Comparison of Box Breathing and Rhythmic Breathing Techniques in Patients With Asthma (BRAS)

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

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Asthma (Diagnosis)
• Intervention / Treatment: Behavioral: Box Breathing; Behavioral: Rhythmic Breathing

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.

• Study Type: Interventional
• Enrollment (Estimated): 36
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Humera Ayub, MS CPPT; Phone Number: +923045938096; Email: humera.ayub@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 59300
      • Ittefaq Hospital and Ghurki Trust Hospital
      • Contact: Humera Ayub, MS CPPT; Phone Number: +923045938096; Email: humera.ayub@riphah.edu.pk
      • Principal Investigator: Ayesha Sehar, MS-CPPT

Participation Criteria

Eligibility Criteria

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

Description

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.

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: Box Breathing Group A; Participants assigned to this arm received standardized baseline respiratory care followed by Box Breathing training. The Box Breathing technique consisted of inhaling for 4 seconds, holding the breath for 4 seconds, exhaling for 4 seconds, and holding the breath again for 4 seconds. The intervention was performed for 20 minutes per session, three sessions per week, for eight weeks. Short rest periods were provided as needed during the intervention.	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 cycles as needed. The intervention was performed in a quiet environment and aimed to improve respiratory control, reduce dyspnea, enhance ventilatory efficiency, and promote autonomic regulation.
Experimental: Rhythmic Breathing Group; Participants assigned to this arm received standardized baseline respiratory care followed by Rhythmic Breathing training. 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 performed for 20 minutes per session, three sessions per week, for eight weeks. Short rest periods were provided as needed during the intervention.	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 minutes as needed. The intervention was designed to promote respiratory efficiency, improve autonomic balance, reduce dyspnea, and enhance pulmonary function and sleep quality.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dyspnea Severity	Dyspnea severity will be assessed using the Modified Borg Scale, a numerical rating scale ranging from 0 to 10, where higher scores indicate greater perceived breathlessness.	Baseline and 8 weeks (post-intervention)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pulmonary Function (Forced Expiratory Volume in 1 Second [FEV₁])	Pulmonary function will be assessed using spirometry. Forced Expiratory Volume in 1 second (FEV₁) will be used to evaluate changes in lung function following the intervention.	Baseline and 8 weeks (post-intervention)
Sleep Quality	Sleep quality will be assessed using the Pittsburgh Sleep Quality Index (PSQI), a validated questionnaire measuring subjective sleep quality over the previous month. Lower scores indicate better sleep quality.	Baseline and 8 weeks (post-intervention)

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Humera Ayub, MS-CPPT, Riphah International University

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): December 10, 2026
• Study Completion (Estimated): December 10, 2026

Study Registration Dates

• First Submitted: July 17, 2026
• First Submitted That Met QC Criteria: July 17, 2026
• First Posted (Actual): July 21, 2026

Study Record Updates

• Last Update Posted (Actual): July 21, 2026
• Last Update Submitted That Met QC Criteria: July 17, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Asthma; Box Breathing; Rhythmic Breathing
• Additional Relevant MeSH Terms: Pathologic Processes; Immune System Diseases; Respiratory Tract Diseases; Lung Diseases; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Pathological Conditions, Signs and Symptoms; Asthma; Disease
• Other Study ID Numbers: REC/RCR & AHS/25/0315

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) collected during this study will not be made publicly available. The decision not to share IPD is based on the need to protect participant privacy and confidentiality, as the informed consent process did not include provisions for public data sharing. Only aggregate and de-identified study findings will be reported and published.

Drug and device information, study documents

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