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Controlling Asthma by Breathing TechniquesAsthma and Anxiety: Role of Anxiety FREE TO VIEW

Sahajal Dhooria, MD, DM; Ritesh Agarwal, MD, DM, FCCP
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From the Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research.

CORRESPONDENCE TO: Sahajal Dhooria, MD, DM, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India; e-mail: sahajal@gmail.com


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):e130. doi:10.1378/chest.14-2755
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To the Editor:

We read with interest the study by Ritz et al1 in CHEST (November 2014) in which the authors showed that respiratory training leads to improvements in asthma control, peak flow variability, lung function, bronchodilator use, airway hyperreactivity, and quality of life. Compared with slow breathing and awareness training, patients in the capnometry-assisted respiratory training group had a greater reduction in respiratory impedance and less distress during methacholine challenge. The authors have hypothesized that training of tolerance to Pco2 elevations in these patients is the mechanism underlying the observed effects.

Although the authors have done well to measure the effects of breathing techniques on a multitude of physiologic variables, an important assessment that was not performed is the objective assessment of anxiety. Anxiety has been found to have a strong association with asthma symptoms. Negative psychologic states may be related, albeit loosely, to airway hyperresponsiveness.2 Further, breathing techniques and training are known to reduce anxiety.3,4 It is possible that breathing training in the capnometry-assisted respiratory training group was more effective due to the better biofeedback and, thus, was more effective in reducing the patients’ anxiety levels, leading to improvements in many of the assessed variables. Thus, whether the observations in this study had a purely physiologic basis, or psychologic factors were involved, or resulted from a combination of the two is an unresolved question.

References

Ritz T, Rosenfield D, Steele AM, Millard MW, Meuret AE. Controlling asthma by training of capnometry-assisted hypoventilation (CATCH) vs slow breathing: a randomized controlled trial. Chest. 2014;146(5):1237-1247. [CrossRef] [PubMed]
 
Wang G, Wang L, Szczepaniak WS, et al. Psychological status in uncontrolled asthma is not related to airway hyperresponsiveness. J Asthma. 2010;47(1):93-99. [CrossRef] [PubMed]
 
Valenza MC, Valenza-Peña G, Torres-Sánchez I, González-Jiménez E, Conde-Valero A, Valenza-Demet G. Effectiveness of controlled breathing techniques on anxiety and depression in hospitalized patients with COPD: a randomized clinical trial. Respir Care. 2014;59(2):209-215. [CrossRef] [PubMed]
 
Brown RP, Gerbarg PL, Muench F. Breathing practices for treatment of psychiatric and stress-related medical conditions. Psychiatr Clin North Am. 2013;36(1):121-140. [CrossRef] [PubMed]
 

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References

Ritz T, Rosenfield D, Steele AM, Millard MW, Meuret AE. Controlling asthma by training of capnometry-assisted hypoventilation (CATCH) vs slow breathing: a randomized controlled trial. Chest. 2014;146(5):1237-1247. [CrossRef] [PubMed]
 
Wang G, Wang L, Szczepaniak WS, et al. Psychological status in uncontrolled asthma is not related to airway hyperresponsiveness. J Asthma. 2010;47(1):93-99. [CrossRef] [PubMed]
 
Valenza MC, Valenza-Peña G, Torres-Sánchez I, González-Jiménez E, Conde-Valero A, Valenza-Demet G. Effectiveness of controlled breathing techniques on anxiety and depression in hospitalized patients with COPD: a randomized clinical trial. Respir Care. 2014;59(2):209-215. [CrossRef] [PubMed]
 
Brown RP, Gerbarg PL, Muench F. Breathing practices for treatment of psychiatric and stress-related medical conditions. Psychiatr Clin North Am. 2013;36(1):121-140. [CrossRef] [PubMed]
 
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