CoChat
Sign Up
Cited by 25Asthma and respiratory diseasesChronic Obstructive Pulmonary Disease (COPD) ResearchOccupational exposure and asthma

A randomised controlled study of the effectiveness of breathing retraining exercises taught by a physiotherapist either by instructional DVD or in face-to-face sessions in the management of asthma in adults

Open access
Thomas, Mike, Bruton, Anne, Little, Paul, Holgate, Stephen, Lee, Amanda, Yardley, Lucy, George, Steve, Raftery, James +14 more·2017·Health Technology Assessment
DOI 10.3310/hta21530PMC PMC5632761
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Asthma control is suboptimal, resulting in quality of life (QoL) impairment and costs. Breathing retraining exercises have evidence of effectiveness as adjuvant treatment, but are infrequently used. Objectives: To transfer the contents of a brief (three-session) physiotherapist-delivered breathing retraining programme to a digital versatile disc (DVD) and booklet format; to compare the effectiveness of the self-guided intervention with that of ‘face-to-face’ physiotherapy and usual care for QoL and other asthma-related outcomes; to perform a health economic assessment of both interventions; and to perform a process evaluation using quantitative and qualitative methods. Design: Parallel-group three-arm randomised controlled trial. Setting: General practice surgeries in the UK. Participants: In total, 655 adults currently receiving asthma treatment with impaired asthma-related QoL were randomly allocated to the DVD (n = 261), physiotherapist (n = 132) and control (usual care) (n = 262) arms in a 2 : 1 : 2 ratio. It was not possible to blind participants but data collection and analysis were performed blinded. Interventions: Physiotherapy-based breathing retraining delivered through three ‘face-to-face’ respiratory physiotherapist sessions or a self-guided programme (DVD plus our theory-based behaviour change booklet) developed by the research team, with a control of usual care. Main outcome measures: The primary outcome measure was asthma-specific QoL, measured using the Asthma Quality of Life Questionnaire (AQLQ). Secondary outcomes included asthma symptom control [Asthma Control Questionnaire (ACQ)], psychological state [Hospital Anxiety and Depression Scale (HADS)], hyperventilation symptoms (Nijmegen questionnaire), generic QoL [EuroQol-5 Dimensions (EQ-5D)], assessments of airway physiology (spirometry) and inflammation (exhaled nitric oxide) and health resource use and costs. Assessments were carried out at baseline and at 3, 6 and 12 months post randomisation. Patient engagement and experience were also assessed using quantitative and qualitative methods. Results: Primary efficacy analysis was between-group comparison of changes in AQLQ scores from baseline to 12 months in the intention-to-treat population with adjustments for prespecified covariates. Significant improvements occurred in the DVD group compared with the control group [adjusted mean difference 0.28, 95% confidence interval (CI) 0.11 to 0.44;p < 0.001] and in the face-to-face physiotherapy group compared with the control group (adjusted mean difference 0.24, 95% CI 0.04 to 0.44;p < 0.05), with equivalence between the DVD and the face-to-face physiotherapy groups (adjusted mean difference 0.04, 95% CI –0.16 to 0.24). In all sensitivity analyses, both interventions remained significantly superior to the control and equivalence between the interventions was maintained. In other questionnaire outcome measures and in the physiological measures assessed, there were no significant between-group differences. Process evaluations showed that participants engaged well with both of the active interventions, but that some participants in the DVD arm would have liked to receive tuition from a professional. Asthma health-care costs were lower in both intervention arms than in the control group, indicating ‘dominance’ for both of the interventions compared with the control, with lowest costs in the DVD arm. The rate of adverse events was lower in the DVD and face-to-face physiotherapy groups than in the control group. Conclusions: Only 10% of the potentially eligible population responded to the study invitation. However, breathing retraining exercises improved QoL and reduced health-care costs in adults with asthma whose condition remains uncontrolled despite standard pharmacological therapy, were engaged with well by patients and can be delivered effectively as a self-guided intervention. The intervention should now be transferred to an internet-based platform and implementation studies performed. Interventions for younger patients should be developed and trialled. Trial registration: Current Controlled Trials ISRCTN88318003. Funding: This project was primarily funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 53. See the NIHR Journals Library website for further project information. Additional financial support was received from Comprehensive Local Research Networks.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.3310/hta21530

Cites

65 of 65 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Three ineffective interventions with at-home practice [39,50] reported either inconsistent or unknown practice compliance.

    “Nonetheless, interventions incorporating at-home practices should motivate and assess practice compliance, as our three ineffective interventions with at-home practice [39,50] reported either inconsistent or unknown practice compliance.”

    From Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature (2023) · cites this paper as [50]

    The Patient engagement with the intervention in the active treatment arms section reports that practice was assessed and that most participants spent considerable time practising. The Correlates and predictors of the amount of practice section reports engagement of 98% in the DVD group and 100% in the physiotherapy group. Thus, this source does not describe practice compliance as unknown or generally inconsistent; its Conclusions also call the intervention clinically effective. (LLM, conf=0.88)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • Of 45 interventions incorporating both human-guided training and multiple sessions, only four were ineffective [44,47,50], likely due to taxing clinical situations, inadequate training/experience, and practice discontinuation.

    “Of the 45 interventions in any population that incorporated both of these components, only four were ineffective [44,47,50], but this was likely due to taxing clinical situations [47], inadequate training or experience for a more technical practice [44], and practice discontinuation [50].”

    From Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature (2023) · cites this paper as [50]

    The Process Evaluation (page unavailable) reports that 97 participants stopped regular practice, supporting the practice-discontinuation part associated with this citation. It does not say that discontinuation caused an intervention to be ineffective; Chapter 8, Conclusions (page unavailable), instead reports improved asthma-related quality of life with both breathing-retraining programmes. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Participants in Thomas et al.'s 2017 ineffective interventions engaged in regular practice for 6 to 8 weeks but were not practicing most days by the 12-month stress measurement [50].

    “Participants in Thomas and colleagues’ 2017 ineffective interventions engaged in regular practice for 6 to 8 weeks but were not practicing most days by the time of the 12-month stress measurement [50].”

    From Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature (2023) · cites this paper as [50]

    The “Impact of breathing retraining” section reports that many participants initially practised regularly, and the Process Evaluation reports that 97 stopped regular practice. But the cited passages do not establish that participants generally practised for 6–8 weeks or were not practising most days at 12 months; the 6–8-week figure appears as a response category. They also do not support describing the asthma interventions as ineffective or the 12-month follow-up as a stress measurement. Page numbers were not supplied for these passages. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

1 of the 66 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Fishbein M, Ajzen I. Predicting and Changing Behavior: the Reasoned Action Approach. New York, NY: Psychology Press; 2010.
  2. Maclean N, Pound P. A critical review of the concept of patient motivation in the literature on physical rehabilitation. Soc Sci Med 2000;50:495-506.

Cited by

Sorted by citations

Related

Authors
Thomas, M., Bruton, A., Little, P., Holgate, S., Lee, A., Yardley, L., George, S., Raftery, J., Versnel, J., Price, D., Pavord, I., Djukanovic, R., Moore, M., Kirby, S., Yao, G., Zhu, S., Arden-Close, E., Thiruvothiyur, M., Webley, F., Stafford-Watson, M., Dixon, E., & Taylor, L.
Affiliations
  • University of Southampton (GB)
  • University of Aberdeen (GB)
  • Asthma UK (GB)
  • University of Oxford (GB)
  • Faculty of Medicine, University of Southampton, Southampton, UK
  • Bournemouth University (GB)
  • Patient and public involvement representative
Corresponding author
Thomas, Mike
ORCID
Venue
Health Technology Assessment
Publisher
National Institute for Health and Care Research
Published
2017-09
Volume
21
Issue
53
Pages
1-162
ISSN
  • 1366-5278 (ISSN-L)
  • 2046-4924
DOI
10.3310/hta21530
PMC
PMC5632761
OpenAlex
W2758147734
Cited by
25
References
66
Citations by year
2026: 4 · 2024: 4 · 2023: 3 · 2022: 5 · 2021: 2 · 2020: 4 · 2019: 1 · 2017: 2
FWCI
1.42
Type
journal article
Language
en
Open access
Licence
Locations
  • Health Technology Assessment (publishedVersion, cc-by)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Bournemouth University Research Online (Bournemouth University) (acceptedVersion)
  • Bristol Research (University of Bristol) (acceptedVersion, cc-by-nc)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Leicester Research Archive (University of Leicester) (submittedVersion)
Funders
  • Health Technology Assessment programme (09/104/19)
  • Comprehensive Local Research Networks
Topics
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
Keywords
asthma, breathing retraining, respiratory physiotherapy, self-guided intervention, asthma quality of life, asthma control, anxiety and depression, exhaled nitric oxide, health economic evaluation, cost-effectiveness, patient engagement, general practice, adult asthma, health care utilization, spirometry, airway inflammation
MeSH terms
Adult, Aged, Asthma, Exercise Therapy, Female, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Video Recording, Physical Therapy Modalities, Physical Therapists

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review