Prof M. Thomas: BREATHE 09/104/19

Although effective drug treatment exists for asthma, many people continue to have distressing symptoms and impaired quality of life. Recent surveys show that over half of all adults with asthma in the UK are not properly controlled on their current treatment regimen, resulting in impaired quality of life, and increased costs to the community. Many people with asthma are interested in non-drug asthma treatments, particularly in breathing exercises. Several recent studies have shown benefits from undergoing a short breathing exercises course taught by a respiratory physiotherapist for people who remained symptomatic despite usual treatment. There is currently not enough access to suitable trained physiotherapists to provide such a service to most people with asthma in the UK. We propose to provide the same breathing training programme we have previously shown to be effective when taught 'face-to-face' by a physiotherapist as a video or DVD, or internet download, that patients can use in their own home in addition to their standard treatment. We will see whether this type of instruction is better than the 'usual care' that is currently provided, and whether it is as good as the 'face to face' physiotherapist instruction (which is more expensive and less convenient for patients). Consenting adult asthma volunteers will be assessed at baseline and then randomly allocated to one of these 3 groups, and then reassessed after 12 months, and by postal questionnaires completed at 3 and 6 months. We will assess the effects of the 'video' and 'face to face' breathing training programmes on asthma control, quality of life, anxiety and depression, how 'in control' of their condition the patient feels ('enablement') as well as assessing lung function and airways inflammation. We will ask patients whether they like the video intervention, feel it helped them and could help others. We will assess the costs and benefits of the 2 ways of delivering the breathing intervention, to see which is most useful for investment of NHS resources. Patients not receiving breathing training will be offered it at the end of the study, and will continue to receive the 'usual care' from their GP.