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Using Breathing Technique to Control AsthmaResearch Paper

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Asthma is an issue that is increasingly problematic for Americans, impacting the lives of more than 25 million individuals in the U.S. (roughly 19 million adults and 7 million children). It accounts for more than 14 million doctor visits annually, more than 400,000 hospitalizations and nearly two million and half ER visits (American College of Allergy, Asthma & Immunology, 2014). Moreover, asthma is responsible for claiming 3,600 lives per year. In total, the yearly economic cost of asthmas is estimated to be $56 billion (American College of Allergy, Asthma & Immunology, 2014).

While there are effective ways to treat asthma, these are not without side effects and cost-related issues. Dependency upon external intervention via drugs such as albuterol is the main method of treating asthma symptoms today, with the use of the corticosteroid inhaler (an anti-inflammatory medication) as the most common form of intervention. However, it presents a number of risks, such as what happens if one loses one's inhaler and has an asthmatic attack; or what if the cost of using the inhaler is deemed too high over a long period of time. By making oneself dependent upon a resource that may not always be available, one is taking on a significant amount of risk regarding one's health over a substantial period of time. The reason that the majority of persons who suffer from asthma accept this risk and engage in a lifestyle that makes them dependent upon external medications like albuterol is that these treatments are the ones most popularized by the established medical community. Thus, they are given to patients as the only suitable or viable means of controlling their asthma. Other options available to asthma patients include immunotherapy and allergy shots but these too have their attendant risks and may not be a method that is pleasing or acceptable to the majority of asthma patients. By being dependent upon an intervention such as the one's described, asthma patients remain in a reactive rather than a pro-active position. They are not in a position of control, as they rely upon external means for support.

By presenting the alternative method of heart rate variability biofeedback treatment, which one can become trained in utilizing, patients could place themselves in a more favorable position regarding their asthma by taking direct control of it and their body's reaction without depending upon external supports. Medical researchers have shown that heart rate variability biofeedback technique is a viable solution to assisting persons who suffer from asthma to be more pro-active in their condition and to be able to depend upon themselves rather than on an external medication (Lehrer, 2013).

It is in this alternative treatment paradigm that heart rate variability biofeedback (HRV-BF) treatment shows potential as a significant source of reducing the effects of asthma and treating in a low cost manner the symptoms suffered by the patient. HRV-BF even has the potential to eliminate the need for high level doses of medication prescribed to patients annually (Lehrer, 1997). By using a breathing technique that focuses on controlling the heart rate and thus regulating the exchange of gas that passes through the body's airways, the individual can use a focused method of conscious regulation to effect the same outcome as that of the external medication. The advantage is that the patient practicing HRV-BF does not have to rely upon the external medication and is thus free to exert greater influence and control over his/her own body as a result. The disadvantage is that the effectiveness of HRV-BF is not entirely corroborated by the scientific community and thus more studies need to be performed in order to evaluate its effectiveness.

Problem Statement

Thus, the gap this study aims to close in the study of HRV-BF is whether or not the technique is an effective alternative to standard common medicines like albuterol. For the purposes of this study, albuterol is used as the main medicine to be representative of the drugs available to patients delivering the same impact.


HRV-BF differs from the two most common standard forms of treatment for asthma currently accepted within the medical field, which are anti-inflammatory medications and bronchodilator medications. Albuterol, for example, is a common bronchodilator that serves to relax the airway muscles, allowing air to flow more efficiently to the lungs. It is not, however, free of side effects, both major and minor, and may act as an irritant to users that is undesirable as a method of treatment. HRV-BF could act as a method of controlling asthma and reducing the patient's dependency upon products like albuterol.

This study poses the question of whether HRV-BF is an efficient means of positively impacting asthma patients by reducing their dependency upon bronchodilators. Albuterol in particular is used in this study, which measures the amount of albuterol used by patients both before and after the HRV-BF intervention is employed. The amounts are recorded by the patients themselves in a daily diary that they maintain over the course of the study.

The purpose of this study is to assess the therapeutic impact o HRV-BF on asthma patients. HRV-BF methods employed in this study are means by which the patient is able to synchronize his/her breathing rate with his/her heart rate. As one's heart rate typically accelerates when breathing in and decelerates when breathing out, a synchronization of heart rate and breathing results in respiratory sinus arrhythmia, which is positively associated with individual health levels (Lehrer, 1997). The goal of asthma patients utilizing HRV-BF is to enable them to control their heart rate and breathing rate and thereby strengthen the airways impacted by inflammation. The gaps in literature associated with HRV-BF are related to the impact of the intervention on the airways, and so this study intends to examine the effect of the HRV-BF intervention on patients' airways through their own dependency upon albuterol (whether that dependency changes as a result of the intervention). The HRV-BF process can be learned in a few, short sessions with a patient and may thus be categorized as like the process of teaching a person to fish, which applies to the maxim "Give a person a fish, you feed him for a day; teach a person to fish, you feed him for life." The application of the HRV-BF is believed to be of the same order: by teaching the technique of synchronizing breathing and heart rate, the patient can gain control of his asthma rather than depend on the bronchodilator for life. In other words, using the body's mechanics to help the body is the intended goal of the intervention.

The three main factors evaluated in the study were the effect of HRV-BF on home peak flows (peak expiratory flow taken at home), the effect of HRV-BF on exhaled nitric oxide; and the effect of HRV-BF on albuterol use as well as comparisons made of albuterol's effect after HRV-BF intervention.

The first effect is focused on primarily because during asthma exacerbations peak expiratory flow decreases and may thus be considered a relative measurement of asthma symptoms. Home peak flows are taken at home during mornings, evenings, and symptomatic occurrences. These measurements were recorded using a piko-1 meter, which minimizes patient recording error.

The second effect is focused on because exhaled nitric oxide is an indirect measure of airway inflammation. When there is greater inflammation there will be greater exhaled nitric oxide. This was measured by having patients exhale into a NIOX machine. Exhaled nitric oxide was taken both before and after biofeedback treatment on 55 subjects. The implications of airway inflammation in regards to asthma is that inflammation is thought to increase vulnerability to asthma exacerbation as well as to be the principle cause of asthma.

The third effect is focused on because albuterol is a short acting beta 2 selective agonist. Its function is to be used as a rescue inhaler so when comparing the effect of HRV-BF and albuterol one may evaluate the overall effectiveness of HRV-BF as a rescue inhaler.


Primary hypothesis: HRV-BF reduces airway reactivity as assessed by the methacholine challenge test (MCT PC20FEV1) among steroid-naive patients with mild or moderate asthma more than a placebo biofeedback procedure (PBO-BF), and does so with an effect size on PC20FEV1 corresponding to at least 75% of the response to a 4-week course of inhaled budesonide 720 mcg/day.

Secondary hypothesis: HRV-BF reduces airway inflammation, as assessed by exhaled nitric oxide (eNO), by at least 35% of the response of a 4-week course of inhaled budesonide 720 mcg/day. We chose a lower percent of the eNO effect than the PC20FEV1 effect, because eNO is a direct measure of inflammation, whereas PC20FEV1 (and biofeedback effects) are more likely to be determined by multiple factors.

Exploratory hypotheses: HRV-BF produces greater improvement in asthma symptoms, asthma quality of life (QoL), rescue albuterol use, perceived stress, and pulmonary function measured both by forced oscillation (FO) and spirometry than the PBO-BF procedure


This is a randomized trial of HRV-BF; participants suffer from mild, persistent asthma, are not currently employing a… [END OF PREVIEW]

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