Buteyko breathing for asthma: how it works and what trials show

What is Buteyko breathing?

The method is named after Konstantin Buteyko, a Soviet doctor who developed it in the 1950s. His theory was that many people with asthma breathe too much, blowing off carbon dioxide, and that this narrows the airways. The method retrains you to breathe less: through your nose, more gently and more slowly.

It has three main parts:

• Nose breathing, all day and, if you can, at night. The nose warms, filters and slows the air.
• The control pause, a short, relaxed breath-hold after a normal out-breath that you use to measure your progress. It is a check, not a test of endurance.
• Reduced breathing, a few minutes at a time of slightly smaller, softer breaths, so you feel a mild, comfortable hunger for air.

The trials suggest the method helps, but not for the reason Buteyko gave. In the Australian trial, people breathed less after learning it, yet their carbon dioxide levels didn’t change and nor did their lung function. The benefit may come from breathing more calmly, using the nose and feeling more in control of symptoms.

When should you use it?

• Daily practice, two or three times a day, if you still have asthma symptoms despite taking your inhalers properly.
• At the first sign of mild symptoms, such as a tickly cough or a slightly tight chest, alongside your reliever as your asthma action plan says.
• Not instead of your reliever during an asthma attack. Follow your asthma action plan and call 999 if your reliever isn’t helping.

What the research shows

Two randomised trials are the main evidence. In an Australian trial of 39 people with asthma, those taught Buteyko cut their daily reliever use far more than a control group over three months, by a median of 904 micrograms of salbutamol-type medicine compared with 57. Their preventer steroid dose fell by about half, though that difference could have been chance. Peak flow and lung function didn’t change.

In a UK trial in Nottingham, 90 people with asthma were taught Buteyko, a yoga-style breathing device or a dummy device and practised for six months. The Buteyko group had fewer symptoms and used two fewer puffs of their reliever a day. There was no change in lung function, airway sensitivity, attacks or the ability to cut down steroid inhalers. The yoga-style device did no better than the dummy.

More broadly, a Cochrane review of 22 studies of breathing exercises for asthma, including Buteyko, found they improve quality of life, with moderate-certainty evidence. 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 alongside medicines. We grade Buteyko as moderate. See breathing exercises for asthma.

How to learn it

Buteyko practitioners run private courses, often over several sessions. You don’t have to pay for one to get the benefits of breathing retraining. NHS respiratory physiotherapists teach a similar approach: breathe through your nose, low into your tummy, slowly and gently. In a UK trial of 655 people with asthma, a physiotherapy breathing programme taught by DVD and booklet worked as well as face-to-face sessions. Ask your GP or asthma nurse about breathing retraining.

Common mistakes

• Cutting down your medicines yourself. This is the real danger. Preventer inhalers stop attacks; any change should be agreed with your GP or asthma nurse.
• Pushing the breath-holds. If your first breath after a control pause is a gasp, you held on too long. It should feel easy.
• Turning air hunger into breathlessness. Reduced breathing should feel slightly uncomfortable at most, never distressing.
• Taping your mouth at night. Not recommended. It may be dangerous if your nose blocks, and there is little evidence that it helps.