Breathing exercises as adjunct therapy in adult asthma: a systematic review

Despite optimal pharmacological treatment, a substantial proportion of adult asthma patients remain symptomatic. Breathing exercises have emerged as a non-pharmacological adjunct specifically targeting dysfunctional breathing patterns (chronic hyperventilation, tachypnea, and aberrant ventilatory mechanics) that pharmacotherapy does not adequately address. Evidence for their efficacy across outcomes and delivery formats warrants systematic evaluation.

We searched five databases (Cochrane Library, PubMed/MEDLINE, Scopus, Web of Science, PEDro) for RCTs, controlled quasi-experimental studies, and uncontrolled pre-post pilot studies in which breathing exercises were the primary intervention for adults with confirmed asthma, published between January 2013 and March 2025. Methodological quality was assessed using the PEDro scale; risk of bias was assessed using the Cochrane RoB 2 tool for randomised trials and descriptively for non-randomised studies. A narrative synthesis was performed due to significant clinical, methodological, and statistical heterogeneity.

Six primary studies (n = 1,098; PEDro scores 3-6) were included: four randomised controlled trials (RCTs) and two uncontrolled pre-post/pilot studies. Several included studies reported significant improvements with breathing retraining in health-related quality of life (AQLQ, Mini-AQLQ, SGRQ) and asthma control scores (ACT, ACQ). Among the modalities studied, the Buteyko method showed relatively consistent benefits, including a ~ 20% reduction in rescue bronchodilator and inhaled corticosteroid use. In one large RCT, digital self-guided delivery was equivalent to face-to-face physiotherapist instruction. Static spirometric volumes (FEV₁, FVC) and airway inflammation markers (FeNO) were not significantly modified. Severe exacerbation rates were unchanged.

Available evidence suggests that structured breathing exercises are safe and potentially effective adjunctive interventions in adult asthma, improving patient-reported outcomes (health-related quality of life and asthma control) by correcting dysfunctional breathing patterns, without altering the underlying airway inflammatory process. Breathing exercises may be considered as part of multidisciplinary asthma management for adults who remain symptomatic despite optimised pharmacological therapy.