The Breath project (Project Number: 2022-1-PL01-KA220-HED-000089283) has been Co-funded by the European Union. Views and opinions expressed are however those of the author or authors only and do not necessarily reflect those of the European Union or the Foundation for the Development of the Education System. Neither the European Union nor the entity providing the grant can be held responsible for them.

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.

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Institution
University of Southampton, Southampton, UK, University of Aberdeen, Aberdeen, UK University of Oxford, Oxford, UK, Bournemouth University, Bournemouth, UK
Institution Typology
University
Country
United
Description
Intervention design
Time: 12 months. All consenting participants received postal questionnaires at 3 and 6 months and a final assessment visit at 12 months post randomization.
G1: the DVD group, The DVD content included: (1) detailed explanations and illustrations of how to carry out the exercises, with footage showing a physiotherapist teaching the exercises to patients (2) motivational components explaining the rationale for the exercises and addressing common doubts and concerns. Those randomised to the DVD were also provided with the booklet.
G2: face-to-face physiotherapy received: three sessions (30–40 minutes each) with a respiratory physiotherapist at their general practice, at 2-weekly intervals following randomization+ the instructional booklet.
G3= control group -usual care, which included recruitment and follow-up assessments but no additional intervention or care.
People involved
655 adults currently receiving asthma treatment with impaired asthma-related QoL. Those with AQLQ score of < 5.5 were recruited.
G1: the DVD group (n = 261),
G2: physiotherapist (n = 132)
G3= control group (usual care) (n = 262)
Age 16–70 years
Age (years), median (IQR), G1:56 (45–65), G2:55 (47–63), G3: 57 (47–65)
Identified barriers.
Overall, the adverse event profile was as expected in the recruited population and adverse events were not felt by the PIs to be study related, with fewer adverse events in the active arms than in the control arm and DVD and physiotherapy programmes appearing to be well tolerated.
Transferability
The intervention should now be transferred to an internet-based platform and implementation studies performed. Interventions for younger patients should be developed and trialled.

Disease
Asthma
Activity level
Medium
Activity Typology
Rehabilitation section-based activities, Home-based activities
Motivation Tools
Available
Innovation
This is the first study of breathing retraining in asthma that has compared a face-to-face programme with a self-guided programme and the first to have a rigorous, prospective health economic evaluation and process evaluations embedded within it.

Evaluation System
AQLQ score, lung function [FEV1, FEV1-to-forced volume vital capacity (FVC) ratio, peak expiratory flow rate (PEFR)]

¢ fraction of exhaled nitric oxide (FeNO)

¢ generic health status [EuroQol-5 Dimensions (EQ-5D)

¢ anxiety and depression scores [Hospital Anxiety and Depression Scale (HADS)

¢ hyperventilation (Nijmegen) questionnaire scores

¢ asthma exacerbations (oral corticosteroid courses)

¢ bronchodilator use

¢ asthma-related health resource use

¢ cost-effectiveness/utility



Significant improvements occurred in the DVD group compared with the control group and in the face-to-face physiotherapy group compared with the control group with equivalence between the DVD and the face-to-face physiotherapy groups. 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 healthcare 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.

Assessment
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.
References
Thomas M, Bruton A, Little P, et al. 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. Health Technol Assess. 2017;21(53):1-162. doi:10.3310/hta21530
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