Symptom scores improved by Papworth method
Asthma management is bread and butter stuff for most GPs, yet many of us will not be familiar with the Papworth method to help breathing and relaxation. There are five components; these focus on breathing training, specific and general relaxation training and physical and breathing responses to stress, as well as integration of appropriate breathing patterns into everyday life. The programme is supported by home exercises with an audiotape. This method has been around for a long time, but with no clear evidence base.
To address this a study recruited 85 patients with asthma from one large, semi-rural English practice. Participants were randomised to study and control groups.
The study group received five treatment sessions with the Papworth method in addition to their usual medical treatment, while the control group received no additional treatment. Treatment was for approximately six months.
Assessments using respiratory symptom scales and anxiety and depression scales were performed at baseline and repeated at the end of treatment and at 12 months post baseline. A capnograph recorded end tidal CO2 and relaxed breathing rate. Data were available for 72 patients at the end of the study.
Results were dramatic, with the intervention group having symptom scores one third less than controls at the end of treatment, an improvement maintained over the follow-up period. The groups did not differ significantly in objective measurements, except for relaxed breathing rate, which was lower in the study group at both the end of treatment and at 12 months post baseline.
Making patients feel better is a key objective and the evidence for the Papworth method supports this outcome. However, there is a nagging doubt about how well this study was controlled. Five sessions with a physiotherapist are bound to have an effect on patients, even if it is a placebo.
Holloway E, West RJ. Integrated breathing and relaxation training (the Papworth method) for adults with asthma in primary care: a randomised controlled trial Thorax 2007;0:1–5. doi: 10.1136/thx.2006.076430reviewerreviewer Reviewer
Dr Peter Saul
GP, Wrexham and hospital practitioner in paediatrics (asthma and allergy)