***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Fifty three patients with asthma underwent training for two weeks in an integrated set of yoga exercises , including breathing exercises , suryanamaskar , yogasana ( physical postures ) , pranayama ( breath slowing techniques ) , dhyana ( meditation ) , and a devotional session , and were told to practise these exercises for 65 minutes daily . They were then compared with a control group of 53 patients with asthma matched for age , sex , and type and severity of asthma , who continued to take their usual drugs . There was a significantly greater improvement in the group who practised yoga in the weekly number of attacks of asthma , scores for drug treatment , and peak flow rate . This study shows the efficacy of yoga in the long term management of bronchial asthma , but the physiological basis for this beneficial effect needs to be examined in more detail To determine if postexercise thermal events play a role in exercise-induced asthma ( EIA ) , nine normal and eight asthmatic subjects on three occasions exercised while they inhaled frigid air . During the recovery period , either cold air , air at room temperature and humidity , or air at body conditions was administered in a r and om fashion . On a fourth occasion , body-condition air was given during exercise .  Pulmonary mechanics were measured before and after each challenge . No changes in mechanics developed when air at body conditions was inhaled during exercise , however , increasing the heat content of the air during recovery produced progressively greater obstruction in both groups . On a separate occasion , seven asthmatics hyperventilated frigid air and either recovered spontaneously or had their ventilation slowly reduced . Controlling ventilation markedly attenuated the obstructive response . These data demonstrate that the severity of EIA is dependent not only on airway cooling but also upon the rapidity and magnitude of airway rewarming postchallenge Background : Sahaja Yoga is a traditional system of meditation based on yogic principles which may be used for therapeutic purpose s. A study was undertaken to assess the effectiveness of this therapy as an adjunctive tool in the management of asthma in adult patients who remained symptomatic on moderate to high doses of inhaled steroids . Methods : A parallel group , double blind , r and omised controlled trial was conducted . Subjects were r and omly allocated to Sahaja yoga and control intervention groups . Both the yoga and the control interventions required the subjects to attend a 2 hour session once a week for 4 months . Asthma related quality of life ( AQLQ , range 0–4 ) , Profile of Mood States ( POMS ) , level of airway hyperresponsiveness to methacholine ( AHR ) , and a diary card based combined asthma score ( CAS , range 0–12 ) reflecting symptoms , bronchodilator usage , and peak expiratory flow rates were measured at the end of the treatment period and again 2 months later . Results : Twenty one of 30 subjects r and omised to the yoga intervention and 26 of 29 subjects r and omised to the control group were available for assessment at the end of treatment . The improvement in AHR at the end of treatment was 1.5 doubling doses ( 95 % confidence interval ( CI ) 0.0 to 2.9 , p=0.047 ) greater in the yoga intervention group than in the control group . Differences in AQLQ score ( 0.41 , 95 % CI –0.04 to 0.86 ) and CAS ( 0.9 , 95 % CI –0.9 to 2.7 ) were not significant ( p>0.05 ) . The AQLQ mood subscale did improve more in the yoga group than in the control group ( difference 0.63 , 95 % CI 0.06 to 1.20 ) , as did the summary POMS score ( difference 18.4 , 95 % CI 0.2 to 36.5 , p=0.05 ) . There were no significant differences between the two groups at the 2 month follow up assessment . Conclusions : This r and omised controlled trial has shown that the practice of Sahaja yoga does have limited beneficial effects on some objective and subjective measures of the impact of asthma . Further work is required to underst and the mechanism underlying the observed effects and to establish whether elements of this intervention may be clinical ly valuable in patients with severe asthma OBJECTIVE To evaluate the effect of Buteyko breathing techniques ( BBT ) in the management of asthma . DESIGN Prospect i ve , blinded , r and omised study comparing the effect of BBT with control classes in 39 subjects with asthma . The study was conducted from January 1995 to April 1995 . PARTICIPANTS AND SETTING Subjects recruited from the community , aged 12 to 70 years , with asthma and substantial medication use . MAIN OUTCOME MEASURES Medication use ; morning peak expiratory flow ( PEF ) ; forced expiratory volume in one second ( FEV1 ) ; end-tidal ( ET ) CO2 ; resting minute volume ( MV ) ; and quality of life ( QOL ) score , measured at three months . RESULTS No change in daily PEF or FEV1 was noted in either group . At three months , the BBT group had a median reduction in daily beta 2-agonist dose of 904 micrograms ( range , 29 micrograms to 3129 micrograms ) , whereas the control group had a median reduction of 57 micrograms ( range , -2343 micrograms to 1143 micrograms ) ( P = 0.002 ) . Daily inhaled steroid dose fell 49 % ( range , -100 % to 150 % ) for the BBT group and 0 ( range , -82 % to + 100 % ) for the control group ( P = 0.06 ) . A trend towards greater improvement in QOL score was noted for BBT subjects ( P = 0.09 ) . Initial MV was high and similar in both groups ; by three months , MV was lower in the BBT group than in the control group ( P = 0.004 ) . ET CO2 was low in both groups and did not change with treatment . CONCLUSION Those practising BBT reduced hyperventilation and their use of beta 2-agonists . A trend toward reduced inhaled steroid use and better quality of life was observed in these patients without objective changes in measures of airway calibre The present multicentre study evaluates the differences in efficacy between a 3 month rehabilitation programme including drug treatment , and a 3 month control period of drug treatment only , for asthmatic patients and patients with chronic obstructive pulmonary disease ( COPD ) . The programme was run by physiotherapists in eight local practice s , and included exercise training , patient education , breathing retraining , evacuation of mucus , relaxation techniques , and recreational activities . In a r and omized controlled trial with a cross-over design , the effects of rehabilitation were evaluated 3 and 6 months after baseline measurements in terms of exercise tolerance and quality of life ( QOL ) . Exercise tolerance was assessed using submaximal cycle ergometer tests and 6 min walking tests .  QOL was evaluated by means of the Chronic Respiratory Disease Question naire ( CRDQ ) . After 3 months , the patients who started with rehabilitation showed significant improvements in endurance time ( 421 s ) and cardiac frequency ( 6 beats.min-1 ) during cycling , walking distance ( 39 m ) , and total CRDQ score ( 17 points ) compared to the control group . These improvements were still significant after 6 months . Additional analysis indicated that the asthmatic patients and the patients with COPD responded to rehabilitation in a similar way , with the exception that there was a greater improvement in walking distance for asthmatics . Improvements in exercise tolerance were not significantly correlated with improvements in QOL .  Rehabilitation of patients with asthma or chronic obstructive pulmonary disease in local physiotherapy practice s improves exercise tolerance and quality of life The Buteyko Breathing Technique ( BBT ) is promoted as a drug-free asthma therapy . It is based on the premise that raising blood PaCO2 through hypoventilation can treat asthma . Our study was design ed to examine whether the Buteyko Breathing Technique , as taught by a video , is an efficacious asthma therapy . Thirty-six adult subjects with mild to moderate asthma were r and omized to receive either a BBT or placebo video to watch at home twice per day for 4 weeks . Asthma-related quality of life , peak expiratory flow ( PEF ) , symptoms , and asthma medication intake were assessed both before and after intervention . Our results demonstrated a significant improvement in quality of life among those assigned to the BBT compared with placebo ( p = 0.043 ) , as well as a significant reduction in inhaled bronchodilator intake ( p = 0.008 ) . We conclude that the BBT may be effective in improving the quality of life and reducing the intake of inhaled reliever medication in patients with asthma . These results warrant further The effects of two pranayama yoga breathing exercises on airway reactivity , airway calibre , symptom scores , and medication use in patients with mild asthma were assessed in a r and omised , double-blind , placebo-controlled , crossover trial . After baseline assessment over 1 week , 18 patients with mild asthma practised slow deep breathing for 15 min twice a day for two consecutive 2-week periods . During the active period , subjects were asked to breathe through a Pink City lung ( PCL ) exerciser -- a device which imposes slowing of breathing and a 1:2 inspiration : expiration duration ratio equivalent to pranayama breathing methods ; during the control period , subjects breathed through a matched placebo device .  Mean forced expiratory volume in 1 s ( FEV1 ) , peak expiratory flow rate , symptom score , and inhaler use over the last 3 days of each treatment period were assessed in comparison with the baseline assessment period ; all improved more with the PCL exerciser than with the placebo device , but the differences were not significant . There was a statistically significant increase in the dose of histamine needed to provoke a 20 % reduction in FEV1 ( PD20 ) during pranayama breathing but not with the placebo device . The usefulness of controlled ventilation exercises in the control of asthma should be further investigated Kurabayashi H , Machida I , H and a H , Akiba T , Kubota K : Comparison of three protocol s for breathing exercises during immersion in 38 ° C water for chronic obstructive pulmonary disease . Am J Phys Med Rehabil 1998;77:145–148 Respiratory function test , arterial blood gas analysis , and ejection fraction were used to compare three protocol s of breathing exercises during immersion in 38 ° C water . Therapy was given for 2 mo to patients with stable chronic obstructive pulmonary disease . Protocol A consisted of a total exercise period of 20 min/wk ( 10 min/day , 2 days/wk ) and was performed by 7 patients ( 5 cases of asthma and 2 cases of emphysema ) . Protocol B consisted of a total exercise period of 120 min/wk ( 20 min x2 per day at 10:00 am and 3:00 pm , 3 days/wk ) and was performed by 9 patients ( 6 asthmas and 3 emphysemas ) . Protocol C consisted of a total exercise period of 120 min/wk ( 20 min/day , 6 days/wk ) and was performed by 8 patients ( 4 asthmas and 4 emphysemas ) . The ratio of forced expired volume in one second to forced vital capacity ( FEV10 % ) was significantly increased in protocol s B and C ( P < 0.01 ) . The ratio of forced vital capacity to the predicted normal value ( % FVC ) was not changed in any of the three protocol s. A significant increase in peak flow was observed in protocol s B and C ( P < 0.05 ) . The maximal expiratory flow at 25 % ( V25 ) was not changed in any of the three protocol s. Pao2 was significantly increased and Paco2 was significantly decreased in protocol B ( P < 0.01 and P < 0.05 , respectively ) , whereas only Paco2 was significantly decreased in protocol C ( P < 0.05 ) . Ejection fraction was increased in protocol s B and C. These results suggest that exercise for a total period of 120 min/wk is preferable to that of 20 min/wk in COPD BACKGROUND Patients with airway obstruction may spontaneously breathe with a positive expiratory pressure by pursing their lips during expiration , especially in case of dyspnea . Dyspnea seems to be related to increased activity of the respiratory muscles . A potential explanation for the use of pursed lips breathing ( PLB ) is that this type of breathing leads to a reduction of respiratory muscle activity . The purpose of this study was to assess the effect of breathing with a positive expiratory pressure of 5 cm H2O , simulating pursed lips breathing ( SPLB ) , on respiratory muscle activity and pulmonary function during induced airway obstruction . METHODS In twelve asthmatic patients , tonic and phasic electromyographic ( EMG ) activity of the following muscles was obtained : scalene muscle , parasternal muscle , and abdominal muscles . Pulmonary function and EMG measurements were performed before and after propranolol induced airway obstruction . RESULTS Simulated pursed lips breathing result ed in a significant increase of functional residual capacity and tidal volume both at baseline and during airway obstruction . Phasic respiratory muscle activity during PEP breathing increased especially at baseline . We conclude that beneficial effects of breathing with a positive expiratory pressure of 5 cm H2O , which is similar to pursed lips breathing , can not be explained by changes in respiratory muscle activity or pulmonary function Abstract The effects of two types of operant muscular relaxation , frontalis relaxation and brachio- radialis relaxation , on peak expiratory flow rate 
    Output:
    
Otherwise benefit of breathing exercises was found in isolated outcome measures in single small studies .
REVIEW ER 'S CONCLUSIONS No reliable conclusions can be drawn concerning the use of breathing exercises for asthma in clinical practice