[Respiratory re-training in asthma. Theoretical basis and results]

The treatment of asthma is medical. The prescription of respiratory physiotherapy should not be routine. It only appears to be indicated in asthmatics with continuous dyspnoea or hypersecretion who are unstable, despite medical treatment which is both correctly prescribed and properly taken. Bronchial drainage, on condition that certain technical precautions are taken, is only useful in asthma with hypersecretion. Asthmatic crises are not relieved by physiotherapy. Standard respiratory exercises could have a certain value on hyperinflation in the chronic asthma of childhood. They are generally without effect on airways resistance or expiratory flow. Likewise, there are reflex massages for relaxation, posture, and respiratory exercises which are borrowed from yoga. Techniques for correction of posture, used preventively, are only of value in chronic asthma of childhood. Respiratory muscle training, in spite of a few successes, is not justified on a theoretical basis, at least in those subjects who have not been subjected to long-term steroid therapy. Overall, exercise training is useful from both the physiological and the psychological point of view. The anaerobic threshold would seem to be the ideal level of intensity for exercise on the basis of 30 minutes, three times a week for subjects who are moderately or severely affected. The rest on condition of certain precautions, can participate in the sport of their choice (or more or less) without any training in the medical milieu beforehand. However, in a minority of these patients the physiotherapists, by their individualised approach and their techniques, sometimes represent a useful transition towards participating in sports. There is no cost benefit study available.