Summary of Buteyko’s Theory on Asthma

Note to medical doctors. Compliments of www.ButeykoNYC.com

Peter Kolb BSc(Eng),MSc(Med),CPEng(Biomed)


BIOMEDICAL ENGINEER

Updated 16 September 2001; pages further updated by www.ButeykoNYC.com 6/30/08

Important note on medication:

Buteyko therapy is a simple education program which does not affect conventional asthma management. Patients are actively encouraged to take medication in accordance with current asthma management practices as recommended by their physician.

Benefits of the treatment manifest initially in a reduction in requirement for bronchodilators and a reduction in symptoms. Reduction in steroids is arranged by the patient’s doctor once the symptoms have disappeared.

Buteyko therapy is a logical approach to dealing with Chronic Hyperventilation Syndrome (CHVS). Whereas prolonged chronic stresses of any kind can lead to physiological habituation to over breathing (Ref 13,23), Buteyko therapy simply reverses this process by relaxation of the respiratory muscles accompanied by deliberate volitional reduction in breathing over time.

The medical literature on CHVS reveals that:

  • Doctors rarely diagnose the disorder or even look for CHVS as a diagnostic possibility (Ref. 1, 13, 15, 20, 23).
  • Treatment for CHVS is not well developed, consisting of counseling and occasionally mild sedation.
  • Prevalence has been found to be between 6 and 11% in outpatient populations (Ref. 4, 13, 15, 24, 25). This excludes patients with organic disease such as asthma.
  • The following are a few of the symptoms and observations associated with CHVS: (Ref. 1, 3, 5, 7, 13, 14, 15, 20, 23, 26) Hypophosphatemia, elevated uric acid, elevated sugar levels, loss of CO2 and base reserve, electrolyte changes, poor oxygenation due to Bohr effect, elevated lipids, elevated calcium ionization, palpitations, cardiac neurosis, angina pain, mitral prolapse, myocardial infarction, tachycardia, Wolfe-Parkinson-White syndrome, arrhythmias, cerebral vascular constriction, stenosis of coronary artery, failure of coronary bypass grafts, right ventricular ectopy, silent ischaemia, elevated blood pressure, ECG: Flat or inverted T-wave, vasoconstriction, hiatus hernia, duodenal spasm, irritable bowel syndrome, spastic colon, Raynaud’s disease, Da Costa’s Syndrome, renal colic, genito-urinary disturbances, weakness, burnout, post traumatic stress disorders, influenza-like symptoms, sleep disturbances, chest pains, restlessness, syncope, excessive sweating, edema, migraines, aerophagia, failure of transurethral resections, chest tightness, muscle spasm, muscular stiffness and aching, paresthesia, seizures, visual disturbances, panic attacks, phobias, anxiety, EEG abnormalities, auditory disturbances, increased sympathetic tone, dizziness, dyspnea, asthma, shortness of breath…..

Since chronic hyperventilators can get any but not necessarily all of the symptoms, genetic predisposition must influence the way the disorder manifests in an individual.

Buteyko therapy has been brought to the west mainly as a treatment for asthma because of its evident and rapid effectiveness on this disorder. “Anecdotal” evidence supplied by asthmatics trying the method would suggest that the treatment is effective for all asthmatics, an observation which is supported by results published in a paper by Bowler et al.(Ref. 2.) This paper discusses a double blind controlled clinical trial in which the 19 long term asthmatics in the test group reduced their bronchodilator usage by 96% and steroids by 49% in 12 weeks.

What makes the hyperventilation theory for asthma difficult to accept at first, is that asthma is understood to be primarily an inflammatory disease. But as Lum (Ref. 13) points out in relation to CHVS “Symptoms may show up anywhere, in any organ, in any system; for we are dealing with a profound biochemical disturbance, which is as real as hypoglycemia and more far reaching in its effects.” The biochemical basis for this theory is spelt out by Kazarinov (Ref.12) who demonstrates why CO2 is so crucial to all biosynthetic and regulatory processes. This biochemical disturbance deranges the immune system leading to immunological disorders like the allergic hyper reactivity seen in asthma, autoimmune disorders as seen in arthritis and a failure by the immune system to pick up cancer cells.

Pathophysiology of chronic hyperventilation in asthmatics:

  1. Hypocapnia is the rule in Asthma and is particularly severe during an attack in mild/early stage asthma. (Ref. 4,16). As damage to the lungs progresses, a perfusion/ventilation mismatch occurs resulting in an improvement in arterial hypocapnia, but increasing hypoxia. At the same time those portions of the lungs still functioning properly become over ventilated. (Ref.16)
  2. Respiratory alkalosis resulting from over-breathing leads to renal pH compensation by the dumping of bicarbonates. The net result is a depletion of the bicarbonate buffer, low pCO2 and a disruption of the electrolytic balance resulting from lost electrolytes (particularly magnesium) which accompany the dumped bicarb.
  3. Habituation to low CO2 is brought about by prolonged episodes of factors causing hyperventilation such as chronic undischarged stress, wearing excessively warm clothing over a long period as well as many other bad western lifestyle habits. The accommodation process is set when these episodes span the time taken for bicarbonate to be dumped by the kidneys and the time taken for bicarbonate to slowly cross the blood-brain barrier.(Ref.10)
  4. Kazarinov (Ref 12) shows how every biosynthetic process in the body is dependent on CO2 either directly or as a catalyst. Low CO2, therefore, affects all processes from the tricarboxylic acid (Krebs) cycle to the synthesis of proteins and lipids. This is the basis of Buteyko’s claim that over-breathing is the cause of many diseases which is consistent with the large and bizarre number of symptoms seen in CHVS.
  5. Low CO2 in the blood reduces oxygenation of the tissues through a depressed Bohr effect. Oxy-hemoglobin dissociation is very strongly dependent on CO2.

Oxy-hemoglobin dissociation is also affected by low 2,3 diphosphoglycerate (2,3 DPG). Production of 2,3 DPG is also depressed in CHVS because of hypocapnia induced hypophosphatemia. (Ref. 15)

All this results in an accumulation of acids such as lactic, pyruvic and uric acids. The expected high venous oxygen is, indeed, seen in conditions such as chronic fatigue syndrome.

Poor oxygenation produces air hunger, which tends to stimulate over-breathing in the form of excessive sighing and yawning.

  1. Low CO2 produces spasm in the smooth muscle of blood vessels, gut, ducts, glands and bronchioles (Ref. 8). Blood vessel spasm together with the depressed Bohr effect produces hypoxia that can account for headaches, migraines and angina pain. (Ref.: 5, 13, 15, 20, 23, 25)
  1. Bronchioles constrict in response to local conditions rather than to CNS innervation. It makes teleological sense that the bronchioles should shunt air in order to even out ventilation. Since alveolar CO2 is low in asthmatics, (Ref.:16) the over ventilated bronchioles are closer to shutting down and are, therefore, seen as “twitchy”.
  2. Buteyko therapy is simply an attempt to get the breathing normalised, i.e.: get the individual to physiologically habituate to breathing less. Effectively the same processes which make acute episodes of hyperventilation become chronic, are simply reversed. Once the respiratory centre is reset to a physiologically more normal level through a restoration of normal bicarbonate level in the CSF, the bronchioles will open up in response to more normal baseline CO2 levels.
  3. According to Professor Buteyko, inflammation and allergic hyper-responsiveness is caused primarily by an immune system which has become deranged due to low CO2. This is also why chronic stress can leave an individual more vulnerable to colds, flues and other disorders associated with an unhealthy immune system. In addition the normal regulation and production of all hormones is affected by low CO2. This includes the normal production of Cortisol which may be impeded by chronically low CO2. Cortisol shortage contributes to the inflammatory hyper-responsiveness of the lungs.
  4. Adrenal insufficiency is considered an important consequence of chronic hyperventilation. Cortisol supplementation along the lines recommended by Mck Jefferies (Ref 17 ) is considered essential in the process of restoring normal biochemical function.
  5. The teleological explanation for mucus build up is that its function is to protect the raw and inflamed tissues. It may become thick and sticky due to the airways drying out as a result of mouth breathing.
  6. Finally, what we have considered to be the cause of asthma, viz allergens, anxiety, transient stresses etc, are all just triggers for asthma and not the cause.
  7. The Buteyko theory makes sense of all the enigmas that have been confounding our classical understanding of asthma, which according to Buteyko, is a single disease with multiple triggers, rather than a complex diseases with multiple causes.
  8. Patients on Buteyko therapy typically report improvements in other CHVS symptoms, corresponding to improvements in their asthma.

 

 

 

References:

  1. Bass C, “The hyperventilation syndrome”, Respiratory Diseases in Practice, VOL , Oct/Nov 1990, 13-16
  2.  Bowler S, Green A, Mitchell C, “Buteyko breathing and asthma: a controlled trial”, Medical J. of Australia, VOL 169, December 1998, 575-578
  3. Brasher RE, “Hyperventilation Syndrome”, Lung, VOL 161, 1983, 257-273
  4. Clarke PS, Gibson J, “Asthma, hyperventilation and emotion”, Australian Family Physician, VOL 9, 1980, 715-719
  5. Cluff RA, “Chronic Hyperventilation and its treatment by physiotherapy: discussion paper”, J of the Royal Society of Medicine, VOL 77, September 1984, 855- 861
  6. DaCosta JM, “On irritable heart: a clinical study of a form of functional cardiac disorder and its consequences.”, Am J Med Sci, VOL 61, 1871, 17-53
  7. Demeter SL, Cordasco EM, “Hyperventilation syndrome and asthma”, The American Journal of Medicine, VOL 81, December 1986, 989-994
  8. Donnelly PM, “Exercise induced asthma: The protective role of CO2 during swimming”, The Lancet, VOL 337, 19 January 1991, 179-180
  9. Gayrard P, Orhek J, Grimaud C, Charpin J, “Bronchoconstrictor effects of deep inspiration in patients with asthma”, Am Rev Respir Dis, VOL 111, 1975, 433-439
  10. Guyton AC, Hall JE, “Textbook of medical physiology”, Chemical control of respiration, PUBLISHER: WB Saunders; ISBN:0-7216-5944-6; 1996; EDITION: 9; PAGES: 527-528.
  11. Hibbert GA, Pilsbury DJ, “Demonstration and Treatment of Hyper-ventilation Causing Asthma”, British J. of Psychiatry, VOL 153, 1988, 687-689
  12. Kazarinov VA, “Buteyko Method: The experience of implementation in medical practice”, The biochemical basis of KP Buteyko’s theory of the diseases of deep respiration, EDITOR: Buteyko KP; PUBLISHER: Patriot Press Moscow; 1990; PAGES: 198-218. [Translation available from http://www.wt.com.au/~pkolb/biochem.htm] 
  13. Lum LC, “Hyperventilation: The tip and the iceberg“, J Psychosom Res, VOL 19, 1975, 375-383. A complete version of this paper is available in PDF format LUM.PDF
  14. Magarian GJ, “Hyperventilation syndrome: infrequently recognized common expressions of anxiety and stress.”, Medicine, VOL 61, 1982, 219-36
  15. Magarian GJ, Middaugh DA, Linz DH, “Hyperventilation Syndrome: a diagnosis begging for recognition“, West J Med, VOL 138, 1983, 733-736
  16. McFadden WR, Lyons HA, “Arterial-Blood Gas Tension in Asthma”, The New England Journal of Medicine, VOL 278:19, 9 May 1968, 1027-1032
  17. Mck Jefferies,MD FACP “Safe uses of Cortisol.” PUBLISHER: Charles C.Thomas – Springfield. ISBN:0-398-06621-3; 1996; EDITION: 2; 
  18. Morgan WP, “Hyperventilation Syndrome: a review”, Am Ind Hyg Assoc J, VOL 44:9, 1983, 685-689
  19. Neill WA, Hattenhauer M, “Impairment of Myocardial O2 supply due to Hyperventilation”, Circulation, VOL 52, November 1975, 854-858
  1. Nixon PGF, “Hyperventilation and cardiac symptoms”, Internal Medicine, VOL 10:12, December 1989, 67-84
  2. Pfeffer JM, “Hyprventilation and the hyperventilation syndrome”, Postgrad Med, VOL 60(Sup.2), 1984, 12-15
  3. Pfeffer JM, “The etiology of the hyperventilation syndrome”, Psychother Psychosom, VOL 30, 1978, 47-55
  4. Sher TH, “Recurrent chest tightness in a 28-year-old woman”, Annals of allergy, VOL 67, September 1991, 310-314
  5. Tavel ME, “Hyperventilation syndromev – Hiding behind pseudonyms?”, Chest, VOL 97, 1990, 1285-1288
    25. Waites TF, “Hyperventilation – chronic and acute”, Arch Intern Med, VOL 138, 1978, 1700-1701
    26. Wheatley CE, “Hyperventilation syndrome: A frequent cause of chest pain”, Chest, VOL 68:2, August 1975, 195-199

Clinical Trials

  1. See Ref 2
  2. Cooper S, Oborne J, Newton S, Harrison V, Thompson-Coon J, Lewis S, Tattersfield A, “Effect of two breathing exercises (Buteyko and Pranayama) in asthma: a randomized controlled trial.”, Thorax, VOL 58, 2003, 674-679
  3. McGowan J, “Health Education: Does the Buteyko Institute Method make a difference?”, Thorax, VOL 58/Sup3, December 2003, p28 see note below.
  4. McHugh P, Aitcheson F, Duncan B, Houghton F, “Buteyko Breathing Technique for Asthma: an effective intervention.”, The Medical Journal of New Zealand, VOL 116, 12 December 2003, see note below.
  5. Opat AJ, Cohen MM, Bailey MJ, Abramson MJ, “A Clinical Trial of the Buteyko Breathing Technique in Asthma as Taught by Video”, J. of Asthma, VOL 37(7), 2000, 557-564
  6. Thorax Medical Journal (Dec 2003 Vol 58 Sup III) “Health Education in Asthma Management – Does the Buteyko Institute Method make a difference?” This report describes the results of the Glasgow Buteyko trial. The trial was designed for 600 adults with asthma aged between 18 and 69 years. 384 of the initial 600 participants (64%) completed the trial. The results for the Buteyko group show average reductions of over 90% for reliever medications, preventer medications and asthma symptoms after 6 months, which were maintained at 12 months. BIBH member Jill McGowan, who ran the trial, also presented these results at the British Thoracic Society Winter Conference in London on 4 Dec 2003.
  7. New Zealand Medical Journal (12 Dec 2003, Vol 116 No 1187) “Buteyko Breathing technique for asthma: an effective intervention” A blinded randomized controlled trial comparing Buteyko with control was conducted on 38 people with asthma aged 18 to 70 over 6 months. The Buteyko group exhibited reductions of 85% in beta 2 agonists (reliever medications) and 50% in inhaled steroids (preventer medications). The conclusion was that Buteyko is a safe and efficacious asthma management technique and has the clinical and potential pharmaco-economic benefits that merit further study. The researcher on this trial was Dr Patrick McHugh from Gisborne, NZ.
  8. Thorax Journal 2006 000:1-7doi  101136/thx2005 054767 CA Slader, HK Reddel, LM Spencer, EG Belousova, CL Armour, SZ Basnic-Anticevich, FCK Thien, CR Jenkins. Results after applying Buteyko techniques for 12 weeks
  • Reliever usage – median reduction of 86%
  • Preventer usage – median reduction of 50%

9) New Zealand Medical Journal Vol 119 No 1234 ISSN 1175 8716 May 2006

Patrick McHugh, Bruce Duncan and Frank Houghton, Gisborne, New Zealand. Results after applying Buteyko techniques to children with asthma for 12 weeks

  • Reliever usage – median reduction of 66%
  • Preventer usage – median reduction of 41%
  • 11 courses of prednisone given 3 months before the trial.               
  • 1 course of prednisone given three months after the trial.

10) Proceedings of the American Thoracic Society, 2006;3:A530                             Foothills Hospital Medical trial, Calgary, Alberta. May 2006. Robert Cowie. Results after applying Buteyko techniques for 6 months

  • Asthma control improved from 41% to 75%, an increase of 34%
  • Decrease of ICS was 39%
  • Elimination of ICS was 21%
  • I’ve been astonished and also very pleased with the excellent result. There is no disruption of their life at all by their disease: normal activities; not waking at night; not needing to use any reliever medications. It’s just great…75% control is about as good as anyone has got in any study of asthma. The neat thing about it is that it has no side effects. It’s very safe. The Buteyko technique certainly has been shown to be an important adjunct to treatment.”                       

Dr. Robert Cowie, Resident Respirologist of Foothills Hospital in Calgary and head researcher on the Buteyko Breathing Technique Medical Trial. (October 2004 – April 2005)

Buteyko & The British Guideline on the Management of Asthma 2008.

  • The British Guideline on the Management of Asthma 2008 grants permission for British health professionals to recommend Buteyko, stating that the method “may be considered to help patients control the symptoms of asthma”. The guideline also grades clinical research on Buteyko with a ‘B’ classification – indicating that high quality supporting clinical trials are available. No other complementary therapy has been endorsed by this body for the treatment of asthma.