RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

AN EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF BUTEYKO BREATHING TECHNIQUE ON REDUCTION OF ASTHMA SYMPTOMS AMONG ASTHMATIC SCHOOL CHILDREN BETWEEN 8 TO 16 YEARS OF AGE AT SELECTED SCHOOLS, BANGALORE.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

SUBMITTED BY:

Ms. ASHA PUTHLY C. K

I YEAR MSc NURSING

SRI SHARADA COLLEGE OF NURSING,

UTTARAHALLI, BANGALORE.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / Ms. ASHA PUTHLY C.K
SRI SHARADA COLLEGE OF
NURSING, UTTARAHALLI,
BANGALORE.
2. / NAME OF THE INSTITUTION / SRI SHARADA COLLEGE OF
NURSING, UTTARAHALLI,
BANGALORE.
3. / COURSE OF THE STUDY AND
SUBJECT / I YEAR Msc NURSING
CHILD HEALTH NURSING
4. / DATE OF ADMISSION / 1.10.2011
5. / TITLE OF THE TOPIC / “AN EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF BUTEYKO BREATHING TECHNIQUE ON REDUCTION OF ASTHMA SYMPTOMS AMONG ASTHMATIC SCHOOL CHILDREN BETWEEN 8 TO 16 YEARS OF AGE AT SELECTED SCHOOLS, BANGALORE”.

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION:

“The way you are breathing can make you sick but it can also make you well’’

Doctor Konstantin Pavlovich Buteyko

Today’s society is complex and ever changing. As children grow they must not only to cope with current demands but also to prepare for many unexpected events they will face in their tomorrows. Changes brought by new techniques and technologies will continue to have an impact on society as a whole.1

Childhood is the age span ranging from birth to adolescence. Many disorders affect the young buds either from birth or on the developmental period. One such accquired disorder is Asthma. The most common chronic disease among children and causes very high degree of morbidity and 25 percent of school absence in children under 17 years of age.2

Asthma is a Greek word which means ‘breathless’ or to breathe with open mouth. The global strategy for Asthma Management and Prevention Guidelines defined asthma as a ‘ chronic inflammatory disorder of the airways associated with increased airway hyper- responsiveness, recurrent episodes of wheezing, breathlessness, chest tightness and coughing particularly at night/early morning. In half of the cases the onset is before 10 years of age.3

A study presented to the International Conference on Health Care Delivery for Asthma found that only 10% of the Indian population have access to the level of care proposed by international guidelines. The obstacles to Asthma care are the costs of care and medications, the socio-economic disparity with in the country and cultural issues.4

Although there is no permanent cure for Asthma, the disorder can be managed in many ways.In asthma management, complimentary and alternative medicine is enjoying a growing popularity worldwide. Buteyko Breathing Technique is a form of complimentary or alternative physical therapy that proposes chronic “breathing retraining” as a treatment for asthma as well as other conditions. It is a set of simple breathing exercises to help control asthma and other breathing disorder. At the core of the Buteyko method is a series of reduced- breathing exercises that focus on nasal breathing, breath holding and relaxation.5

The Buteyko Breathing Technique was originally developed in the 1950s by physiologist Konstantin Pavlovich Buteyko in Russia. This method is based on the assumption that numerous medical conditions including asthma caused by chronically increased respiratory rate (hyperventilation). Normally, when the amount of CO2 in our blood rises, we breathe. This replaces some of the CO2 with oxygen, and so lowers the CO2 level back to normal. During an asthma attack, people panic and breath too quickly. They actually overbreathe because they are breathing so rapidly. This overbreathing causes the amount of CO2 in the blood to fall too low, which can subsequently lead to disturbances of the acid- base balance in the blood and lower tissue oxygen level. The body reacts by causing the airways in the lungs to narrow and reduce the amount of air inhaled in each breath, which panics the patient into trying to breath even harder. Buteyko Breathing Technique will break this “negative feedback” cycle by teaching us to breath more shallowly and to tolerate a higher concentration of CO2 in our blood.6

Buteyko uses a measurement to monitor the condition of asthmatics called the Control Pause (CP) defined as the amount of time that an individual can comfortably hold breath after a normal exhalation. According to Buteyko teachers, with buteyko reduced-breathing practice, asthmatics are expected to find their CP gradually increases in parallel decreased asthma symptoms. By increasing the control pause asthmatics can control the initial overbreathing phase and they can prevent a “vicious circle of overbreathing” from developing and spiraling into an asthma attack.This means that asthma attacks may be averted simply by breathing less.6

6.1 NEED FOR THE STUDY

About one third of our world population is children only. Asthma is the most common chronic illness of childhood causing significant morbidity from symptoms as well as impairment of quality of life and functional impairment. According to World Health Organization (WHO) estimates 300 million people suffer from asthma, 255,000 annual deaths attributed to the disease. The number of people with asthma will grow more than 100 million by 2025. Nine million US children under 18 have been diagnosed with asthma at some point in their lifetime. 8.9% of children in the United States currently had asthma. Approximately 40% of children who have asthmatic parents will develop asthma.7

In India,an estimated that 57,000 death were attributed to asthma. It is the third ranking cause of childhood hospitalizations under the age of 15. One out of every 12 children has asthma, on average there are two children with asthma in every class room. The effects are impaired physical activity and exercise, academic underachievement, poor self concept and disruption of family function. Children with asthma also have to deal with emotional problems such as being frightened by an asthma attack, frustrated at not being able to do the things they wish to do, feeling different and left out, and not being able to keep up with their peers and they sat that their asthma makes them feel irritable, grumpy and grouchy. Younger children often express anger at having asthma although in older children this usually alters into frustration.8

The total estimated burden of asthma in India at an overall prevalence of 3%, Asthma and bronchitis takes major toll in India. It has recorded to be highest in Karnataka and lowest in Punjab. The risk factor for asthma include tobacco, smoking (active and passive) in and outdoor pollution, urbanization, obesity, extreme emotional expression, family history, genetic factors and prenatal influences. The estimated annual cost of treating a child with asthma is higher than the cost per adult with asthma.9

A study on 900 school children in Delhi reported 15.5% prevalence of asthma like symptoms among them 82.2% were unlabelled asthmatics, 17.8% were physician diagnosed asthmatics.10

A school survey in 12 schools on 6550 children on the age group of 6 to 15 years was undertaken for prevalence of asthma. Children from schools of heavy traffic area showed prevalence of 19.34% children from low traffic region and low socio-economic population had 31.4% respectively.11

Buteyko breathing technique had focused almost exclusively on the treatment of asthma.A review of medical literature have found few quality studies such as randomized controlled trials looking at the efficacy of treating asthma with “breathing retraining” methods in general buteyko method, yoga training and other relaxation techniques.The result from these studies have found trends of subjective improvement in factors such as asthma symptoms and measurement of quality of life with use of the buteyko method.12

A clinical trial was conducted to examine whether the buteyko breathing technique is an effective therapy. Those who practice buteyko breathing technique reduced hyper ventilation and their use of B2 agonists. A trend toward reduced inhaled steroid use and better quality of life was observed.13

Buteyko breathing technique is a simple, easy way to relieve the symptoms of asthma and other breathing disorder. According to Dr. Konstantin Pavlovich Buteyko, the inventor of buteyko breathing technique proposes breathing retraining as a treatment for asthma however it’s easy to try, it’s free and it’s not surgical and doesn’t involve taking any drugs and more than 50% of people with asthma benefit from it.5

One school of thought says that usefulness of breathing technique in asthmatics is limited and should be further investigated14.

Buteyko Breathing technique has been identified as a complementary therapy. However there are lack of studies hence the need arise to measure the effects of buteyko breathing technique. Based on the above facts the investigator has taken an attempt to study the effectiveness of buteyko breathing technique on reduction of asthma symptoms among asthmatic school children between 8 to 16 years of age

6.2 REVIEW OF LITERATURE.

Review of literature is a key step in research process. It refers to extensive, exhaustive and systemic examination of publications revelant to the research project. The researcher analyses existing knowledge before delving into a new area of study while conducting a study, when interpreting the results of the study, and when making judgements about application of a new knowledge on nursing practice.15

The review of literature is defined as a broad, comprehensive in depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, audio visual materials and personal communication.15

An extensive review of literature to the research study topic was undertaken to gain deeper understanding and insight into the problem. Several text books, journals, reports, articles, circulations and websites were referred to collect maximum information to the study.

Review of literature is sectioned under the following headings.

Section I. Studies related to Buteyko Breathing Technique on asthma.

Section II. Studies related to other breathing retraining methods used for asthma treatment.

STUDIES RELATED TO BUTEYKO BREATHING TECHNIQUE ON ASTHMA

An experimental study was conducted with the objective to assess the effectiveness of a non–pharmacological intervention in clients with asthma on conventional therapy including inhaled corticosteroid among a group of adults with asthma. The study findings indicated that in the Buteyko group the proportion of asthma control increased from 40%-79% and the control group from 44% -72% and concluded that Buteyko technique provide additional benefit and prevented the exacerbations there by improved the quality of life among adult clients with asthma who are being treated with inhaled corticosteroid.16

A randomized controlled trial was conducted among 32 subjects to explore the effect of 5 week course of Buteyko Breathing Technique on post exercise end tidal carbon dioxide and Dyspnoea versus Conventional therapy. Results showed that among 32 subjects 20 completed the study, their mean age was 48 years, Body Mass Index 28 kgm−2. End tidal Carbon di-oxide and Borg Breathlessness score at 5min post−exercise were significantly improved with Buteyko Breathing Technique. The study demonstrated the hypothesized physiology of Buteyko Breathing Technique improving hyperventilation induced hypocapnoea and breathlessness, following maximal exercise and concluded that Buteyko Breathing Technique may reduce asthma symptoms and improve exercise tolerance and control.17

A blinded randomized control trial was conducted to assess the impact of Buteyko Breathing Technique on medication use in Asthma among 38 people aged between 18 &70. The results showed that a reduction in inhaled steroid use of 50% and beta-2 agonist use of 85% at 6 months from baseline and no change of steroid use in control group and concluded that Buteyko Breathing Technique is safe and efficacious and has clinical and potential pharmaco-economic benefits and recommended further study.18

A Double-blinded cross sectional study was conducted to examine the effects of breathing 3% carbondioxide on exercise–induced asthma on 10 adults confirmed with Exercise induced Asthma and showed that the shape of Forced Expiratory Volume response curve after 3% CO2 suggests a greater degree of Exercise induced Asthma. They concluded that increased airway CO2 alone is an unlikely mechanism for the reported benefits of Buteyko Breathing Technique and recommended further study on it.19

A clinical trial was conducted to examine whether the Buteyko breathing technique taught by a video is an efficacious asthma therapy. 36 adult subjects with mild to moderate asthma were randomized to receive either Buteyko Breathing Technique or placebo video to watch at home twice per day for 4 weeks. The results demonstrated a significant improvement in the quality of life among those assigned to Buteyko Breathing Technique as compared with placebo, as well as significant reduction in inhaled bronchodilator intake in clients with asthma.20

A six-year clinical trial was conducted among 100,000 clients with asthma who were being treated with drugs and showed that, approximately 92,000 of the subjects do not take drugs today. Clinical trial demonstrated that most people who complete the Buteyko course no longer need their reliever medication and eventually give up steroids as well.21

A randomized controlled trial was conducted to determine the effectiveness of Buteyko Breathing Technique for individuals treated with asthma. 600 adult clients aged 18-19 years diagnosed and currently treated with asthma with symptom score ˃1 per day were recruited for the study. This study was tested between active Buteyko Group with Health Education Group and Continued medication Group. Results revealed that, the use of medication is decreased in Buteyko Group by 98% and remained same at 12 months experienced significant improvement in asthma and improvement in the quality of life. The study clearly concluded that teaching people with asthma to breathe correctly with Buteyko Breathing Technique provides significant improvement.22

A double blind randomized controlled trial was conducted with an objective to compare the effects of breathing exercises focusing on shallow nasal breathing with those of non-specific upper body exercises on asthma symptoms, quality of life, other measures of disease control and inhaled corticosteroid dose among 57 subjects and they showed that both groups, at the end of 28th week the use of symptom reliever medications decreased by 86%, and inhaled corticosteroid use decreased by 50%. In their most recent trial on Buteyko confirmed that, Buteyko Breathing Technique is useful in the management of clients with mild asthma symptoms.23