Current asthma management focuses very strongly on encouraging the appropriate use of the main asthma drugs. Asthma Action Plans, peak flow metres, spacers and the numerous asthma devices available all highlight the importance of this. The Palmerston North Conference provided a forum with a wider focus which included one of the important roles of the physiotherapist in asthma and an afternoon of alternative approaches to asthma management.

There was an interesting link between the physiotherapist's session and one of the alternative approaches. Auckland physiotherapist, Tania Clifton and Hawke's Bay Buteyko teacher, Russell Stark, both described ways they were addressing the problem of hyperventilation in people with asthma. Having met some Hawke's Bay people who have described marked improvement from the Buteyko method, it was an interesting opportunity to see how the Buteyko approach related to the more conventional treatment approach for hyperventilation in people with asthma.

At an earlier conference in Auckland a physiotherapist had said, "There is no need to pay a lot of money to learn the Buteyko method. We provide these same techniques free." So what are the differences?

The Buteyko method appears to be based primarily on teaching breathing techniques which correct imbalances in carbon dioxide levels that have arisen from hyperventilation. This overbreathing needn't be extreme or obvious to the observer to have a detrimental effect.

Less pronounced hyperventilation will still have effects but over a longer period. While it appears to be well recognised that overbreathing lowers the level of carbon dioxide in the body, the effect of this has been much less investigated.

Buteyko, the Russian doctor who developed the method, came to understand, after many years of research, that bronchial spasm and increased mucus and phlegm are part of the body's mechanism to guard against loss of carbon dioxide. They act in much the same way as fainting protects against too much carbon dioxide eg. in prolonged breath holding. It was interesting to hear Tania Clifton comment during this session that the physiological basis to the Buteyko method appeared sound. Her concern was that the Buteyko techniques did not include teaching diaphragmatic breathing which she saw as central to any breathing retraining.

The results of the first six weeks of a three month controlled randomised study of Buteyko breathing techniques in Brisbane were described. The study was carried out by Dr Simon Bowler, a respiratory physician at Mater Hospital in Brisbane who did not expect to see any differences. The result came as quite a surprise. After six weeks of exercises there was no difference in lung function measurements between Buteyko group subjects and control. However, Buteyko subjects felt substantially better, used 90% less beta agonist and on average as a group used less inhaled steroid.

I understand that the NZ Buteyko teachers would like to see this technique adopted by Government funded health services so it can be made more widely available to New Zealanders with asthma. From a financial point of view, I believe the 90% bronchodilator reduction achieved in the Brisbane study certainly challenges NZ health funders and providers to consider this possibility. The cost of the course would be quickly recouped and the country's asthma drug costs significantly lowered if this reduction could be consistently achieved in others and more importantly, if it could be safely maintained. In my opinion the Buteyko method definitely needs further research to begin soon.