Self-taught breathing retraining improves quality of life just as much as training by a physiotherapist, according to the largest randomised controlled trial to test such training published in The Lancet Respiratory Medicine journal.

The self-taught training includes a video and booklet, and shows similar results to face-to-face training with a physiotherapist in helping improve people's quality of life by improving symptoms, mood, and ability to conduct day-to-day activities. The self-taught training was cheaper and less resource-intensive than physiotherapist training.

Many people with asthma still have difficulties breathing despite drug treatment, and access to breathing retraining physiotherapy is limited due to low numbers of appropriately trained specialist physiotherapists worldwide. The technique helps people to cope better with having asthma, but it does not reduce inflammation of the airways or improve lung function. As a result, it is not a replacement for medication and people would need to continue their usual treatment alongside the breathing exercises.

"Our findings suggest that a self-help breathing intervention can be offered conveniently and cost-effectively alongside usual drug treatments to people with asthma whose quality of life is impaired by their disease, despite treatment," says lead author Professor Mike Thomas, University of Southampton, United Kingdom.

The self-taught training involved breathing exercises (diaphragmatic breathing, nasal breathing, slow breathing, controlled breath holds, and relaxation techniques), information on how the techniques worked to improve symptoms and a daily planner and progress chart.

By comparison, participants assigned to the physiotherapy group were seen by a respiratory physiotherapist for three one-to-one sessions that lasted 30-40 minutes. During these sessions they were taught the same breathing techniques as the self-taught group. The usual care group received no additional treatment.

One year after the beginning of the trial, participants in the self-taught and physiotherapist training groups showed improved quality of life, compared to those given usual care. Quality of life was similar in both training groups.

These groups also showed slightly reduced levels of depression compared to the usual care group, but the breathing retraining had no effect on anxiety. In addition, none of the participants in any groups showed improvements in their lung function, or reduced inflammation of their airways.

Participants rated the self-taught and physiotherapist training positively, and felt that they had better control over their breathing, less need for rescue medication during breathing difficulties, felt more relaxed and had a better quality of life.

There were similar rates of adverse events in the three groups (39% in self-taught group; 42% in physiotherapist group; 50% in usual care), suggesting that the breathing retraining caused no additional adverse events or side effects.