Breathing REtraining for people with AsTHma and breathing pattern disorder (BREATH)

Background: Asthma is a respiratory condition characterised by spasm in the bronchi of the lungs. Current NHS guidelines for asthma recommend pharmacological management, typically using bronchodilators which widen narrowed airways. However, research has shown at least 1/3 of people with asthma exhibit breathing pattern disorder (BPD), a condition which can result in breathlessness because of ineffective coordination of the breathing muscles (e.g. diaphragm). Given the high prevalence of BPD in people with asthma, new interventions are needed which can enable patients to improve breathing control, reduce symptoms of breathlessness and improve quality of life. There is some evidence that existing breathing exercises can reduce breathlessness in asthma. However, these existing approaches deliver only small effects. We suggest that this is because they do not teach people to change postural muscle patterns which can interfere with breathing and because patients don t always understand how to improve their breathing. We have developed a new physiotherapy treatment for musculoskeletal pain in which patients learn to reduce overactivity of postural muscles and gain experiential understanding of how postural muscle activity can affect the mechanics of breathing. We have also developed computer software which uses small 3D cameras to track body movements and uses this information to visualise breathing patterns on an avatar in real-time. Aims and objectives: Through co-design with stakeholders, we will create a version of our treatment, called "Cognitive Muscular Therapy (CMT)", for people with asthma+BPD. This treatment will include software to visualise breathing patterns in real-time. Once developed, we will test the treatment on 20 participants. Methods: Through a co-design approach with patients and physiotherapists, we will map out a prototype of CMT for asthma+BPD. We will then deliver this treatment to ten patients and use a co-design approach to understand how it could be improved. Once we have used this feedback to finalise the treatment, we will deliver it to a further 20 patients with asthma+BPD. In this group, we will collect questionnaire data on breathlessness, asthma control, quality-of-life, and collect laboratory measures of breathing function. We will also carry out a qualitative exploration to understand patient s experiences of the treatment. Timelines for delivery: We plan to develop a prototype of the intervention by the end of Month 3 and then iteratively refine the intervention during Months 4-9. During Months 10-13, we will deliver the final intervention to 20 patients. This will allow two further months for data analysis and write up. Anticipated impact and dissemination: We aim to publish a description of our intervention development along with preliminary clinical data in a leading respiratory journal. We will also publish our qualitative exploration in a respiratory journal. With positive results, we will apply for a funding for a feasibility study which would compare our proposed intervention with existing breathing retraining approaches. This would then inform the design of a large-scale RCT. In the long-term, if our intervention proves effective, it could improve NHS management of asthma, improving quality of life for large numbers of people who live with this condition.