Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For adults and children with asthma what is the effectiveness of the Buteyko Breathing method on reducing bronchodilator and inhaled steroid use and improving health status?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

no

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

People diagnosed with asthma of any severity aged from 5 years (no upper age limit). Patients must be mentally and functionally capable of understanding and performing basic breathing exercises on a daily basis.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

No

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improvement or elimination of asthma symptoms (cough, wheeze, dyspnea) Reduction or elimination of bronchodilator use in the short-medium term. Reduction or elimination of inhaled and oral steroid use in the medium to long term.

Describe any health-related risks, side effects, or harms that you are concerned about.

There are no known or recorded side effects from the Bueteyko breathing method. It is essentially breathing re-education aimed at restoring "normal" breathing volumes and thereby preventing asthma symptoms from being triggered. There are several published studies in international medical journals but none in the U.S. where the method has not been accepted as a treatment for asthma despite significant evidence of its clinical effectiveness. Buteyko breathing is taught in many hospitals and clinics in the U.K. and other parts of Europe, Australia, New Zealand and Canada - places where drug therapy does not have quite the monopoly it has here. Buteyko is designed to be an adjunct to pharmaceutical therapy, not an immediate replacement for it, but the ultimate outcome is that patients who can reduce their ventilation no longer require any or as much drug therapy.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Pulmonary disease/asthma

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children
• Elderly

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)
• Other

Importance

Describe why this topic is important.

To reduce the overall costs of treating asthma and to improve health status outcomes and the incidence of asthma.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

I am a certified Buteyko practitioner as well as a trained physiotherapist and I am increasingly frustrated at the pharmaceutically oriented bias of our health care. Little responsiblity is demanded of people to manage their own health status. Despite several recent controlled trials (citations available upon request) that demonstrate the effectiveness of the Buteyko breathing method to control asthma symptoms and reduce or eliminated the need for drug therapy, this treatment approach is not entertained by the medical establishment here. It is cost and clinically effective and yet no one is told about it because doctors and drug companies hold all the cards. I would like to see it fairly evaluated for its efficacy by an unbiased organization or body.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

As discussed above. This method is controversial because it is a simple, non-pharmaceutical but demonstrably effective approach to asthma management and it is generally rejected by the medical and (obviously) the pharmaceutical community. It does involve patient compliance over and above simply ingesting a drug and so it is a method that will not necessarily be popular with those who demand a no-effort cure.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

It will either validate or discount the Buteyko Breathing method as a legitimate treatment modality for asthma and allow the Buteyko practitioners of North American to organize and validate their clinical practise to ensure a high and consistent standard of care delivery.

Describe the timeframe in which an answer to your question is needed.

Like most things, sooner rather than later would be preferable!

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Asthma drug therapy creates further demand for itself as people need increasing doses of therapy to achieve the same effect. People on low incomes and/or the uninsured are disadvantaged by the high cost of drug therapy. the Buteyko method is low cost and, once learned, can be applied for life.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

It will either validate or discount the Buteyko Breathing method as a legitimate treatment modality for asthma and allow the Buteyko practitioners of North American to organize and validate their clinical practise to ensure a high and consistent standard of care delivery.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program