Buteyko method

The Buteyko Method, or Buteyko Breathing Technique (BBT) is an set of breathing exercises developed by the Ukrainian doctor Konstantin Pavlovich Buteyko (Russian: Бутейко) that claim to alleviate various breathing disorders, such as asthma and emphysema.

BBT advocates controlling the process of breathing in order to better regulate and even increase the quantity of carbon dioxide in the bloodstream. As well as asthma and emphysema, it's also claimed that a multitude of medical conditions can be eased - everything from obesity to migraines.

Advocates of the technique claim that asthmatics can abandon inhalers and live a medication-free life. Sceptics claim that the causal relation is flawed and there is little evidence there is any effect other than placebo.

Contents

1 Theory and practise 2 Critical analysis 3 Clinical study 4 External links

Theory and practise

Central to the method is the theory that respiratory illnesses are caused (or at least made worse) by poor breathing patterns - what Buteyko calls "hyperventilation". In particular, Buteyko claimed that the bloodstream of asthmatics contained too much oxygen and not enough carbon dioxide. He postulated that the body cannot utilize oxygen unless there is a healthy supply of CO₂ and that the balance in increasing numbers of ordinary people is improper.

The technique revolves around breathing exercises designed to increase the 'control pause' - the amount of time the individual can survive comfortably between exhaling and having to breath in again. The control pause is effectively a method of measuring the quantity of carbon dioxide gas in the bloodstream - a short pause means that the individual has less CO₂ and is over-oxygenated.

Typically asthmatics are measured to have control pauses of less than 15 seconds. On practice by the patient, using the control pause exercise, this is usually increased to 40 seconds (which is considered 'normal'). It is at this stage that the patient usually notes asthma attacks are greatly reduced. With extreme practice, a control pause of anywhere upwards of a minute is possible.

Buteyko also advocated shallow breathing and breathing through the nose rather than the mouth, in order that smaller and therefore less oxygenated breaths might be taken.

Under the Buteyko model, an asthma attack is considered the body's response to chronic hyperventilation (depletion of CO₂) - that is, the body recognizes its need to breathe less and causes an attack, which in turn lowers CO₂. Asthmatics chronically overbreathe, causing (or providing a catalyst for) various physiological symptoms, asthma attacks among them. There's also the fact that, by practice of shallow breathing, the control pause can be lengthened significantly so something on a physiological level is clearly being changed or retrained. It has been demonstrated that blood CO₂ levels do decrease during the practice of shallow breathing.

Note that the technique/method isn't designed to be a treatment for an asthma attack. It's effectively a change in lifestyle which is designed to minimise or stop attacks occurring in the first place.

The technique is very popular in Australia and is starting to get a foothold in Britain. It's normally learned via weekend or five-day courses from teachers trained in the technique. It's widely agreed that it must be learned from a teacher and that students may cause harm by attempting to self-teach.

By the end of Buteyko treatment, most asthma and even emphysema suffers are able to abandon the majority of their medication, such as inhalers.

Critical analysis

Critics of the methods consider it another example of quack medicine - a technique that has no real reason to work. This situation isn't helped by the great many medical conditions, many unrelated to respiratory complaints, which the technique claims to alleviate. Additionally, Buteyko courses are often expensive and attendees are made to sign pledges that they will not teach the technique to others.

Buteyko's theory is based on the idea that oxygen can best be metabolized with the proper amount of carbon dioxide. There is simply no reason to believe this is the case, and no such mechanism is known to exist. It is also claimed that the problems Buteyko claims to assist are due to "overbreathing", yet there is nothing to suggest this is the case.

Furthermore the claimed success against asthma is supposed to be the increased CO₂ concentration, yet asthma sufferers are noted for increased levels of CO₂ during attacks. This is a side effect of the inability to exhale fully. Critics suggest that making the CO₂ problem even worse one is unlikely to improve the condition.

Moreover, others suggest that asthma is greatly affected by general mental state, and relaxation of any form is known to be fairly effective. Despite the anecdotal evidence, some claim that no scientific evidence has been presented to suggest this is anything but placebo.

Clinical study

In 1998 a randomized double blind study on the technique was run using the methacholine challenge test, which triggers short-term asthma attacks.

People in the test were taught either the Buteyko method or a placebo breathing method, and changes in behavior noted. The results of the test showed no benefit on physiological measures of asthma, such as forced expiratory volume in one second, peak flow, and number of attacks, of Buteyko compared with the placebo technique. Additionally, the tests also showed no change in actual CO₂ or hypocapnia.

However, the study detected statistically significant changes in drug use, with the Buteyko group showing a decrease in inhaler use. To quote the summary of the trial: "Those practising [the Buteyko technique] reduced hyperventilation and their use of beta2-agonists. A trend toward reduced inhaled steroid use and better quality of life was observed in these patients without objective changes in measures of airway calibre."

Since it is well known that asthmatics are generally overmedicated in terms of beta2-agonist use, it has been suggested that this portion of the test is being unduly effected by the placebo effect. Unfortunately there is no way to know, because the test regimen did not include a placebo group as an additional control.

The results are also clouded because it was later learned that the Buteyko group was being telephoned by the Buteyko teacher during the trial, something that was not happening with the control group.

Other double blind studies, such as the 2003 New Zealand study, have shown repeated favourable results under more controlled conditions.

External links

• http://www.buteyko.com
• Biography of Dr Buteyko (http://www.buteyko.com/doctor_buteyko.html)
• Practical example of control pause (http://www.buteyko.com/test.html)
• Buteyko breathing techniques in asthma: a blinded randomised controlled trial (http://www.mja.com.au/public/issues/xmas98/bowler/bowler.html)
• Buteyko self-help (http://members.westnet.com.au/pkolb/buteyko.htm)