INFORMATION FOR MEDICAL PROFESSIONALS

Buteyko Guide for Doctors, by Peter Kolb, BSc(Eng), MSc(Med), Biomedical Engineer. http://members.westnet.com.au/pkolb/doc-A4G.pdf
This is a brief, clear, accurate description of the Buteyko method, and of the role of Buteyko practitioners. Read this if nothing else for a good overview. Many references at the end.

New Zealand Medical Journal report on double blind study assessing impact of Buteyko Breathing Technique on medication used in asthma.
http://www.nzma.org.nz/jounal/116-1187/710/

Report from Vanderbilt University on early halt to study of mechanical ventilators.
March 1999. http://www.mc.vanderbilt.edu/reporter/?ID=746

Asthma: Ignorance or Design? Comprehensive discussion of Buteyko with case history, by respected Buteyko teacher Jennifer Stark. http://www.nexusmagazine.com Volume 13, Number 1
(December 2005–January 2006)

Books
The Carbon Dioxide Syndrome, by Jenifer Stark and Russell Stark. Buteyko On Line, Ltd. 2004
Traces the physiological path of how low levels of CO2 can lead to various chronic
disease. Clear, factual, understandable for lay people as well as professionals.
At present only available in New Zealand and needs to be ordered though Pippa Kiraly.

Every Breath You Take, By Paul J. Ameisen, MBBS, ND, Dip.Ac. Lansdowne, 1997
A new edition will be available later this year, but this is a useful description of a doctor, initially sceptical, who became an advocate of the Buteyko method, and why. Available at Amazon.com

Freedom from Asthma, by Alexander Stalmatski, with foreword by Professor
Konstantin Buteyko. Kyle Cathie, LTd. 1997. Latest reprint 2001.
Written by the student of Dr. Buteyko who first brought the method out of Russia.

Program structure—more or less similar in all Buteyko programs

Lifelong Easy Breathing Buteyko Method– Program Structure

The principle aim of the Buteyko Method is to teach breathing exercises to retrain the breathing in order that the participant’s Minute Volume reduces toward normal: that is, the person no longer chronically hyperventilates. The Lifelong Easy Breathing program teaches the Buteyko Method techniques, theory and related lifestyle issues over five two hour sessions usually within a ten-day period. As the rate of hyperventilation decreases, experience of symptoms reduces. Frequent monitoring and reinforcement of the BM techniques is essential during the first week of instruction.

Sessions are conducted either on a one-on-one basis or else in a small group class
setting. Review appointments are scheduled as required. Students can attend as many refresher courses as they like, and consult with the practitioner by telephone as needed.

Lifelong Easy Breathing is a program of education and simple breathing exercises that allows asthmatics to control and reduce the frequency of their asthma symptoms. The method encompasses the Buteyko breathing exercises, as well as a comprehensive description of asthma and how it should be managed. The Buteyko breathing exercises are the key to success of the Lifelong Easy Breathing program. While education is proven effective, the exercises give asthmatics useful tools to help clients control their condition. Buteyko exercises are used to monitor the daily health of the asthmatic and can be used to stop oncoming symptoms—a lifesaver in those cases in which help and the inhaler isn’t at hand. Children over four and adults to their nineties can learn this safely, with excellent results.

While the program is directed towards asthmatics in particular, it is equally useful
in cases of other breathing disorders such as chronic sinus problems, panic atttacks, even emphysema. Because it works at a fundamental level in the body, retraining the breathing centers and bringing the blood pH closer to normal, it is also helpful in many other conditions which are affected by hyperventilation, such as high blood pressure, poor sleep patterns, chronic fatigue syndrome, migraines or stress-caused digestive disorders.

In the five day class, students learn the following:
Day 1
Overview of medication and its proper usage, identification of triggers, and the
Physiology of Hyperventilation and Asthma, Introduction of Exercises, The Control
Pause and Relaxed Breathing

Day 2
Buteyko Breathing Exercises: Review and refinement of Control Pause, introduction of Reduced Breathing, The Extended Pause (for asthmatics only), How to overcome an asthma attack using the exercises Foods which trigger asthma, How to measure foods as triggers.

Day 3
Buteyko Breathing Exercises: practice, review and refinement Hyperventilation: How is it different from Asthma? What are the symptoms? Anti-HV Exercises
Control Pause – Correlation to the CO2 level and the likelihood of Asthma or other physiological symptoms.

Day 4
Buteyko Breathing Exercises: practice, review and refinement
Exercise induced asthma and how to exercise with asthma. Using the Buteyko Method in everyday life An individual action plan is designed for each asthmatic.

Day 5
What to do if you have a cold/flu. How to work with your doctor to decrease your medications safely as your symptoms decrease. Decreasing the Buteyko Breathing Exercises Maximizing your success with the method, Important Points to remember, Conclusion

There is a full money-back guarantee at 30 days if at least four sessions were attended and the program followed.

Pippa Kiraly – Lifelong Easy Breathing – 2648 E Aloha St, Seattle, WA 98112 – 206- 329-6604 info@lifelongeasybreathing.com

Regular use of asthma drugs poses respiratory, cardiac dangers,
Cornell, Stanford researchers find in study critical of drug industry

FOR RELEASE: June 17, 2004
Contact: Roger Segelken
Office: 607-255-9736
E-Mail: hrs2@cornell.edu

ITHACA, N.Y. -- Physicians who prescribe the regular use of beta-agonist drugs for
asthma could be endangering their patients, two new studies by researchers at Cornell and Stanford universities find. One study compiles previously published clinical trials to conclude that patients could both develop a tolerance for beta-agonists and be at increased risk for asthma attacks, compared with those who do not use the drug at all. The second study shows that beta-agonist use increases cardiac risks, such as heart attacks, by more than two-fold, compared with the use of a placebo.

Furthermore, the researchers say that their analyses lead them to suspect a conflict of interest among scientists who are supported by pharmaceutical companies that make beta-agonists, among the world's most widely used drugs. This conflict, they say, could be putting 16 million U.S. asthma sufferers in harm's way. Their statement comes as the American Medical Association is voicing its concerns that drug industry sponsorship of clinical tests is affecting the quality of research.

The first study (a meta-analysis, meaning a study of other previously published studies) of more than a dozen research papers on the respiratory effects of beta-agonists is published in the journal, Annals of Internal Medicine (May, 2004), by Shelley R. Salpeter, M.D., Thomas M. Ormiston, M.D., and Edwin E. Salpeter. The second metaanalysis pooled the results from 33 trials on the cardiac effects of beta-agonists, and is published in Chest ( June, 2004), the cardiopulmonary and critical-care journal.

Edwin Salpeter, the eminent astrophysicist who is professor of physics emeritus at Cornell, has turned his interest to medical issues in recent years. He assisted his daughter, Shelley, by performing statistical analyses for asthma drug studies. Shelley Salpeter is a clinical professor of medicine at Stanford University School of Medicine and a physician at Santa Clara Valley Medical Center in San Jose, Calif., where Ormiston also is a physician.

Adrenergic beta-agonists, such as albuterol and terbutaline, work on receptors located on smooth muscles and inflammatory cells in the lungs. These bronchodilator medicines can relax the muscles around the airways that constrict during an asthma attack. Short-term use of beta-agonists has been shown to be helpful in reducing symptoms associated with acute asthma attacks. But continuous use of beta-agonists is a riskier proposition, the authors suggest in their Internal Medicine article.

"Almost all the scientifically valid studies we examined associated continuous betaagonist use by asthma patients with a decreased bronchodilator response to subsequent beta-agonist administration, and with increased airway inflammation compared to placebo use," says Shelley Salpeter. Continuous use of beta-agonist drugs cause asthma patients to develop a tolerance for the drugs, she adds, making beta-agonists less effective in true emergencies.

Edwin Salpeter questions why so many physicians ignore warning signs of beta-agonist
overuse, and why drug companies continue to promote the products for continuous use.
"We think the studies warning of adverse respiratory effects are getting lost among the
dozens of poor-quality studies that missed the point," he says.

Most studies of continuous use of the drugs that showed favorable results were eliminated from the Salpeter-Ormiston-Salpeter meta-analysis because Cornell and Stanford researchers considered them to be scientifically flawed -- in part because they allowed the as-needed use of beta-agonists in the placebo groups of clinical trials.

Most of these "poor-quality studies" that were eliminated from the meta-analysis, the three researchers say, also turned out to involve conflicts of interest -- because the studies were funded by pharmaceutical companies, because researchers had financial ties to the industry, or both.

"If you want to push continuous use of beta-agonists, you'll find plenty of published studies to back your point of view," Shelley Salpeter says. "However, because of their flawed study designs, none of these trials were truly placebo-controlled and therefore should not be used to make valid conclusions about the safety of beta-agonists. We worry that physicians who recommend regular use of beta-agonists may actually be putting their patients at risk."

To make matters worse, beta-agonist use in patients with asthma and chronic obstructive lung disease also increases the risk for adverse cardiac events (such as heart attacks) by over two-fold compared to placebos, the Cornell-Stanford researchers warn. Betaagonists work on receptors found in the heart, to increase the heart rate and decrease the level of the essential element potassium. These effects are the exact opposite of betablocker drugs, such as atenolol, that often are used in patients with heart disease to decrease their risk for heart attacks and congestive heart failure.

In the spirit of full disclosure, the meta-analysis authors say they have no ties whatsoever to the pharmaceutical industry. In the course of the meta-analyses, Ormiston and Shelley Salpeter received salary support from Santa Clara Valley Medical Center. Edwin Salpeter received no support from Cornell. He did the statistical analysis work, he says, "just for the fun of it, and because I want to see good science rise to the top."
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| June release index | | Cornell News Service Home Page |

Quick summary with trial abstracts
Lifelong Easy Breathing Program
The Buteyko Method (byõõ-tã-ko)
SUMMARY SHEET

TRADE NAMES: Lifelong Easy Breathing,The Buteyko Institute Method (BIM)*, The
Buteyko Method

The Buteyko Method (BM) is an add-on therapy for patients with mild to severe
persistent asthma who are inadequately controlled by their medication and/or who wish to learn to control their asthma without medication under their doctor’s supervision. It is a system of asthma education and simple breathing exercises for the treatment of asthma and breathing conditions in all adults and children from age four.

BM is currently used successfully for the treatment of asthma, emphysema, allergies, chronic bronchitis, hyperventilation syndrome, panic attacks, bronchiectasis, the relief of hay fever, chronic sinusitis and other stress-related diseases. The Buteyko Method offers another option in the management of asthma—its goal is to help asthmatics achieve maximum control of their asthma with the minimum amount of medication.

Important Note
The Buteyko Method 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 and the advice of 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.

Background information
The Buteyko Method was developed by Russian doctor and respiratory specialist Konstantin Buteyko, in the 1940’s. His method underwent extensive research in the ’50’s and was finally implemented into widespread use by the medical community in Russia in the 80’s. In the early 90’s, practitioners of the method introduced the technique into Australia. Australia remains the Buteyko stronghold outside of Russia, though the United Kingdom is fast on its heels.

Adverse Effects
The Buteyko Method has no known side-effects. It involves no herbs, vitamins, special diets, positive thinking, traditional chest physiotherapy, medication, religion or new drugs. There is no equipment needed, and there is no physical contact with the tutor or anyone else in the class.

Economic Considerations
The Buteyko Method is currently only available by workshop through a private
instructor. Even so, it is very cost-effective. The workshop cost is often recouped within the year by the savings from a reduction in medication usage alone.

* BIBH –
The Buteyko Institute of Breathing and Health Inc is a non profit organization committed to improving health by correcting asthma through research, development, promotion and application of the Buteyko Institute Method of Breathing Reconditioning

Clinical Efficacy
Since its introduction into the western world in the 1990’s, the Buteyko Method has been scrutinized in several clinical trials.

Recent trials not yet published include…

  • Hamilton Polytechnic, New Zealand, pilot study.
  • Victoria University, Victoria. (Cameron Gosling, Steve Lee). BIBH (Paul O’Connell)
  • Glasgow, UK, pilot study 2000. Researcher, Jean McGowan employed at Paisley University
  • Gisborne Hospital New Zealand. Dr Patrick McHugh. (report recently submitted for publication)

Abstracts of Published Trials

Journal of Asthma
J Asthma 2000;37(7):557-564
A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video. Opat AJ, Cohen MM, Bailey MJ, Abramson MJ.

Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Prahan, Vic, Australia. The Buteyko Breathing Technique (BBT) is promoted as a drug-free asthma therapy. It is based on the premise that raising blood PaCO2 through hypoventilation can treat asthma. Our study was designed to examine whether the Buteyko Breathing Technique, as taught by a video, is an efficacious asthma therapy. Thirty-six adult subjects with mild to moderate asthma were randomized to receive either a BBT or placebo video to watch at home twice per day for 4 weeks. Asthma-related quality of life, peak expiratory flow (PEF), symptoms, and asthma medication intake were assessed both before and after
intervention. Our results demonstrated a significant improvement in quality of life among those assigned to the BBT compared with placebo (p = 0.043), as well as a significant reduction in inhaled bronchodilator intake (p = 0.008). We conclude that the BBT may be effective in improving the quality of life and reducing the intake of inhaled reliever medication in patients with asthma. These results warrant further investigation.

Medical Journal of Australia
MJA 1998; 169: 575-578
Buteyko breathing techniques in asthma: a blinded randomised controlled trial
Simon D Bowler, Amanda Green and Charles A Mitchell

Objective: To evaluate the effect of Buteyko breathing techniques (BBT) in the management of asthma. Design: Prospective, blinded, randomised study comparing the effect of BBT with control classes in 39 subjects with asthma. The study was conducted from January 1995 to April 1995.

Participants and setting: Subjects recruited from the community, aged 12 to 70 years,
with asthma and substantial medication use. Main outcome measures: Medication use;
morning peak expiratory flow (PEF); forced expiratory volume in one second (FEV1);
end-tidal (ET) CO2; resting minute volume (MV); and quality of life (QOL) score,
measured at three months.

Results: No change in daily PEF or FEV1 was noted in either group. At three months,
the BBT group had a median reduction in daily beta2-agonist dose of 904 µg (range, 29 µg to 3129 µg), whereas the control group had a median reduction of 57 µg (range, - 2343 µg to 1143 µg) (P = 0.002). Daily inhaled steroid dose fell 49% (range, - 100% to 150%) for the BBT group and 0 (range, - 82% to +100%) for the control group (P = 0.06). A trend towards greater improvement in QOL score was noted for BBT subjects (P = 0.09). Initial MV was high and similar in both groups; by three months, MV was lower in the BBT group than in the control group (P = 0.004). ET CO2 was low in both groups and did not change with treatment.

Conclusion: Those practising BBT reduced hyperventilation and their use of beta2 agonists. A trend toward reduced inhaled steroid use and better quality of life was observed in these patients without objective changes in measures of airway calibre.

Related Research

British Medical Journal
BMJ 2001 May 5;322(7294):1098-1100
Prevalence of dysfunctional breathing in patients treated for asthma in
primary care: cross sectional survey.
Thomas M, McKinley RK, Freeman E, Foy C.

Surgery, Minchinhampton, Stroud, Gloucestershire GL6 9JF.
drmthomas@oakridge.sol.co.uk

OBJECTIVES: To estimate the prevalence of dysfunctional breathing in adults with asthma treated in the community. DESIGN: Postal questionnaire survey using Nijmegen questionnaire.

SETTING: One general practice with 7033 patients.

PARTICIPANTS: All adult patients aged 17-65 with diagnosed asthma who were
receiving treatment. MAIN OUTCOME MEASURE: Score >/=23 on Nijmegen
questionnaire.

RESULTS: 227/307 patients returned completed questionnaires; 219 (71.3%)
questionnaires were suitable for analysis. 63 participants scored >/=23. Those scoring>/=23 were more likely to be female than male (46/132 (35%) v 17/87 (20%), P=0.016) and were younger (mean (SD) age 44.8 (14.7) v 49.0 (13.8, (P=0.05). Patients at different treatment steps of the British Thoracic Society asthma guidelines were affected equally.

CONCLUSIONS: About a third of women and a fifth of men had scores suggestive of dysfunctional breathing. Although further studies are needed to confirm the validity of this screening tool and these findings, these prevalence’s suggest scope for therapeutic intervention and may explain the anecdotal success of the Buteyko method of treating asthma.


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Lifelong Easy Breathing
2648 E Aloha St • Seattle WA 98112 

Questions or comments?
Write, telephone or e-mail Pippa Kiraly, 206-329-6604
info@lifelongeasybreathing.com