Mansoura Nursing Journal (MNJ)            Vol. 8.  No.2 - 2021  
                              Print  ISSN: 2735 – 4121           Online ISSN : 2735 – 413X 
                     Buteyko Breathing Technique:The Golden Way for Controlling 
                                       Asthma among Children 
                         1Esraa Elwan Mohammed Hassan, 2 Fawzia Elsayed Abusaad, 3Boshra Attia Mohammed 
                       1Demonstrator in Pediatric Nursing Department, Faculty of Nursing, Mansoura University 
                    2Professor of Pediatric Nursing, Faculty of Nursing, Mansoura University, 3Assistant Professor of 
                                Pediatric Nursing, Faculty of Nursing, Mansoura University 
                             E-mail:1esraa_elwan@mans.edu.eg&1esraaelwan1992@gmail.com 
                                2 fawziaabusaad2013@gmail.com&3toboshra@yahoo.com 
                                Corresponding author: 1 Esraa Elwan Mohammed Hassan 
                                                   
                                                   
                                                   
                   Abstract 
                         Asthma is one of the chronic respiratory disorder affecting children of all age 
                   group .It is characterized by long-term airway inflammation with respiratory symptoms 
                   such  as  dyspnea,  wheezes,  shortness  of  breath  and  episodes  of  coughing  of  variable 
                   severity.The possible effects of asthma and other chronic respiratory problems to children 
                   are  often  attributed  to  restrictions  in  activity  and  its  dangerous  consequences.  Despite 
                   there is a better awareness of the causes that cause asthma and new pharmacological 
                   measures are available for the treatment of asthma, the goal is to ensure that as many 
                   children  with  asthma  worldwide  have  access  to  cost-effective  management  methods  to 
                   minimize  morbidity  and  mortality  as  possible.This  can  be  achieved  by  combination  of 
                   medical therapy and complementary alternative medicine techniques.One such method is 
                   Buteyko breathing technique (BBT). This technique is a distinctive breathing treatment that 
                   uses  breathing control  and  breath-holding  techniques  to treat  a  wide  variety  of health 
                   problems that are suspected to be due to hyperventilation as bronchial asthma. This article 
                   review describes the process of BBT, the physiology behind it, and discusses the available 
                   evidence for its efficacy.  
                   Keywords:Buteyko  Breathing  Technique,  Childhood  Asthma,  Controlling  Asthma, 
                   Effectiveness. 
                    
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                                 Esraa Elwan Mohammed Hassan et. al. 
                                Introduction 
                                        Asthma  is  one  of  the  most                    and     development        of    the     child 
                                prevalent  chronic  disorders  affecting                  (Mohamed,  Elderiny,  &  Ibrahim, 
                                bronchial      trees   that    triggered     by           2017;Kalaci,  et.al.,2019).  This  can  be 
                                hyperresponsiveness  of  the  airways.  It                done by combination of pharmacological 
                                was  described  as  the  narrowing  of  the               therapy     and     other    complementary 
                                airways  in  response  to  a  variety  of                 alternative medicine (CAM),one of these 
                                stimuli  (World  Health  Organization                     alternative          therapiesis           the 
                                (WHO),  2020).It  causes  intermittent                    Buteykobreathing  technique  (BBT).  It 
                                breathing difficulties that are marked by                 was  developed  by  Dr.  Konstantin 
                                completely or partially reversible airflow                Buteyko  in  Russia  in  1952,  which 
                                limitation,     and    may     spontaneously              believed  that  hyperventilation  induces 
                                improve  or  subside  only  after  specific               asthma.  Buteyko  approach  seeks  to 
                                treatment.This         symptom         appears            educate  asthmatic  patients  to  decrease 
                                especially  at  night  and  early  morning,               airflow by teaching them the best way to 
                                which  may  be  life  threatening  if  left               hold  their  breath  at  the  functional 
                                untreated,  but  can  be  reversible  with                residual  capacity  (Mohamed,  et.al., 
                                proper care (El-Gilany, El Desoky, El-                    2017).  Global  interest in  the  BBT  has 
                                Hawary, & Farrag, 2018) All over the                      been  picking  up  in  recent  years,  but 
                                                                . 
                                world,  asthma  is  one  of  the  prevalent               further studies are possibly also needed 
                                non-communicable          diseases     (NCDs)             to  be  approved  by  the  public  and  in 
                                with large  variations  in  prevalence  and               particular by the healthcare team (Ward, 
                                severity. For the future, it may remain a                 & Baptist, 2016). 
                                challenge  and  still  receive  insufficient              Literature Searching Strategy  
                                support and treatment.There are around                            The  authors  searched  electronic 
                                300  million  people  diagnosed  with                     medical  and  health  care  databases, 
                                asthma.  In  the  last  40  years,  the                   including  “Google  Scholar”,  “Cochrane 
                                incidence  of  allergy-related  asthma  has               library”,   “Science  Direct”,“PubMed”, 
                                grown.  By  2025,  the  number  of                        “Scopus”,      “DOAJ”,       “ERIC”,       and 
                                individuals with asthma will rise by more                 “EBSCOhost”,        to    find    appropriate 
                                than  100  million  (Nunes,  Pereira,  &                  literature  on  this  subject.As  keywords, 
                                Morais-Almeida,  2017;WHO,  2020).                        the following search phrases were used: 
                                Extreme  and  uncontrolled  asthma  can                   “Buteyko breathing technique, ”Buteyko 
                                endanger  life.  Many  medications  are                   breathing        exercise,”“complementary 
                                used for the treatment of  children with                  alternative       therapy,”        “asthma,” 
                                asthma.  However,  they  have  not  been                  “childhood  asthma,”  “asthma  physical 
                                shown to adequately improve the quality                   therapy,” “breathe holding”. 
                                of life (QoL). Moreover, they also have                   Background about Asthma  
                                severe  adverse  effects  that  hinder  their                     Asthma  is  a  long-lasting  illness 
                                long-term  use  (Global  Initiative  for                  that  varies  and  fluctuates  over  time, 
                                Asthma, 2019). It is important to have                    happens  frequently  in  early  childhood 
                                quick  and  economical  managementto                      and  is  the  dominant  constant  illness  in 
                                effectively  monitor  asthma  symptoms                    children (WHO, 2020).There is no fully 
                                and  reduce  the  incidence  of  acute                    accepted  definition  of  asthma  to  date, 
                                exacerbation,  which  prevents  its  harsh                which  encompasses  children  from  birth 
                                consequences from restricting the growth                  to  puberty.  It  can  be  operationally 
                                 
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                                                                        Buteyko Breathing Technique:The Golden Way for etc…
                                    described as a bronchial tree obstructive                      (Bush,2019).The dominant physiological 
                                    disease  due  to  airway  smooth  muscle                       event  in  asthma  contributing  to  clinical 
                                    contraction,      increase      secretion,     and             signs  and  subsequent  disruption  of 
                                    swelling  or inflammation of the airway                        airflow is bronchoconstriction.  In acute 
                                    (Ahmed,  &  Turner,  2019).  Asthma                            asthma             exacerbations,              this 
                                    affects all age classes, but mostly begins                     bronchoconstriction arise in response to 
                                    in infancy. It is a condition characterized                    exposure  to  a  number  of  stimuli, 
                                    by repeated breathlessness and wheezing                        including  allergens  or  irritants,  that 
                                    attacks,  which  vary  in  severity  and                       rapidly  narrows  the  airways  (Sanak, 
                                    duration      from      person      to    person.              2016;Fehrenbach,              Wagner,            & 
                                    Moreover,  for  the  same  person,  it  can                    Wegmann,  2017).  Other  variables 
                                    vary  from hour to hour and day to day                         further  limit  airflow  as  the  disease 
                                    (WHO, 2020). Childhood asthma make                             becomes more persistent and constriction 
                                    the child, their families and community                        becomes       more      progressive.       Which 
                                    under  a  substantial  burden.   It  is                        include  edema,  inflammation,  increase 
                                    associated  with  poor  lung  function                         mucus  secretion  and  the  formation  of 
                                    development,  this  impairment  increase                       phlegm,  as  well  as  structural  changes, 
                                    the risk of chronic obstructive pulmonary                      including       smooth        muscle       airway 
                                    disease and affect the respiratory health                      hypertrophy and hyperplasia. These latter 
                                    in  adult  life  (El-Gilany, et.al.,  2018).A                  alterations may not respond to standard 
                                    sharp  rise  in  asthma  incidence  was                        therapy (Inyor, & Perez,2019). Asthma 
                                    observed  in  a  number  of  developing                        is  a  complex  condition  that  includes 
                                    countries  during  the  second  half  of  the                  biochemical, autonomic nervous system, 
                                    twentieth  century,  especially  after  the                    immunological,  viral,  endocrine,  and 
                                    1960 (Dharmage, Perret, & Custovic,                            psychosocial factors of different degrees 
                                    2019).     About  300  million  people                         in  different  individuals.  Therefore,  the 
                                    globally affected by asthma which it is a                      causes of childhood asthma are not well 
                                    persistent condition for both children and                     known  (Meatty,  et.al.,  2018).The  risk 
                                    adults, and it is likely that another 100                      factors    for    asthma  include  genetic 
                                    million will be affected by 2025(Nunes,                        patterns, family history, certain forms of 
                                    et.al.,   2017).The  asthma  burden  is                        airway  infections  at  a  very  early  age, 
                                    considerable.  In  developing  countries,                      susceptibility  to  environmental  triggers 
                                    over 80% of asthma-related deaths occur                        such as tobacco smoking, dust mite, pet 
                                    (WHO,  2020).  Asthma,  particularly                           dander,      pollen,      physical       activity, 
                                    among children from poor families, is a                        variations  in  temperature,  food  allergy, 
                                    common health problem in Egypt and is                          obesity,  and  emotions. Sometimes with 
                                    possibly           underdiagnosed              and             no visible triggers, asthma attacks arise 
                                    undertreated (El-Gilany, et.al., 2018).In                      (Bhattacharjee, et.al., 2018). Recurrent 
                                    Delta  region  the  childhood  asthma                          wheezing, coughing, chest tightness, and 
                                    overall  prevalence  is  13.4  percent.  In                    dyspnea  are  signs  and  symptoms  of 
                                    boys, it is substantially higher than girls                    asthma, which becoming more common 
                                    (15.4  percent  vs.11.3  percent)  (Meatty,                    at    nighttime       and     early     morning, 
                                    El-Desoky, El-Domyaty, El-Gilany, &                            that often  diminishing  QoL  (Thomson, 
                                    Nasef,  2018).Ventilation  restriction  in                     2015).      Diagnosing          a     child      as 
                                    asthma is frequent and influenced by a                         having asthma  is  only  the  first  step  in 
                                    variety         of        airway         changes               reducing symptoms, physical disabilities, 
                                     
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                              Esraa Elwan Mohammed Hassan et. al. 
                              QoL  deficiency,  and  the  possibility  of          pharmacological      therapy     involves; 
                              disease-related   adverse    effects   (Al-          reliever medicines- that enable symptom 
                              Moamary, et.al., 2019).The diagnosis of              relief  within  a  few  minutes,  during 
                              asthma  is  based  on  history,  physical            asthma worsening or exacerbations; and 
                              examination, lung function examinations,             control  medicines-that  are  used  to 
                              and     other     differential    diagnosis          maintain  asthma  care  (Ellwood,  et.al. 
                              assessments (Horak, et.al., 2016).There              2017). Beta-adrenergic agonist has long 
                              is no cure for asthma, but with the proper           been the cornerstone of asthma medicine, 
                              diagnosis,  care  and  an  asthma  control           in  which  the  key  of  acute  asthma 
                              plan,  the symptoms  can  be  controlled             treatment  is  inhaled short-acting  beta-2 
                              (Tesse, Borrelli, Mongelli, Mastrorilli,             agonist   (SABA)  therapy.  Systemic 
                              &  Cardinale,  2018).Controlling  of                 steroids  as  an  anti-inflammatory  agent 
                              asthma  concentrates  on  two  areas:  first         are  also  important  in  the  treatment  of 
                              reducing impairment-the recurrence and               asthma.  It  is  essential  in  managing 
                              severity of a child's immediate or recent            persistent  inflammation  and  stabilizing 
                              signs and functional limitations; and the            the   exacerbation    of   acute   asthma. 
                              second  area  is  to  reducing  risk-the             Intracellular  magnesium  sulfate,  that  is 
                              probability  of  potential  asthma  attacks,         essential  for  airway  smooth  muscle 
                              gradual  reduction  in  lung  capacity  (or          relaxation  and  mast  cell  release  of 
                              decreased     lung     development      for          histamine,  was  found  to  be  weak  in 
                              children),  or  side  effects  of  medication        children with acute asthma exacerbation. 
                              (Al-Moamary, et.al.,  2019).  Childhood              In  children  with  less  than  50  percent 
                              asthma  poses  special  challenges.  The             peak  expiratory  flow  rate  (PEFR)  who 
                              child's  age,  the  fluctuating  nature  of          have  not  had  a  substantial  reaction  to 
                              asthma  incidence,  clinical  presentation           inhaled    bronchodilators,    magnesium 
                              instability,  exacerbations,  comorbidities,         sulfate  should  be  considered.  (Hunter, 
                              socio-economic       and      psychosocial           Vaddi, Krvavac, Regunath, & Guntur, 
                              influences,  and  environmental  factors             2019).    In   all   cases    of    asthma 
                              can all affect the activity of the disease           exacerbation,  hypoxemia  should  be 
                              and  thus,  strategies  for  monitoring              treated with supplementary oxygen with 
                              (Tesse, et.al., 2018). Children with mild            a  SpO2  target  of  93-95  percent  and 
                              to  serious  exacerbations  can  be  treated         frequent  reassessments  are  required.In 
                              effectively with bronchodilators and oral            acute        asthma         exacerbations, 
                              steroids in the emergency department, as             recommendations       advocate      against 
                              outpatients.    Hospitalization    to   the          routine  use  of  antibiotics.  In  those 
                              pediatric      intensive      care     unit          without    signs    and    symptoms      of 
                              (PICU) should be      prompt in    extreme           inflammation,  the  antibiotic  use  not 
                              exacerbations,    while    life-threatening          recommended  in  the  recent  studies 
                              risks  of  asthma  could occur.  Children            (Stefan, et.al., 2020). 
                              with  a  sudden  exacerbation  of  asthma            Complementary  Alternative  Therapy 
                              needs  immediate  care  and  assessment.             for Asthma  
                              The primary principles of therapy are to                    However  there  is  a  deeper 
                              alleviate  blocking  of  airflow,  enhance           recognition of the causes of asthma and 
                              respiratory     work      and      improve           new public  health and  pharmacological 
                              oxygenation  and  perfusion  of  tissue              approaches are available to decrease the 
                              (Arakawa,        et.al.,     2017).Asthma            occurrence of asthma, the purpose is to 
                               
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