiki. Novosibirsk,, 1969 (Problems of Functional Diagnostics. Novosibirsk, 1969).

24. Buteyko K.P. The Theory of CO2-Deficient Diseases of Civilisation as an Adaptation to the Evolution of Atmosphere. Kiberneticheskie Aspekty Adaptatsii Sistemy "Chelovek-Sredall. Tez. Seminars. Moscow, 1975 (Cybernetic Aspects of Adaptation of the System "Man-Environment". Seminar Thesis, M., 1975).

25.Buteyko K.P. Therapy of Hemohypocarbia. Patent No.1067640. Registered in the State Record of Inventions of the U.S.S.R., 15.9.1983.

26. Buteyko K.P., Genina V.A. Concerning Pathogenesis of Asthma Attack during Physical Exercise. Non-medical Methods for Treatment of Patients with Bronchial Asthma. Tez. Dokl. Vsesoyuzn. Conf. Moscow, 1986 (Report Thesis from the All-Union Conference. M., 1986).

27. Buteyko K.P., Genina V.A. The Comparison of Justification and Effectiveness of the Complex, Symptomatic and Monoetiological Principles of Treatment of Bronchial Asthma and Other Allergies. Ibid.

28. Buteyko K.P., Genina V.A. The Theory of Discovery of Deep Respiration (Hypervention) as a Main Cause of Allergic,, Bronchial-vascular-spasmodic and Other Diseases of Civilisation. Ibid.

29. Buteyko K.P., Genina V.A., Nasonkina N.S The Reactions of Sanogenesis in Medical Treatment Using the ISDR Method. Ibid.

30. Putintsev E.V., Varlamova Z.A., Meshcheryakova L.R. Concerning Medical Physical Culture for-Bronchial Asthma. Sb.Materialov k Godichnoy Nauchnoy Sessii Instituta. Novokuznetsk, 1967 (Collection of Reports for Annual Sci. Session of the Institute. Novokuznetsk, 1967).

31. Shelomova K.V. Intentional Normalisation of Respiration in the Complex of Medical Physical Culture for Bronchial Asthma. Proceedings of the 4th Sci. -Practical Conf. on Medical Control and Medical Physical Culture. Sverdlovsk, 1968 (as in 22).

32. Panova L.A. Bronchial Asthma - a Model of Adaptation to the Changed Environmental Conditions. (As in 24.).

33. Gavalov S.M., Genina V.A., Gavalova R.F. Intentional Regulation of Respiration in Complex Medical Treatment of Bronchial Asthma in Children. Saratov, 1976.

34. Genina V.A., Glur-,henko I.R. The Construction of a Generalised Indicator of the Bronchial Asthma Condition. Methods for Physical Measurements of Parameters of the Ecological Systems and the Mathematical Processing of the Obtained Data. Novosibirsk, 1982.

35. Genina V.A. The Role of Hyperventilation in the Pathogenesis of Bronchial Asthma and Its Medical Treatment by means of Reduction in Ventilation of the Lungs. Epidemiological Characteristics of Non-r.,pecific Diseases of the Lungs in Various Professional Groups. Novosibirsk, 1982.

36. Genina V.A. et al. The Medical Treatment of Bronchial Asthma in Children Using the Method of Intentional Normalisation of Respiration (INR) according to the Data of the 1st MMI Children's Clinic. Pediatriya, 1982, No.2 (Pediatrics, 1982, No.2).

37. Genina V.A. The Technique for Elimination of Chronic Hyperventilation in the Treatment of Patients with Obstructive Syndrome. Medical Treatment of Non-specific Diseases of the Lungs.

Respiration

 

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