Bronchial asthma is a chronic inflmmatory airway disease characterized by recurrent episodes of dyspnea, wheezing, and airflow limitation.
Dysfunctional breathing pattern and chronic hyperventilation
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)
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
Parallel
Alternative Nostril Breathing Technique along with standard pharmacological management
Other interventionPatients 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
Buteyko breathing along with pharmacological management
Other interventionPatient 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
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.
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.
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.
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.
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