Breathing Exercises in Asthma Targeting Dysfunctional Breathing

NCT ID: NCT03127059

Last Updated: 2024-03-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

190 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-04-27

Study Completion Date

2024-08-31

Brief Summary

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Dyspnoe can disable patients with asthma. Dysfunctional breathing (DB), resulting in dyspnoe, can mimic or exaggerate asthma. Around every forth patient with asthma have DB. Breathing exercises (BrEX) can improve asthma-related quality of live (QOL) in less severe asthma. No study has investigated the effect of BrEX on QOL neither on level of physical activity in severe asthma.

A randomised controlled multicentre trial will include 190 adults with poor asthma control (Asthma Control Questionnaire (ACQ6)-score≥0.8) from seven outpatient departments and one specialized private clinic. Patients will be allocated to either usual care (no intervention) or breathing exercises (BrEX)-treatment consisting of 12-week intervention including three physiotherapist-sessions focusing on breathing pattern modification (Papworth Method; Buteyko technique) in rest and activity and 10 minutes home-exercise twice daily. Primary outcome is change in Mini Asthma Quality of Life Questionnaire (MiniAQLQ) at six-months follow-up.

Detailed Description

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In Denmark around 300,000 suffer from asthma. Dyspnoe can disable patients with asthma. Dysfunctional breathing (DB), resulting in dyspnoe, can mimic or exaggerate asthma. Around 20-29% of asthmatic patients have DB. Breathing exercises (BrEX) can improve asthma-related quality of life (QOL) and control of asthma symptoms in less severe asthma. No study has investigated the effect of BrEX on QOL neither on level of physical activity in severe asthma.

A randomised controlled multicentre trial will include 190 adults with poor asthma control (Asthma Control Questionnaire (ACQ6)-score≥0.8) from seven outpatient departments and one specialized private clinic. After optimizing of inhalation technique, patients will be allocated to either usual care (no intervention) or BrEX-treatment consisting of 12-week intervention including three physiotherapist-sessions focusing on breathing pattern modification (Papworth Method; Buteyko technique) in rest and activity and 10 minutes home-exercise twice daily. Primary outcome is change in Mini Asthma Quality of Life Questionnaire (MiniAQLQ) at six-months follow-up. Secondary outcomes are changes in ACQ6, Nijmegen Hyperventilation Questionnaire (NQ), Hospital Anxiety and Depression Scale (HAD), accelerometry (physical activity level, number of steps), 6 minutes walk distance, and forced expiratory volume in first second (FEV1), besides response of Global perceived effect rate (GPE) in asthma-related QOL and asthma control.

Conditions

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Dysfunctional Breathing in Asthma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Multi-centre, assessor-blinded, 2-arm randomised controlled trial.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
Three assessors (physiotherapists) will perform the objective assessment of capacity and lung parameters. Nurses in the outpatient departments will obtain data from medical records. The assessors and the nurses will be blinded for the allocation.

The primary invenstigator will have no access to the data during the period of datacollection.

Primary and most of the secondary outcomes will be patient-reported.

Study Groups

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Breathing Exercises

Individual instruction from a nurse at baseline aimed at knowledge on pharmacological treatment and optimized inhalation techniques. The participants will be encouraged to use online video instruction.

Three physiotherapist-sessions of Breathing Exercises (BrEX) with duration of 60 minutes (the initial) and 30 minutes (other sessions) at week 1, 4, and 9. The participant is expected to do 10 minutes of home exercise twice daily. The entire intervention combines elements of the Papworth method, and the Buteyko technique.

Group Type EXPERIMENTAL

Breathing Exercises

Intervention Type OTHER

Key points in the intervention are

* Reduction (or normalising) of the respiration rate; use of rhythmic, nasal inspiration, diaphragmatic breathing; reduction of depth of breath, longer expiration; breath-holding at functional residual capacity.
* Relaxation, especially the neck, jaw, tongue, and shoulders. Emphasizing the impact of gravity to the body.
* Inclusion of the breathing modification into walking and other physical activities.
* Daily home exercise of BrEX.

Usual care

Individual instruction from a nurse at baseline aimed at knowledge on pharmacological treatment and optimized inhalation techniques. The participants will be encouraged to use online video instruction.

Besides the individual instruction described above, patients will receive only short information given initially at recruitment. They are allowed to receive instruction in positive expiratory pressure-treatment and physiotherapy targeting other problems than dysfunctional breathing (DB).

Group Type OTHER

Usual care

Intervention Type OTHER

Participants will receive only short information given initially at recruitment. No instruction or booklet will be distributed in the Usual care-Group.

Interventions

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Breathing Exercises

Key points in the intervention are

* Reduction (or normalising) of the respiration rate; use of rhythmic, nasal inspiration, diaphragmatic breathing; reduction of depth of breath, longer expiration; breath-holding at functional residual capacity.
* Relaxation, especially the neck, jaw, tongue, and shoulders. Emphasizing the impact of gravity to the body.
* Inclusion of the breathing modification into walking and other physical activities.
* Daily home exercise of BrEX.

Intervention Type OTHER

Usual care

Participants will receive only short information given initially at recruitment. No instruction or booklet will be distributed in the Usual care-Group.

Intervention Type OTHER

Other Intervention Names

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BrEX UC

Eligibility Criteria

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Inclusion Criteria

* Referred from GP to a secondary, out-patient respiratory clinic for lack of asthma control
* Pulmonologist-diagnosed asthma
* ≥ 2 consultations at a pulmonologist-lead asthma clinic
* ACQ6 ≥0.8
* Able to provide written informed consent.

Exclusion Criteria

* Trained in breathing exercises by physiotherapist last 6 months
* Aged \<18
* Pregnancy
* Not able to speak, read or understand Danish
* Any severe disease as judged by the responsible physician
* Participating in another pulmonary interventional research-project.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Zealand University Hospital

OTHER

Sponsor Role collaborator

Hvidovre University Hospital

OTHER

Sponsor Role collaborator

Aalborg University Hospital

OTHER

Sponsor Role collaborator

Bispebjerg Hospital

OTHER

Sponsor Role collaborator

TrygFonden, Denmark

INDUSTRY

Sponsor Role collaborator

Slagelse Hospital

OTHER

Sponsor Role collaborator

Region Zealand

OTHER

Sponsor Role collaborator

Association of Danish Physiotherapists

OTHER

Sponsor Role collaborator

Allergi og Lungeklinikken Helsingør

UNKNOWN

Sponsor Role collaborator

Regionshospitalet Silkeborg

OTHER

Sponsor Role collaborator

Odense University Hospital

OTHER

Sponsor Role collaborator

Naestved Hospital

OTHER

Sponsor Role lead

Responsible Party

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Karen Hjerrild Andreasson

Ph.D.-Student, PT

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Karen H Andreasson, PT MSc

Role: PRINCIPAL_INVESTIGATOR

University of Southern Denmark, Dep. of Physiotherapy and Occupational Therapy, Neastved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark

Uffe Bødtger, MD PhD

Role: STUDY_CHAIR

University of Southern Denmark and Naestved Hospital

Søren T Skou, PT PhD

Role: STUDY_CHAIR

University of Southern Denmark and Naestved-Slagelse-Ringsted Hospitals

Mike Thomas, Prof MD PhD

Role: STUDY_CHAIR

University of Southampton and Aldermoor Health Centre, Southampton

Celeste Porsbjerg, Prof MD PhD

Role: STUDY_CHAIR

University of Copenhagen and Bispebjerg Hospital

Charlotte S Ulrik, Prof MD PhD

Role: STUDY_CHAIR

University of Copenhagen and Hvidovre Hospital

Peder G Fabricius, MD

Role: STUDY_CHAIR

Universityhospital Roskilde

Karin D Assing, MD

Role: STUDY_CHAIR

Aalborg University Hospital

Kirsten E Sidenius, MD PhD

Role: STUDY_CHAIR

Allergi og Lungeklinikken Helsingør

Charlotte Hyldgaard, MD

Role: STUDY_CHAIR

Diagnostisk Center, Regionshospitalet Silkeborg

Hanne Madsen, MD PhD

Role: STUDY_CHAIR

University of Southern Denmark and Odense University Hospital

Locations

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Dep. of Physiotherapy and Dep. of Pulmonology

Silkeborg, Central Jutland, Denmark

Site Status

Dep. of Physiotherapy and Dep. of Pulmonology

Bispebjerg, Danish Capital Region, Denmark

Site Status

Allergi og Lungeklinikken Helsingør

Elsinore, Danish Capital Region, Denmark

Site Status

Dep. of Physiotherapy and Dep. of Pulmonology

Hvidovre, Danish Capital Region, Denmark

Site Status

Dep. of Physiotherapy and Dep. of Pulmonology

Aalborg, Region North, Denmark

Site Status

Dep. of Physiotherapy and Dep. of Pulmonology

Næstved, Region Sjælland, Denmark

Site Status

Dep. of Physiotherapy and Dep. of Pulmonology

Roskilde, Region Sjælland, Denmark

Site Status

Dep. of Physiotherapy and Dep. of Pulmonology

Odense, Region Syddanmark, Denmark

Site Status

Countries

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Denmark

References

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Andreasson KH, Skou ST, Ulrik CS, Madsen H, Sidenius K, Jacobsen JS, Assing KD, Rasmussen KB, Porsbjerg C, Thomas M, Bodtger U. Protocol for a multicentre randomised controlled trial to investigate the effect on asthma-related quality of life from breathing retraining in patients with incomplete asthma control attending specialist care in Denmark. BMJ Open. 2019 Dec 31;9(12):e032984. doi: 10.1136/bmjopen-2019-032984.

Reference Type BACKGROUND
PMID: 31892661 (View on PubMed)

Andreasson KH, Skou ST, Ulrik CS, Madsen H, Sidenius K, Assing KD, Porsbjerg C, Bloch-Nielsen J, Thomas M, Bodtger U. Breathing Exercises for Patients with Asthma in Specialist Care: A Multicenter Randomized Clinical Trial. Ann Am Thorac Soc. 2022 Sep;19(9):1498-1506. doi: 10.1513/AnnalsATS.202111-1228OC.

Reference Type RESULT
PMID: 35588357 (View on PubMed)

Other Identifiers

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SJ-552

Identifier Type: -

Identifier Source: org_study_id

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