Buteyko method
From Free net encyclopedia
The Buteyko Method, or Buteyko Breathing Technique (BBT) is an set of breathing exercises developed by the Ukrainian doctor Konstantin Pavlovich Buteyko (Russian: Бутейко) that claim to alleviate various breathing disorders, such as asthma and emphysema.
BBT advocates controlling the process of breathing in order to better regulate and even increase the quantity of carbon dioxide in the bloodstream. As well as asthma and emphysema, it's also claimed that a multitude of medical conditions can be eased - everything from obesity to migraines.
Advocates of the technique claim that asthmatics can abandon 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.
Contents |
Theory and practise
For the real Buteyko-theory, please read Buteyko theory Rus-Eng.pdf (page 52 for the English version)! Critics on the theory should in the first place be based on the there well-documented theory:
Vladimir K. Buteyko and Marina M. Buteyko THE BUTEYKO THEORY ABOUT A KEY ROLE OF BREATHING FOR HUMAN HEALTH Scientific introduction to the Buteyko therapy for experts Buteyko Co LTD Voronezh, 2005
For a simplified (and possibly wrong) interpretation of the theory, read further.
[A REFERENCE LIST, RUSSIAN BIBLIOGRAPHY AND LIST OF CLINICAL TRIALS HAS BEEN APPENDED. THE INTRODUCTION TO THIS ARTICLE STILL NEEDS TO BE UPDATED - SEE DISCUSSION]
Central to the method is the theory that respiratory illnesses are just 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". Buteyko also supported the view of others, that chronic hyperventilation was attributable largely to the sedentary modern life style.
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. The control pause is effectively a method of measuring the quantity of carbon dioxide gas in the bloodstream - a short pause means that the individual has less CO2.
Typically asthmatics are measured to have control pauses of less than 15 seconds. On practice by the patient, using reduced breathing exercises, this is usually increased to 40 seconds (which is considered 'normal'). Asthma attacks and medication use gradually reduce with increasing control pause. With extreme practice, a control pause of anywhere upwards of a minute is possible.
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.
Under the Buteyko model, an asthma attack is considered the body's response to chronic hyperventilation (depletion of CO2) - that is, the body recognizes its need to breathe less and causes an attack, which in turn raises CO2. Asthmatics chronically overbreathe, causing (or providing a catalyst for) various physiological symptoms, asthma attacks among them. There's also the fact that, by practice of shallow 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 technique/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 Britain. It's normally learned via weekend or five-day 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 abandon the majority of their medication, such as inhalers.
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 – a technique that has no real reason to work. This situation isn't helped by the great many medical conditions, many unrelated to respiratory complaints, which the technique claims to alleviate.
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, 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. 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 study
In 1995 a randomized double blind placebo controlled study on the technique was run in Brisbane, Australia.
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. Additionally, the tests also showed no statistically significant increase in actual CO2.
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 [the 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 redution 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.
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.
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 has to be thoroughly revised to be convincing and up to date. (Maybe someone can write something about research on NO?)
External links
- Buteyko Asthma Management - provides an introduction to Buteyko including the theory, clinical studies and practical asthma help
- http://www.buteyko.com
- Biography of Dr Buteyko
- Practical example of control pause
- Buteyko breathing techniques in asthma: a blinded randomised controlled trial
- Comprehensive, non-commercial web site on Buteyko, by Peter Kolb and Mark Reardon
REFERENCES, RUSSIAN BIBLIOGRAPHY AND CLINICAL TRIALS:
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. [Translation 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 [available: 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 [available: 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 Heartrythm 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 Rythm. 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.
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