Comparison of Box Breathing and Rhythmic Breathing Techniques in Patients With Asthma

Official title

Comparative Effects of Box and Rhythmic Breathing Techniques on Dyspnea, Pulmonary Functions, and Quality of Sleep Among Asthmatic Patients

Overview

Asthma is a chronic respiratory disease that can cause breathing difficulties, reduced lung function, and poor sleep quality. Breathing exercises are increasingly used as non-pharmacological interventions to improve respiratory symptoms and overall well-being in individuals with asthma. This study aims to compare the effects of two breathing techniques, Box Breathing and Rhythmic Breathing, on dyspnea (breathlessness), pulmonary function, and quality of sleep in patients with asthma. Participants with asthma will be randomly assigned to receive either Box Breathing or Rhythmic Breathing exercises in addition to standard care. Both interventions will be performed three times per week for eight weeks. The primary outcomes of this study include changes in dyspnea severity, pulmonary function measured by spirometry, and sleep quality assessed using validated questionnaires. The findings of this study may help determine which breathing technique is more effective and provide evidence for incorporating structured breathing exercises into asthma management programs.

Detailed description

Asthma is a chronic inflammatory airway disease characterized by recurrent episodes of dyspnea, airflow limitation, and impaired quality of life. In addition to respiratory symptoms, many individuals with asthma experience sleep disturbances and reduced functional capacity. Breathing exercises have emerged as important non-pharmacological interventions that may improve respiratory control, autonomic regulation, and symptom perception.

Box Breathing and Rhythmic Breathing are structured breathing techniques that have shown potential benefits in respiratory rehabilitation. Box Breathing involves a controlled breathing pattern consisting of equal durations of inhalation, breath holding, exhalation, and breath holding. Rhythmic Breathing involves continuous and controlled breathing with a prolonged expiratory phase to promote respiratory efficiency and relaxation. However, limited evidence exists regarding the comparative effectiveness of these techniques in individuals with asthma.

The purpose of this study is to compare the effects of Box Breathing and Rhythmic Breathing on dyspnea, pulmonary function, and sleep quality among patients with asthma. Participants will receive standardized baseline respiratory care followed by either Box Breathing or Rhythmic Breathing interventions for eight weeks. The interventions are designed to improve breathing patterns, reduce breathlessness, enhance pulmonary function, and improve sleep quality.

This study aims to provide evidence regarding the effectiveness of structured breathing techniques as adjunctive interventions in asthma management. The findings may contribute to the development of evidence-based respiratory rehabilitation protocols and support the integration of breathing exercises into comprehensive asthma care programs.

Interventions

• Behavioral Box Breathing
  Participants assigned to the Box Breathing intervention received a structured breathing exercise protocol following standardized baseline respiratory care. The Box Breathing technique consisted of inhalation for 4 seconds, breath holding for 4 seconds, exhalation for 4 seconds, and a second breath hold for 4 seconds (4-4-4-4 pattern). The intervention was administered for 20 minutes per session, three sessions per week, for eight weeks. Short rest periods were permitted after every 5-6 breathing
• Behavioral Rhythmic Breathing
  Participants assigned to the Rhythmic Breathing intervention received a structured breathing exercise protocol following standardized baseline respiratory care. The Rhythmic Breathing technique consisted of a controlled breathing pattern using a 4:6 ratio, with inhalation through the nose for 4 seconds and exhalation through the mouth for 6 seconds. The intervention was administered for 20 minutes per session, three sessions per week, for eight weeks. Short rest periods were provided every 6-7 m

Primary outcome measures

• Dyspnea Severity [Time frame: Baseline and 8 weeks (post-intervention)]

Secondary outcome measures (2)

• Pulmonary Function (Forced Expiratory Volume in 1 Second [FEV₁]) [Time frame: Baseline and 8 weeks (post-intervention)]
• Sleep Quality [Time frame: Baseline and 8 weeks (post-intervention)]

Eligibility criteria

Inclusion criteria

• Male and female patients diagnosed with asthma.
• Age between 18 and 40 years.
• Patients with mild to moderate asthma who are clinically stable.
• Patients able to understand and follow breathing exercise instructions.
• Patients willing to provide informed consent and participate in the study.

Exclusion criteria

• Patients with severe or uncontrolled asthma.
• Patients with acute asthma exacerbation during the study period.
• Patients with other significant respiratory diseases (e.g., chronic obstructive pulmonary disease, pulmonary fibrosis).
• Patients with severe cardiovascular, neurological, or musculoskeletal disorders that may interfere with participation.
• Patients who are pregnant.
• Patients unable to perform the breathing interventions or complete study assessments.
• Patients participating in another structured respiratory rehabilitation or breathing exercise program.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• Ittefaq Hospital and Ghurki Trust Hospital — Lahore

Identifiers

NCT: NCT07717476 · REC/RCR & AHS/25/0315

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗