Review of Western Clinical Trials of the Buteyko Method

or Why Medical Community Deny, Neglect, and Reject the Buteyko technique

MDs smiling I gave some second and even third thoughts and still decided to publish this review due to importance of the topic for 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 medical people. 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.

Any trial has a certain intervention: some parameter of factor that is to be changed so that to see its impact on other factors. What was the intervention in these clinical studies? The participating asthmatics performed breathing exercises and made some lifestyle changes in order to get rid of asthma.

Evening landscape during sunset with a lake and mountain Could breathing exercises and lifestyle changes, according to Dr. Buteyko, cure asthma? What did Dr. Buteyko find in relation to asthma? After invention 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). 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 tried to find, so far, the link between practicing breathing exercises (with some lifestyle changes) and symptoms, medication, and lung function results for asthma. However, such link, in a strict scientific sense, does not exist. I can provide an example.

Lighting strikes the houses at night 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 install 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? 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 should get confused by this, kind of 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. Scientists disagree

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.

Young MDs smiling 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 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 asking each other, "How could we get rid of this nasty hyperventilation?" Because now they just generally 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

Jigsaw puzzle solved 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 even 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.

References

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)

Reference Web Pages: Breathing norms, Medical Graphs and Tables about Breathing Rates (Minute Ventilation) and Body Oxygen in Healthy, Normal and Sick People
Breathing norms Parameters, graph, and description of the normal breathing pattern
6 breathing myths 6 myths about breathing and body oxygenation (prevalence: over 90%)
Hyperventilation Definitions of hyperventilation: their advantages and weak points
Hyperventilation Syndrome in the Sick. Table 1. Western scientific evidence about prevalence of CHV (chronic hyperventilation) in patients with various chronic conditions (34 medical studies)
Normal Minute Ventilation in Healthy Subjects: Easy and Light Breathing (14 Studies)
Hyperventilation Prevalence Present in Over 90% of Normal People (24 medical publications)
HV and hypoxia How and why deep breathing reduces oxygenation of cells and tissues of all vital organs
Body oxygen test How to measure your own breathing and body oxygenation (a simple DIY test)
Body oxygen in healthy Table 4. CP (body oxygen level) in healthy people (27 medical studies)
Body oxygen in sick Table 5. CP (body oxygen level) in sick people (14 medical studies)
Buteyko Table of Health Zones with clinical description of most common zones
Morning HV Morning hyperventilation effect or how and why critically ill people are most likely to die during early morning hours

References: CO2 Effects Web Pages
Vasodilation: CO2 expands arteries and arterioles facilitating perfusion (or blood supply) to all vital organs
The Bohr effect How and why oxygen is released by red blood cells in tissues
Cell Oxygen Levels and oxygen transport are controlled by alveolar CO2 and breathing
Oxygen Transport depends on breathing and these two effects (Vasoconstriction-Vasodilation and the Bohr effect) are parts of two diagrams that summarize influences of hypocapnia (low CO2 content in the blood and cells) on circulation and O2 delivery
Free Radical Generation takes place due to anaerobic cell respiration caused by cell hypoxia. Hence, antioxidant defenses of the human body are also regulated by CO2 and breathing
Inflammatory Response is controlled by breathing since hypoxia leads to or intensifies chronic inflammation through over-expression of the hypoxia-inducible factor 1, while normal breathing reduces these processes
Nerve stabilization takes place due to calmative or sedative effects of carbon dioxide in neurons or nerve cells
Muscle relaxation or relaxation of muscle cells is normal at high CO2, while hypocapnia causes muscular tension, poor posture and, sometimes, aggression and violence
Brochodilation - dilation of airways (bronchi and bronchioles) by carbon dioxide, and their constriction due to hypocapnia
Blood pH regulation and regulation of other bodily fluids
CO2: Lung Damage Healer: Elevated carbon dioxide prevents injury and promotes healing of lung tissues
CO2: Skin and Tissue Healer
Synthesis of Glutamine in the Brain, CO2 fixation, and other chemical reactions
CO2 myth "CO2 is a toxic waste gas" myth
Breathing control How is our breathing regulated? Why hypocapnia makes breathing uneven and erratic

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