The Buteyko method or Buteyko Breathing Technique is a form of complementary or alternative physical therapy that proposes the use of breathing exercises as a treatment for asthma as well as other conditions. The method takes its name from Ukrainian doctor Konstantin Pavlovich Buteyko (Ukrainian: Бутейко) (1923 – 2003), who first formulated its principles during the 1950s. This method is based on the assumption that numerous medical conditions, including asthma, are caused by chronically increased respiratory rate or deeper breathing (hyperventilation). However, this theory is not widely supported in the medical community due to the lack of evidence supporting either the theory behind the method or that it works in practice. This method purportedly retrains the breathing pattern through chronic repetitive breathing exercises to correct for the hyperventilation, which, according to the method's proponents, will therefore treat or cure asthma as well as any other conditions purportedly caused by hyperventilation. At the core of the Buteyko method is a series of reduced-breathing exercises that focus on nasal-breathing, breath-holding and relaxation.
Research into the use of the Buteyko method has focused almost exclusively on the treatment of asthma, and have had methodological problems. Studies have not found objective measures to support its use such as improvement in lung function, though there are results showing it may improve subjective measures such as asthma symptoms and quality of life. Reviews of this medical literature have come to different conclusions about the strength of evidence supporting the Buteyko method, with older literature saying the evidence does not support its use, while more recent and up-to-date reviews and guidelines have found the evidence is enough to consider qualified support. The literature that supports considering its use note the Buteyko method should be used with traditional therapies (and not in place of mainstream treatment) and is unlikely to affect the underlying cause of asthma. There is no support for the use of the Buteyko method in other diseases, such as diabetes mellitus or any of the over 150 diseases supporters of this method claim to treat.
The Buteyko method was originally developed in the 1950s by physiologist Konstantin Buteyko in Russia. The first official study into the effectiveness of the Buteyko Method on asthma was undertaken in 1968 at the Leningrad Institute of Pulmonology. The second, held at the First Moscow Institute of Pediatric Diseases in April 1980, eventually led to the head of the ministry of health to issue an order (No 591) for the implementation of the Buteyko method in the treatment of bronchial asthma. Later, this method was introduced to Australia, New Zealand, Britain and the United States, where it has received increasing exposure. Anecdotal reports of life-changing improvements attributed to the Buteyko method abound on the internet and in books.
The Buteyko method is just one of a number of breathing retraining methods in use for treating lung diseases, including conventional techniques such as physiotherapist led breathing exercises as well alternative medicine techniques like Buteyko such as yoga.
The Buteyko method is based on the concept that "hidden" or undiagnosed hyperventilation is the underlying cause of numerous medical conditions, including asthma. It is known that hyperventilation can lead to low carbon dioxide levels in the blood (or hypocapnea), which can subsequently lead to disturbances of the acid-base balance in the blood and lower tissue oxygen levels. Advocates of this method believe that the effects of chronic hyperventilation would have even wider effects than is commonly accepted. These effects include widespread spasms of the muscle in the airways (bronchospasm), disturbance of cell energy production via the Krebs cycle, as well as disturbance of numerous vital homeostatic chemical reactions in the body. The Buteyko method is a purported method of "retraining" the body's breathing pattern to correct for the presumed chronic hyperventilation and hypocapnea, and thereby treat or cure the body of these medical problems.
The Buteyko method is not widely supported in the medical community, in part due to the fact that research has not supported this theory that hyperventilation and hypocapnea causes disease, with one review noting that there is no convincing evidence to indicate that trying to change asthmatic's carbon dioxide level is either "desirable or achievable." Studies that have looked for evidence to corroborate this theory, such as looking at the carbon dioxide levels in practitioners of Buteyko, have not found this evidence, leading some to propose alternate theoretical pathways for this method to improve symptoms.
Although variations exist among teachers of the technique in different countries, the main objective is "normalization" of breathing and the three core principles of Buteyko remain the same: nasal breathing, reduced breathing and relaxation.
The Buteyko method emphasizes the importance of nasal breathing, which protects the airways by humidifying, warming, and cleaning the air entering the lungs. A majority of asthmatics have problems sleeping at night, and this is thought by Buteyko practitioners to be linked with poor posture or unconscious mouth-breathing. By keeping the nose clear and encouraging nasal breathing during the day, night-time symptoms can also improve. Strictly nasal breathing during physical exercise is another key element of the Buteyko method.
Reduced breathing exercises
The core Buteyko exercises involve breath control; consciously reducing either breathing rate or breathing volume. Many teachers refer to Buteyko as 'breathing retraining' and compare the method to learning to ride a bicycle. Once time has been spent practising, the techniques become instinctive and the exercises are gradually phased out as the condition improves.
Buteyko uses a measurement called the Control Pause (CP), defined as the amount of time that an individual can comfortably hold breath after a normal exhalation. According to Buteyko teachers, with regular Buteyko reduced-breathing practice, asthmatics are expected to find that their CP gradually increases and their pulse rate decreases in parallel decreased asthma symptoms.
Dealing with asthma attacks is an important factor of Buteyko practice. The first feeling of an asthma attack is unsettling and can result in a short period of rapid breathing. By controlling this initial over-breathing phase, asthmatics can prevent a "vicious circle of over-breathing" from developing and spiraling into an asthma attack. This means that asthma attacks may be averted simply by breathing less.
Advocates of the Buteyko method report a wide range of other diseases and symptoms (numbering up to 150), including diabetes, reproductive disorders and psychological disorders, which they believe is aggravated by hyperventilation and hypocapnea, and therefore are treated by use of the Buteyko method. However, research into the effectiveness of Buteyko have focused almost exclusively on asthma with a small amount of research on sleep apnea. Members of the medical community have been skeptical of the efficacy of Buteyko due to the often "exaggerated and unsubstantiated claims" earlier made by Buteyko practitioners.
There are few high quality studies such as randomized controlled trials looking at the efficacy of treating asthma with "breathing retraining" methods in general, which include the Buteyko method, yoga training and other relaxation techniques. Many of the studies that have evaluated breathing retraining have significant methodological flaws, including small sample sizes, possible patient selection bias as well as heterogeneity in design that makes coming to a firm conclusion difficult. These studies are also hampered by the difficulty in proper blinding and placebo control which could introduce more bias into these studies.
The results from these studies have found trends of subjective improvement in factors such as asthma symptoms and measurement of quality of life with use of the Buteyko method and possible reduced rescue inhaler usage. However, these studies have found no improvement in objective measures such as peak flow and FEV1 which are the typical measures for measuring the severity of asthma, or carbon dioxide level in the blood.
Based on the available evidence, reviews of the literature and expert medical guidelines have come to conflicting conclusions about the Buteyko method, though most have called for more research, including larger trials involving more patients. On the one hand, a Cochrane review found "no reliable conclusions" could be determined based on the limited available evidence, and the U.S. National Heart, Lung, and Blood Institute asthma guideline concluded "there is insufficient evidence to suggest that breathing techniques provide clinical benefit to patients who have asthma." On the other hand, two more recent reviews have expressed qualified support for considering breathing retraining techniques, which include techniques such as physiotherapist led breathing exercises and yoga breathing in addition to Buteyko. These reviews noted these techniques should only be used as adjuncts to typical treatment with medications for symptom control, as these techniques are unlikely to affect the underlying processes causing the asthma and that the weight of available evidence is not strong enough to come to a definitive conclusion. The British Thoracic Society stated the Buteyko method "may be considered to help patients control the symptoms of asthma" while recognizing the lack of data showing an objective improvement in prior studies. An expert guideline by the Global Initiative for Asthma noted that results from one study suggested that improvement in symptoms by breathing exercises may be due to causes other than changes in the underlying physiology of the disease, such as relaxation, voluntary reduction in medication use and increased participation of the patient in their own care. This result suggests patients who experience anxiety or who overuse their rescue inhalers in particular may benefit from any breathing techniques as an adjunct to conventional treatments, though cost of using these techniques may be prohibitive.