Comparative Effects of Buteyko Breathing Technique and Active Cycle of Breathing Technique on Dyspnea and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Main Article Content

Bilal Baig
Mamaoona Anwar
Maryam Rasheed
Akhtar Rasul
Aiman Fiaz
Sidra Faisal


Background: Chronic Obstructive Pulmonary Disease (COPD) significantly impacts the quality of life due to symptoms like dyspnea. Non-pharmacological interventions, particularly breathing techniques, have gained attention for their potential to improve patient outcomes.

Objective: This study aimed to compare the effectiveness of the Buteyko Breathing Technique (BBT) and the Active Cycle of Breathing Technique (ACBT) in reducing dyspnea and enhancing the quality of life in COPD patients.

Methods: In a randomized clinical trial conducted at Jinnah Hospital, Lahore, 40 COPD patients (mean age 59.70 ± 5.89 years; 70% male) were assigned to either BBT or ACBT groups. Both groups received standard treatments of bronchodilators and inhaled corticosteroids. The intervention involved three sessions per week for six weeks. Dyspnea was measured using the Modified Borg Scale (MBS), and quality of life was assessed through the St. George’s Respiratory Questionnaire (SGRQ). Normality of data was confirmed via the Shapiro-Wilk test, and parametric tests (paired and independent T-tests) were used for statistical analysis.

Results: Pre-treatment MBS in the BBT group was 6.7 ± 1.56, reducing to 2.9 ± 1.21 post-treatment. The SGRQ scores also showed improvement from 71.5 ± 8.44 to 36.8 ± 6.6. In the ACBT group, the MBS score decreased from 7.3 ± 1.56 to 3.95 ± 1.36, and SGRQ scores from 71.6 ± 8.46 to 42.55 ± 6.61. The between-group comparison indicated a more significant improvement in the BBT group, with post-treatment p-values of 0.01 for MBS and 0.009 for SGRQ.

Conclusion: Both BBT and ACBT effectively improved dyspnea and quality of life in COPD patients, with BBT showing a greater impact. These findings suggest that BBT could be a preferable non-pharmacological intervention in COPD management. However, individual patient factors should be considered when choosing the appropriate technique.

Article Details

How to Cite
Baig, B., Anwar, M., Rasheed, M., Rasul, A., Fiaz, A., & Faisal, S. (2024). Comparative Effects of Buteyko Breathing Technique and Active Cycle of Breathing Technique on Dyspnea and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease. Journal of Health and Rehabilitation Research, 4(1), 250–255.
Author Biographies

Mamaoona Anwar, University of Management Sciences Lahore Pakistan.


Maryam Rasheed, Riphah International University Lahore Campus Pakistan.


Akhtar Rasul, University of Sargodha Pakistan.

Assistant Professor at Department of Allied Health Sciences.

Aiman Fiaz, Riphah International University Lahore Campus Pakistan.


Sidra Faisal, Riphah International University Lahore Campus Pakistan.

Senior Lecturer.


Viegi G, Pistelli F, Sherrill DL, Maio S, Baldacci S, Carrozzi L. Definition, epidemiology and natural history of COPD. Eur Respir J. 2007;30(5):993-1013.

Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. The European respiratory journal. 2019;53(5).

Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet. 2007;370(9589):786-96.

Mohigefer J, Calero-Acuña C, Marquez-Martin E, Ortega-Ruiz F, Lopez-Campos JL. Understanding of COPD among final-year medical students. Int J Chron Obstruct Pulmon Dis. 2018;13:131-9.

Hastie AT, Martinez FJ, Curtis JL, Doerschuk CM, Hansel NN, Christenson S, et al. Association of sputum and blood eosinophil concentrations with clinical measures of COPD severity: an analysis of the SPIROMICS cohort. Lancet Respir Med. 2017;5(12):956-67.

May SM, Li JT. Burden of chronic obstructive pulmonary disease: healthcare costs and beyond. Allergy Asthma Proc. 2015;36(1):4-10.

Tabyshova A, Hurst JR, Soriano JB, Checkley W, Wan-Chun Huang E, Trofor AC, et al. Gaps in COPD Guidelines of Low- and Middle-Income Countries: A Systematic Scoping Review. Chest. 2021;159(2):575-84.

Fazleen A, Wilkinson T. Early COPD: current evidence for diagnosis and management. Ther Adv Respir Dis. 2020;14:1753466620942128.

Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2014;9:871-88.

Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. European Respiratory Journal. 2008;32(4):962.

Wedzicha JA, Donaldson GC. Exacerbations of chronic obstructive pulmonary disease. Respir Care. 2003;48(12):1204-13; discussion 13-5.

Dacydchenko SV, Bova AA. [The role of respiratory infection in exacerbation of chronic obstructive pulmonary disease]. Klin Med (Mosk). 2007;85(5):10-5.

Agarwal AK, Raja A, Brown BD. Chronic Obstructive Pulmonary Disease. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Avais Raja declares no relevant financial relationships with ineligible companies. Disclosure: Brandon Brown declares no relevant financial relationships with ineligible companies.: StatPearls Publishing

Copyright © 2023, StatPearls Publishing LLC.; 2023.

Stockley RA. Neutrophils and protease/antiprotease imbalance. Am J Respir Crit Care Med. 1999;160(5 Pt 2):S49-52.

Strickland SL. Year in review 2014: airway clearance. Respir Care. 2015;60(4):603-5.

Zisi D, Chryssanthopoulos C, Nanas S, Philippou A. The effectiveness of the active cycle of breathing technique in patients with chronic respiratory diseases: A systematic review. Heart & lung : the journal of critical care. 2022;53:89-98.

Pryor JA, Prasad SA. Physiotherapy techniques. Physiotherapy for Respiratory and Cardiac Problems: Adults and Paediatrics 4th ed Churchill Livingstone/Elsevier, Edinburgh. 2008:134-217.

Osadnik CR, McDonald CF, Holland AE. Airway clearance techniques in acute exacerbations of COPD: a survey of Australian physiotherapy practice. Physiotherapy. 2013;99(2):101-6.

Tang CY, Taylor NF, Blackstock FC. Chest physiotherapy for patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD): a systematic review. Physiotherapy. 2010;96(1):1-13.

Zhang Y, Tu YH, Fei GH. The COPD assessment test correlates well with the computed tomography measurements in COPD patients in China. International journal of chronic obstructive pulmonary disease. 2015;10:507-14.

Banerjee D, Kamuren J, Baird GL, Palmisciano A, Krishnan I, Whittenhall M, et al. The Modified Borg Dyspnea Scale does not predict hospitalization in pulmonary arterial hypertension. Pulm Circ. 2017;7(2):384-90.

Loubert A, Regnault A, Meunier J, Gutzwiller FS, Regnier SA. Is the St. George's Respiratory Questionnaire an Appropriate Measure of Symptom Severity and Activity Limitations for Clinical Trials in COPD? Analysis of Pooled Data from Five Randomized Clinical Trials. Int J Chron Obstruct Pulmon Dis. 2020;15:2103-13.

Ferrer M, Alonso J, Prieto L, Plaza V, Monsó E, Marrades R, et al. Validity and reliability of the St George's Respiratory Questionnaire after adaptation to a different language and culture: the Spanish example. Eur Respir J. 1996;9(6):1160-6.

Jones PW, Quirk FH, Baveystock CM. The St George's Respiratory Questionnaire. Respiratory medicine. 1991;85 Suppl B:25-31; discussion 3-7.

Arora RD, Subramanian VHJIJoHS, Research. To Study the Effect of Buteyko Breathing Technique in Patients with Obstructive Airway Disease. 2019;9:50-64.

Salehi Derakhtanjani A, Ansari Jaberi A, Haydari S, Negahban Bonabi T. Comparison the Effect of Active Cyclic Breathing Technique and Routine Chest Physiotherapy on Pain and Respiratory Parameters After Coronary Artery Graft Surgery: A Randomized Clinical Trial. Anesthesiology and pain medicine. 2019;9(5):e94654.

Illidi CR, Romer LM, Johnson MA, Williams NC, Rossiter HB, Casaburi R, et al. Distinguishing science from pseudoscience in commercial respiratory interventions: an evidence-based guide for health and exercise professionals. European journal of applied physiology. 2023:1-27.

Elnaggar RK, Shendy MA. Efficacy of noninvasive respiratory techniques in the treatment of children with bronchial asthma: a randomized controlled trial. Bulletin of Faculty of Physical Therapy. 2016;21(1):1-10.

Law N, Ruane LE, Low K, Hamza K, Bardin PG. Dysfunctional breathing is more frequent in chronic obstructive pulmonary disease than in asthma and in health. Respiratory physiology & neurobiology. 2018;247:20-3.

Campbell TG, Hoffmann TC, Glasziou PP. Buteyko breathing for asthma: Cochrane Database Syst Rev. 2018 Aug 22;2018(8):CD009158. doi: 10.1002/14651858.CD009158.pub2. eCollection 2018 Aug.

Hassan EEM, Abusaad FE, Mohammed BA. Effect of the Buteyko breathing technique on asthma severity control among school age children: Egypt J Bronchol. 2022;16(1):45. doi: 10.1186/s43168-022-00149-3. Epub 2022 Jul 23.

Zhong J, Zhang S, Li C, Hu Y, Wei W, Liu L, et al. Active cycle of breathing technique may reduce pulmonary complications after esophagectomy: A randomized clinical trial. Thoracic cancer. 2022;13(1):76-83.