Breathing Exercises for Asthma: Evidence, Limits and Working With Your Care Team

Urgent first

An asthma attack can be life-threatening. The NHS (UK) says that during an attack you should sit up, try to stay calm, use your reliever inhaler as your plan directs, and call its emergency number (999) if you feel worse, do not feel better after the maximum dose, or have no inhaler. [1] MedlinePlus says that if short-term relief medicines do not work in a severe attack, you will need emergency care. [2] In the US, call 911 when breathing difficulty comes on suddenly or interferes with breathing and even talking. [3] Do not try to "breathe through" an attack with an exercise instead.

Not a replacement for asthma treatment

The NHS says the main treatment for asthma is inhaled medicine, and that your care team records how and when to use it in a personal asthma action plan. [1] MedlinePlus describes two kinds of medicine: quick-relief medicines, and daily control medicines that reduce airway inflammation. [2] Nothing in this page suggests changing, skipping or reducing inhalers. If you want to try a breathing program, tell your asthma nurse or doctor, and keep your inhalers and plan exactly as prescribed.

What counts as a "breathing exercise for asthma"

The Cochrane review of adults with asthma, updated in 2020, covered 22 trials with 2,880 people. Fourteen tested yoga, four breathing retraining, and one each the Buteyko method, Buteyko with pranayama, the Papworth method and deep diaphragmatic breathing. Participants had mild to moderate asthma and were outpatients. [4] Pranayama is a set of breathing practices from the Indian yoga tradition; see our pranayama overview.

The review noted that breathing training in asthma has often focused on relaxation, nasal breathing, lower rib cage and abdominal breathing, and in some programs holding of the breath. [4] This site gives no breath-holding instructions. Such programs should be taught by a trained clinician, never practiced alone, in water or while driving.

What the evidence shows

Evidence labels: promising but limited for quality of life and some symptoms; insufficient evidence for lung function and asthma control.

All from [4]. The authors concluded breathing exercises may have some positive effects on quality of life, hyperventilation symptoms and lung function, but certainty ranged from moderate to very low and more studies with full descriptions of the methods are needed. [4]

What this limits. Twenty of 22 trials compared breathing exercises with an inactive control, and breathing trials cannot be blinded, which is a limit for self-reported scores. [4] Quality of life is a questionnaire, not a lung measurement.

Specific methods

• Buteyko. In a 90-person trial, symptoms and bronchodilator use fell in the Buteyko group, but lung function and airway responsiveness did not change; a pranayama-mimicking device and a placebo device showed no benefit. [5] In another trial the control group was taught breathing and relaxation by a physiotherapist: both groups improved similarly, and the Buteyko group reduced inhaled steroid use more. [6] Our page on the Buteyko method covers claims and cautions.
• Papworth method. A trial of 85 adults gave five sessions on top of usual care: symptom, breathing-pattern and mood questionnaire scores were better than usual care, but objective lung function did not differ, apart from relaxed breathing rate. The authors called for further trials. [7] See the Papworth method page.
• Children. The Cochrane review for children found three small studies (112 participants) in which breathing exercises were part of a larger package, and concluded no reliable conclusions could be drawn. [8] Proper evidence not found for breathing exercises alone in children with asthma.

Related

The claim check on breathing exercises replacing asthma medicine and our guide to breathing exercises, COPD and rehabilitation cover neighboring questions.