Review of Western Clinical Trials of the Buteyko Method
or Why The Medical Community Deny, Neglect, and Reject the Buteyko technique
You can find description and references for Buteyko clinical trials on this page: Buteyko clinical trials. It includes both Soviet/Russian and Western clinical trials.
After many thoughts, some second and even third thoughts, and with some remaining reservations, I have decided to publish this review. I have decided to publish it because it is of vital importance for the future of the Buteyko technique and Buteyko discoveries.
Western Buteyko breathing practitioners apply huge efforts and energy in order to prove that asthma can be reversed using the Buteyko breathing technique. Western clinical trials of the Buteyko method are examples of these heroic efforts.
At the same time, these clinical trials are the main source, and sometimes, the only source of information about the Buteyko method for the medical establishment. Tens of thousands of MDs, GPs, and other health professionals form their opinions about the Buteyko method based on results of these trials. What should these people conclude after reading abstracts and maybe even the content of these publications?
In relation to medication, the results of Western Buteyko clinical trials are astonishing. Up to 70-90% less bronchodilators and about 2 times less steroids were used by asthmatics after 3-6 months of practicing the Buteyko breathing technique. Meanwhile, lung function test results remained unchanged.
All trials have a certain intervention: some parameter or factor is to be changed so as to demonstrate its impact on other factors. What was the intervention in these clinical studies? The participating asthmatics were to perform breathing exercises and make some lifestyle changes in order to get rid of asthma.
Could breathing exercises and lifestyle changes, according to Dr. Buteyko, cure asthma? What did Dr. Buteyko find in relation to asthma? After pioneering and testing the Buteyko breathing technique, Dr. Buteyko and his Soviet medical colleagues discovered that there was a relationship between symptoms of chronic diseases (e.g., asthma and hypertension) and degree of chronic hyperventilation. Later, Dr. Buteyko applied for a patent application (No. 9114075/14, Russia, “Method of assessment of human health”, date of publication: 27.04.2001 - Its abstract can be found here: Buteyko Table of Health Zones). This patent application claims that respiratory parameters of people predict their health states.
Dr. Buteyko never claimed that practicing Buteyko breathing exercises for 2, 3 or even 6 hours per day can cure asthma within a certain period of time (e.g., 3 or 6 months or even 5 years). No such rigid stuctures were to be imposed. Dr. Buteyko also did not suggest that a certain Buteyko practitioner (even the most skillful one) can cure 50, 90, or 99% of asthmatics in 3 or 6 months or any longer period.
All Western clinical trials of the Buteyko method have tried to find the link between practicing breathing exercises (with some lifestyle changes) and symptoms, medication, and lung function results for asthma. However, such a link, in a strict scientific sense, does not exist. I can provide an example.
Assume that 100 asthmatics start to practice 2-3 hours of breathing exercises per day, but the local carpet company makes a deal with all local communities and installs beautiful carpets in all houses. These stunning, soft, and fluffy brand new carpets have 4 powerful fire retardants (exceptionally toxic chemicals for the human body), several paints, and some other chemicals together with traditional dust, dust mites, and their droppings. What is the expected effect of practicing breathing exercises in such conditions? The truth is that most people are likely to get worse.
In my view, it is easier and simpler to understand and teach the Buteyko method if we assume or suggest that the intervention of the Buteyko method is measured as a change in the automatic breathing patterns. It can be measured as minute ventilation, CO2 concentration in the expired air (ETCO2 is not so good due to the chest breathing effect that inflates real alveolar CO2 numbers), CP test, or even the respiratory frequency at rest.
There are 2 approaches: activities vs. results as interventions of the Buteyko technique. They can be called activities-oriented and results-oriented approaches in analyzing the Buteyko method and asthma.
The Buteyko technique is a set of activities
If the Buteyko method is a set of activities, then we can anticipate the following effects. The expectation of the medical community, since the activity is hidden or mysterious, is that the Buteyko practitioner is a kind of a magician, who will deliver a magic remedy (breathing exercises and lifestyle changes), and doctors are to decide if there is real magic hidden in the Buteyko technique or not. Indeed, there are mysterious breathing exercises that are not easy to learn and they are to be practiced. Even most participating subjects and other people can get confused by this almost secretive approach. Furthermore, based on the description of the trials, the final results are impossible to predict: the Buteyko method is a kind of a lottery for participants.
On a psychological level, this approach should naturally lead to confusion and division of medical people on supporters (a very small part) and objectors (over 90% of medical people) of the Buteyko method. This general confusion and polarity of opinions are present now, while the cause of asthma and the way to deal with asthma remain beyond the scope of current scientific studies and clinical trials.
The Buteyko technique has the goal to make
permanent changes in unconscious breathing
We can also consider the result-oriented approach. The Buteyko method can be viewed and measured as a change in basal breathing parameters: from 15 L/min for minute ventilation down to 6 or even 4 L/min; from 10-15 s CP up to 40 or 60 s at least; from less than 3% CO2 in the exhaled air up to 5% or more; etc. I realize that very few asthmatics would be able to get such excellent results. Most will stuck a half way to the norms.
However, the goal-oriented approach has the following benefits. Instead of mysterious breathing exercises (that can easily frighten or confuse most doctors since they usually have no clue about Buteyko), there are some clear targets to achieve: medical norms. The goal-oriented approach immediately sheds light on hyperventilation as the cause of asthma. Why? This is because if one's initial breathing parameters are normal, there is nothing to change, and no intervention is possible. The result-oriented approach also eliminates unnecessary mystery and confusion related to breathing exercises. Get back to the medical norms whatever it takes!
Dr. Buteyko investigated the physiological science, not a lottery. This was the reason why he said, speaking about hatha yoga and their breathing exercises:
Therefore, it is practically unimportant for us how and what you do: feet upwards or downwards, through the right or left nostril, or by right or left side. We are interested in where you will arrive as a result of these exercises. If carbon dioxide increases, and breathing decreases, with each day, then this will ensure the transition of man into a super-endurance state...
This goal-oriented approach also provides abundant research material for scientists to investigate pathophysiology and real causes of asthma instead of incessant digging for better drugs. Other patients and the general public will also get more clarity in relation to what they need to achieve.
If there are only a few asthmatics who can get back to the medical norms and have more than 40 s for the morning CP, this is totally fine. Let us measure their lung function results then. If people are divided in groups, in accordance with their results (exactly as this Buteyko patent suggests), then the link between asthma and breathing parameters will pop up itself. Then we are going to discover what it takes to cure asthma.
In addition, the doctors will start to scratch their heads and ask each other, "How could we get rid of this nasty hyperventilation?" Because now they generally just dump the confusing and mysterious method, and this makes total sense. With the result-oriented approach, they will be looking for solutions themselves. You never know, some of them can even come up with better solutions.
One Australian study actually measured minute ventilation of asthmatics before and after the intervention: from 15 L/min down to 9, while the norms are 6 and 4 L/min at rest (medical and Buteyko's standards), and these norms are even not mentioned in the article creating an illusion that these are secondary or even third-order parameters.
Buteyko technique: mystery vs. clarity
From the practical viewpoint, there are reasons for mystification of the Buteyko method. In the 1970's, Dr. Buteyko and his Soviet Buteyko MDs noticed and suggested that people with less than 60 s CP were usually poor promoters of the method probably due to still present over-excitement and inability to reflect or see the real world.
One can observe a different approach, in relation to testing the Buteyko method, in the clinical study on metastasized breast cancer patients organized by Sergey Paschenko, MD from Ukraine. The study measured CO2 concentrations in the exhaled air: before and after. The results are stunning: 5 times reduction in mortality, and deaths only due to combined conditions: cancer with heart disease and diabetes. However, for whatever reasons, Dr. Paschenko even did not claim that he was teaching the Buteyko method to his patients. He wrote about effects of reduced breathing on metastasized cancer. It is possible that he thought that he did not know the Buteyko method well enough to claim that he was teaching the Buteyko technique.
The practical suggestion of this article is that the outcomes of future trials can focus on intervention in relation to basal breathing parameters and how they influence symptoms/medication/life quality factors. This will help to promote cooperation of doctors in finding causes of asthma. In addition, the use of the CP test (that has abundant Western evidence related to asthma) would provide another valuable contribution to clarity in understanding the Buteyko breathing technique.
How a clinical trial can measure effects of breathing retraining?
Q: What would be the correct way to measure effects of the Buteyko method or another breathing retraining technique in a clinical trial?
A: Real life shows that there are two types of practice (doing the work) for Buteyko breathing students (or experimental subjects, in cases of trials).
The easy or lazy way is to practice for 40-60 minutes per day. In this case, measuring etCO2 is not a good idea due to problems with etCO2 capnography caused by chest-to-diaphragm-transition effect discussed here: etCO2 and capnography. Dr. KP Buteyko himself was against use of capnometers for measuring progress during breathing retraining. Hence, for this "lazy" approach, the parameters that can be measured are following:
- MV or minute ventilation (one Western Buteyko trial found changes from 14 to 9.6 L/min: 1995, Mater Hospital, Brisbane, Australia (asthma) - see the reference below.)
- Total CO2 in all exhaled air (as for Paschenko cancer trial)
- CP (as more recent studies did - and the CP, in my view, is the most accurate parameter that reflects a physiological state of a person).
The second way is to have students who practice 2 hours daily and have got really large CP changes (with over 30 s for their average CP). Then even end-tidal CO2 would be improved too.
There were 6 randomized controlled trials of the Buteyko
method (follow these links in order to read all abstracts on another web page):
• 1995, Mater Hospital, Brisbane, Australia (asthma)
• 1999, Alfred Hospital, Prahan, Australia (asthma)
• 2003, Gisborne Hospital, Gisborne, New Zealand (asthma)
• 2003, Division of Respiratory Medicine, City Hospital, Nottingham, United Kingdom (asthma)
• 2006, Royal Prince Alfred Hospital, Camperdown, Australia (asthma)
• 2008 Calgary COPD and Asthma Program, University of Calgary, Alberta, Canada (asthma)
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