Improvements in multi-dimensional measures of dysfunctional breathing in asthma patients after a combined manual therapy and breathing retraining protocol: a case series report

Abstract Background Dysfunctional breathing (DB), which is present in 30–65% of asthmatics, can contribute to increased levels of dyspnea and non-respiratory symptoms which respond poorly to usual pharmacological treatment and impact on asthma control and quality of life. Treatments that target DB in asthmatics have been shown to improve symptoms, asthma control, and quality of life and, in some cases, to improve lung function. Case presentation This case series reports on outcomes of a standardised breathing retraining and manual therapy package in 1 male and 5 females with physician-diagnosed asthma, who were also assessed using biochemical, biomechanical and symptomatic measures of DB. After 6 weeks of treatment most participants showed normalisation of all objective DB measures and reduction in respiratory and non-respiratory symptoms. This was associated with improved perceived control of asthma, despite improvements in lung function parameters occurring in only one participant. Participants without signs of DB at the initial evaluation did not show reduced symptoms or improved perceived control of asthma. Conclusions These observations suggest that there may be an important role for manual therapy and breathing retraining packages as adjunctive treatments to improve management of patients with asthma and other chronic respiratory disease whose condition is aggravated by DB. The substantial number of individuals with chronic respiratory disease who have poor disease control, disproportionate dyspnea and unexplained symptoms due to DB may be more likely to benefit from non-pharmacological treatments like manual therapy and breathing retraining than those with normal or functional breathing.