Comparative Effects of Alternative Nostril Breathing Versus Buteyko Breathing on Control Pause, Dyspnea and Pulmonary Function in Patients With Bronchial Asthma

Bronchial asthma is a chronic inflmmatory airway disease characterized by recurrent episodes of dyspnea, wheezing, and airflow limitation.

Dysfunctional breathing pattern and chronic hyperventilation

Study Overview

• Status: Recruiting
• Conditions: Asthma (Diagnosis)
• Intervention / Treatment: Other: Alternative Nostril Breathing Technique along with standard pharmacological management; Other: Buteyko breathing along with pharmacological management

Detailed Description

Bronchial asthma is a chronic inflammatory airway disease in which there are recurrent episodes shortness of breath, wheezing,and limitation in airflow.

Chronic hyperventilation and dysfunctional breathing pattern and commonly contribute to symptom severity and poor asthma control.This study aims to compare the effects of Alternate Nostril Breathing and Buteyko Breathing Technique on control pause, dyspnea, pulmonary function, and asthma control in patients with bronchial asthma.This study aims to compare the effects of Alternate Nostril Breathing and Buteyko Breathing Technique on control pause, dyspnea, pulmonary function, and asthma control in patients with bronchial asthma.This study aims to compare the effects of Alternate Nostril Breathing and Buteyko Breathing Technique on control pause, dyspnea, pulmonary function, and asthma control in patients with bronchial asthma.A total of 40 patients with mild to moderate persistent bronchial asthma will be recruited and randomly allocated into two groups. Group A will receive Alternate Nostril Breathing, while Group B will receive the Buteyko Breathing Technique, along with standard pharmacological management.

The intervention will be conducted over a period of four weeks, with two supervised sessions per week and additional home-based sessions.

• Study Type: Interventional
• Enrollment (Estimated): 46
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Zara Khalid, PhD; Phone Number: +92333-5415822; Email: zara.khalid@fui.edu.pk
• Study Contact Backup: Name: Maryam Arooj, MSPT-CPPT; Phone Number: +923428190176; Email: maryamarooj418@gmail.com

Study Locations

• Pakistan
  • Islamabad, Pakistan
    • Recruiting
    • Foundation University Islamabad
    • Contact: Zara Khalid, PhD; Phone Number: +92333-5415822; Email: zara.khalid@fui.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 18-45 years
• Both genders (male and female)
• Grade 1-3 on mMRC scale of dyspnea
• Asthma severity classes- intermediate,mild persistent and moderate persistent asthma (acc. to NAEPP National Asthma Education and Prevention Program guidlines 2020)

Exclusion Criteria:

• Patients having acute exerbation of COPD/status asthmaticus
• Patients diagnosed with acute infection
• Patients unable to follow command and instructions
• Asthma patients with >40sec control pause duration

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Alternate Nostril Breathing; Patients in this group will receive Alternate Nostril Breathing (ANB) along with standard pharmacological management as prescribed by the pulmonologist. The breathing intervention will be performed for a duration of 4 weeks. Two sessions per week will be supervised by a physiotherapist, and five sessions per week will be performed at home. Each session will last 10-15 minutes, following a structured ANB protocol involving slow nasal inhalation and exhalation with brief breath holds. A home exercise diary will be provided to ensure adherence and follow-up of breathing exercises performed at home.	Other: Alternative Nostril Breathing Technique along with standard pharmacological management; Patients in this group will receive alternative nostril breathing technique along with standard pharmacological management. A total 4 weeks protocol will be followed in which 2 seesions per week will be supervised by physiotherapist and 5 days at home. Alternative nostril breathing will be performed in sitting position. The patient will be asked to place their right thumb to gently close their right nostril. Inhale slowly for 4 sec deeply through left nostril and hold breath for 2-3 sec. Release right nostril and use your right ring finger to close your left nostril. Exhale slowly 6 sec and completely through right nostril.Inhale slowly 4 sec and deeply through right nostril.Then hold breath for 2-3 sec. Patients will be asked to release the left nostril and use their right thumb to close their right nostril. Exhale slowly and completely through left nostril over 6 sec.Repeat the cycle. Pharmacological management: Patient will receive medications as per prescribed by pulmonologist
Experimental: Buteyko Breathing; Patients in this group will receive the Buteyko Breathing Technique (BBT) along with standard pharmacological management as prescribed by the pulmonologist. The intervention will be administered over a period of 4 weeks. Two sessions per week will be supervised by a physiotherapist, while five sessions per week will be carried out at home. Each session will last 10-15 minutes and will include controlled nasal breathing, relaxed exhalation, and breath holding (control pause) until the first sensation of air hunger. A home diary will be provided to monitor compliance and ensure regular performance of breathing exercises at home.	Other: Buteyko breathing along with pharmacological management; Patient in this group will receive Buteyko breathing along with pharmacological management. A total 4 weeks protocol will be followed in which 2 sessions per week will be supervised by physiotherapist and 5 days will be done by patients at home. The patient will sit comfortably in upright position. The patients will be give following instructions. Breathe normally for 2-3 minutes (nasal inhalation and nasal exhalation). After relax exhale, hold your breath, use index finger and thumb to plug nose. Retain your breath until you feel the urge to breathe (first sign of air hunger) then inhale. Breath normally for 10 sec. Repeat several times. Pharmacological management: Patient will receive medications as prescribed by pulmonologist

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Control Pause	Evaluation will be performed using the Control Pause test, defined as the duration (in seconds) a participant can comfortably hold their breath after a normal exhalation. The measurement will be recorded using a stopwatch. Participants will be assessed in a seated position following normal tidal breathing, and breath-hold will be initiated after a normal exhalation without prior deep inspiration. The Control Pause duration ranges from 0 seconds to the maximum voluntary breath-hold time. Higher values indicate better breath control and improved respiratory function, whereas lower values indicate poorer respiratory status.	04 weeks
Dyspnea	Evaluation will be performed using the Dyspnea-12 Questionnaire (D-12), a validated patient-reported outcome measure consisting of 12 items assessing both physical and affective components of breathlessness. The total score ranges from 0 to 36, with each item scored from 0 (none) to 3 (severe). Higher scores indicate greater severity of dyspnea and worse symptom burden.	04 weeks
Pulmonary Function Test	Evaluation will be performed using spirometry, conducted according to standard guidelines. The primary parameters assessed will include Forced Expiratory Volume in 1 second (FEV₁), Forced Vital Capacity (FVC), and FEV₁/FVC ratio. Values will be recorded in liters (L) and as percentage of predicted values (%) based on age, sex, height, and ethnicity. Higher values of FEV₁ and FVC indicate better pulmonary function, while a higher FEV₁/FVC ratio indicates reduced airflow obstruction and improved respiratory status.	04 weeks
Asthma Control	Evaluation will be performed using the Asthma Control Test (ACT), a validated patient-reported questionnaire consisting of 5 items assessing asthma symptoms and control over the past 4 weeks. Each item is scored on a 5-point scale (1-5), with a total score ranging from 5 to 25. Higher scores indicate better asthma control, while lower scores indicate poorer control. A score of ≥20 suggests well-controlled asthma, whereas scores <20 indicate partially controlled or poorly controlled asthma.	04 weeks

Collaborators and Investigators

• Sponsor: Foundation University Islamabad

Study record dates

Study Major Dates

• Study Start (Actual): February 28, 2026
• Primary Completion (Estimated): May 15, 2026
• Study Completion (Estimated): May 15, 2026

Study Registration Dates

• First Submitted: March 28, 2026
• First Submitted That Met QC Criteria: April 7, 2026
• First Posted (Actual): April 14, 2026

Study Record Updates

• Last Update Posted (Actual): April 14, 2026
• Last Update Submitted That Met QC Criteria: April 7, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: pulmonary function; asthma control; dyspnea; Bronchial asthma; alternative nostril breathing; buteyko breathing
• Additional Relevant MeSH Terms: Pathologic Processes; Immune System Diseases; Respiratory Tract Diseases; Lung Diseases; Respiration Disorders; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Signs and Symptoms, Respiratory; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Asthma; Disease; Dyspnea
• Other Study ID Numbers: FUCP/CTR/2026/04

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No