Breathing exercises for asthma: what helps and what trials show

How breathing exercises help asthma

Asthma causes inflammation and narrowing of the airways, and the medicines you take treat that. Breathing exercises work on something different: how you breathe. Many people with asthma breathe faster, from the top of the chest and through the mouth, even when their asthma is under control. That pattern can cause breathlessness, chest tightness and anxiety of its own, which is easy to mistake for asthma.

Breathing retraining teaches you to breathe more calmly and efficiently: through your nose, low into your tummy, at a slower, steady pace. Over weeks, many people find their symptoms are less frequent and less frightening, and they feel more in control.

Which exercises to use

• Breathing retraining is what NHS respiratory physiotherapists teach. Start with diaphragmatic breathing (breathing control) and practise it daily.
• Nose breathing through the day warms and filters the air, which some people find helps with triggers such as cold air.
• Buteyko breathing is a related method that focuses on breathing a little less, with short relaxed breath-holds. Two trials found it cut reliever use.
• Pursed-lip breathing and positions that ease breathlessness can help you stay calm while your reliever works.

What the research shows

A Cochrane review in 2020 pooled 22 studies with 2,880 adults with asthma. Breathing exercises improved asthma quality of life at up to three months, with moderate-certainty evidence, and reduced symptoms of over-breathing. The effect on lung function was inconclusive.

The largest single trial was run in 34 UK GP practices. It randomly assigned 655 adults with asthma that affected their quality of life to a physiotherapy breathing programme by DVD and booklet, three face-to-face sessions with a physiotherapist, or usual care. After a year, both breathing groups had better asthma quality of life than usual care, and the DVD worked as well as face-to-face sessions. Lung function and airway inflammation didn’t change. An earlier UK trial of physiotherapist-taught breathing found similar improvements in quality of life, anxiety and over-breathing symptoms at six months.

UK asthma guidance from BTS, NICE and SIGN says breathing exercise programmes, including face-to-face sessions with a physiotherapist and video programmes, can be offered to people with asthma alongside their medicines. We grade the evidence as moderate.

What breathing exercises don’t do

They don’t reduce the inflammation in your airways, improve lung function tests or prevent serious attacks. In the trials, people kept taking their usual medicines. So keep using your preventer inhaler every day as prescribed, carry your reliever, and follow your personal asthma action plan.

What to do in an asthma attack

1. Sit up straight and try to stay calm.
2. Use your reliever inhaler as your asthma action plan says. The NHS advises one puff of a blue reliever every 30 to 60 seconds, up to 10 puffs, or one puff of an AIR or MART inhaler every 1 to 3 minutes, up to 6 puffs, unless your plan says otherwise.
3. Call 999 if you feel worse at any time, aren’t better after the maximum dose, or don’t have your inhaler.

Even if you recover, see your GP within two days.

How to learn breathing retraining

Ask your GP or asthma nurse about breathing exercises, especially if your quality of life is still affected despite taking your inhalers properly. They may refer you to a respiratory physiotherapist. If you also feel breathless when your asthma seems controlled, ask about breathing pattern disorder.