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A
Shorter Intake of Breath
The Independent
Newspaper (UK), 10th June 1996
Hundreds of asthma sufferers claim the Buteyko method has changed
their lives. So why does the medical establishment seem suspicious
of it?
Every four minutes a child is admitted to hospital with a severe
asthma attack. Over the next few months the figure is likely to
be even higher as pollen counts rise and the weather stays unsettled.
We are in the middle of a mysterious asthma epidemic - the number
of cases is increasing yearly and there is no cure.
The medical response has been to develop more drugs and get people
on to them sooner - annual sales of inhalers now top 18 million.
A recent pilot project in Kent looking for asthma among children
found that for every one known case there was another undiagnosed.
All of the children were put on drugs. Many parents are not happy
with this approach, but there is no alternative.
Or rather there is, but it is being firmly ignored. Last year a
couple of newspaper stories described a radical new treatment for
asthma which simply involved learning a new breathing pattern. Scores
of patients reported that they no longer needed to use drugs and
had much better control over their symptoms.
One satisfied customer was the MP Jonathan Aitken, who says it
reduced his symptoms and made drugs unnecessary. Another was Dr
John Stanley of the National Public Health Laboratory, who said,
'It changed my life. Before, I could barely walk up stairs now I
can manage a 10-mile hike. I was using my puffer four times a day
as well as steroids and now I'm off all drugs.' You might think
that such results would be welcomed by the National Asthma Campaign
- motto: 'getting your health back'. After all, they are dedicated
to relieving the plight of asthmatics and most sufferers worry about
the quantity of drugs they have to take. But the campaign's response
to any queries about the Buteyko method, as it is known, is the
following statement: 'We would strongly advise people with asthma
not to pay several hundred pounds to be taught a method of treatment
that is of unproven benefit.' The reason they give is that they
are not aware of any scientifically validated trials of the method.
This claim makes Chris Drake, a Buteyko practitioner, furious.
'Why do they say it has not been adequately researched when there
has been a double-blind clinical trial in Australia and the interim
results have been written up in an Australian medical journal? They
were the best in terms of help for asthmatics ever published.'
The Buteyko method - it was developed by the Russian physiologist
Professor Konstantin Buteyko - involves no mystical concepts, it
is firmly based in Western physiology and yet getting it taken seriously
by a medical establishment rooted in the drug culture has proved
extraordinarily difficult.
The technique does make one revolutionary claim: that the problem
asthmatics have is that they breathe too much. The reasoning is
this. We all know that we breathe in oxygen, which passes through
the lungs into the blood stream, and breathe out the waste gas carbon
dioxide (CO2). What is not so familiar, although it is in all the
physiology text books as the Verigo- Bohr effect, is that we actually
need CO2 in the lungs for the oxygen to pass efficiently into the
blood. The body needs a concentration of about 6 per cent CO2 and
the amount in the air is only about 0.03 per cent. The body's solution
has been for the alveoli - the tiny air sacs in the lungs - to act
as CO2 accumulators. But because CO2 is a very light gas, heavy
breathing has the effect of diluting the CO2 stored in the air sacs.
Professor Buteyko tested thousands of asthmatics and found that
all of them were over-breathing. The optimum amount is around 5
litres per minute, but asthmatics were breathing two, three or even
four times that amount. The result is that the CO2 levels go down
and the body responds by constricting the airwaves - its way of
saying, 'Stop breathing so much!' The essence of the Buteyko method
is that by reducing the level of breathing, the CO2 levels rise
and the airways open. It is an interesting theory and would seem
easy enough to test. But it hasn't quite turned out like that. Five
years ago a Russian Buteyko trainer, Alexander Stalmatsky began
teaching in Australia, which has one of the highest proportions
of asthma sufferers in the world. Since he started, some 6,000 people
have learnt the technique, including former Australian squash champion
Karen Clonda, and media interest has been considerable. One of the
most thorough TV programmes was made by Peter Wilkinson, an investigative
journalist with his own slot, A Current Affair, for Channel 9. 'I'm
a pretty sceptical bloke,' says Wilkinson, 'but this technique really
seemed to work.' His team followed two classes of 30 people each
for about three months and found the majority enjoyed considerable
benefit. They also contacted 100 patients from the Buteyko centre's
records. About 60 to 70 per cent told the researchers they were
much improved. 'But when we put all of this to the official asthma
people they refused to budge an inch.'
The interest generated by media coverage led to the setting up
of a trial, which was run by Professor Charles Mitchell of Queensland
University. Forty middle-aged, chronic asthmatics, who had had asthma
for an average of 23 years, were divided into two groups. The control
group - average age, 43 - were given physiotherapy, taught standard
breathing techniques and given instruction on drug use. The others
- average age, 48 - were taught the Buteyko method.
Six weeks after the trial the Australian Doctor ran a story entitled
'Doctors Gasp at Buteyko Success'. The preliminary findings were
that while there was no change in the control group, the Buteyko
group had reduced their use of beta agonists (bronchodilators) by
90 per cent and reported an improvement in their symptoms. Eight
months later the improvement not only continued, they had also reduced
their steroid intake. The method seemed to be vindicated. In fact
it was only the beginning of a bitter debate that is still going
on, even between the authors of the study. Professor Mitchell describes
the results as impressive, but only superficially. The crux of the
matter for him was that the trial provided no objective proof that
the patients were better. Even though they took fewer drugs and
said they felt better, the FEV1 test, a routine test to assess the
severity of asthma, showed no change.
What's more, the claims about CO2 didn't stand up either. 'We measured
CO2 levels,' says Professor Mitchell, 'and found no correlation
between the patients whose CO2 levels had gone up the most and the
ones who improved the most. So it looks as though CO2 is not the
relevant factor here.' All of which is a gross misrepresentation
of what actually happened at the trial, according to Tess Graham,
co-author of an as yet unpublished paper and the trainer for the
Buteyko group. 'It is such rubbish to say the drug reduction was
due to some psychological effect,' she says, 'I must be an absolute
genius if I can persuade people who have been taking a drug for
more than 20 years to stay off them just because I say so.'Graham,
a physiotherapist who first became involved when her own asthmatic
children lost all their symptoms after learning the technique, has
now trained more than 700 patients. She was furious that Mitchell
failed to mention anything about the over-breathing results. 'They
weren't even going to test for hidden hyperventilation to begin
with,' she says, 'even though it is the central point of the Buteyko
method. We measured the patients in both groups and found they were
all breathing, on average, 14 litres per minute, three times the
healthy amount.'
Afterwards the Buteyko group was down to an average of 9.6 litres
while the others had not changed. 'What's most important, though,
is that those who reduced their breathing the most also reduced
their drugs the most. This shows that there's a logical link between
the Buteyko method and a reduction in drug use. Nobody is telling
the asthma foundations that.' The asthma establishment does not
even consider over-breathing to be a factor in asthma. The British
National Asthma Campaign says, 'there is no evidence that a person
with stable asthma is over-breathing'. This finding, if it is replicated,
suggests they are wrong.
Given their share of positive results from the trial and the mound
of anecdotal reports of success, it hardly surprising that the Buteyko
supporters believe they are being ignored and the results played
down. 'The Asthma Foundation is happy to support research into anything
that may contribute to asthma - dust mites, dog hairs, fish oil,
lack of lipid acids,' says Chris Drake, 'but their basic principle
is that asthma is incomprehensible and incurable. Come up with a
cure and they get worried. On the day our first results came out
in Australia the Asthma Foundation put out a story about how a new
study had shown margarine might be a factor. Margarine! If we are
right a lot of research projects will go down the tube.'
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