buteyko method

where it came from

The method is associated with Konstantin Buteyko, a physiologist who worked in Novosibirsk. The idea attributed to him sounded counter-intuitive: that many illnesses, asthma first among them, come not from too little air but from too much — a person chronically breathes deeper than needed, washes out carbon dioxide, and the airways answer with a spasm.

Hence a treatment that runs against instinct: breathe less. Students of the method practise short pauses after the exhale, breathe through the nose only, and measure how long they can go without air comfortably.

As with other schools of this kind, the biography and the history live in retellings; there are no peer-reviewed sources for them.

what is true in the theory

There’s no point picking the theory apart in full — it is contested, and in any case the studies test the outcome, whether people got better, and leave the explanation alone. But one part of it is certainly true, and worth knowing.

Fast breathing really does wash out carbon dioxide, and that really does make things worse: the head goes light, the fingers tingle, and it starts to feel as if there still isn’t enough air. This is called hyperventilation, and when you’re anxious it happens by itself — set out in detail in why you can’t breathe when anxious.

So the instinct “breathe a bit less and a bit slower” isn’t made up. What’s contested is something else: that chronic hidden hyperventilation is the cause of asthma.

how the school actually does it

What follows is a description rather than an instruction: this is how the method is set out in its practitioners’ own manuals. None of it has been tested — the trials measured outcomes, not whether a student holds a pause correctly.

The method’s full name in Russian translates as “volitional elimination of deep breathing”, and it states the intention better than the surname does: you deliberately breathe less.

The control pause is the school’s central measure. It is taken sitting, after a while of ordinary breathing: an ordinary exhale, then the nose is pinched shut until the first wish to breathe. Holding to the limit is not the point. The nose is released, and the first breath should be an ordinary one — if it had to be gulped, the pause ran too long and the number doesn’t count.

From there the school assigns meaning to those seconds, and this is the place to slow down. The scales differ between accounts. In one, over forty seconds means healthy, twenty to forty is the first stage of disease, under ten the third. In another, twenty to forty is already normal and anything below counts as hidden hyperventilation. The thresholds don’t agree, and both scales are stated with the same confidence.

The control pause is the method’s in-house measure. Nobody outside the school uses it, it plays no part in assessing asthma, and the length of the pause also depends on lung volume, fitness and how wound up you happen to be. There is nothing in it to diagnose yourself with.

The sessions themselves come down to one thing: breathe so that a light air hunger is always present, and breathe through the nose only. They run in sets of a few minutes with rests between.

what the studies found

Here Buteyko is unusual among the named breathing schools: it has been through controlled trials, and more than one.

It made it into the Cochrane review of breathing exercises for asthma from 2020 — of the twenty-two studies there, one was on Buteyko specifically and another on Buteyko combined with pranayama.

And this year a separate meta-analysis appeared, gathering seven randomised trials. In all of them the method was given in addition to usual treatment and compared against usual treatment alone. The results:

• asthma control improved — in adults and in children alike. The effect is small; the studies didn’t disagree with each other, though with seven small trials that may only mean there isn’t enough data for a disagreement to show;
• quality of life didn’t change overall; the gain showed up only in children and adolescents;
• no adverse events were reported.

The authors are cautious in their conclusion: the data is limited, larger trials are needed.

and then an argument about it

In the same journal and the same year a separate paper appeared — a methodological review of that very meta-analysis. What it says we can’t tell you: only the title is in open access. But the fact itself means something: questions have been raised in public about the meta-analysis’s methods.

There is an administrative side to this too, worth knowing while we’re on the subject of evidence. Nowhere is the method offered as a replacement for medication: where breathing exercises reach asthma guidelines at all, they sit there as an addition to treatment. In Australia it went on a 2015 list of non-drug therapies with no clear evidence behind them, and since April 2019 private health insurance no longer covers it.

There’s also a mismatch that is more honest to show than to hide. The Cochrane review of breathing exercises in general found an improvement in quality of life, and on asthma control it could say nothing definite — one small study, and confidence limits wide enough to hold anything. The Buteyko meta-analysis lands the other way round: control yes, quality of life no. Either the method works differently from the other practices, or we are looking at noise in small samples. For now it isn’t clear.

where there is no room to improvise

In all seven trials Buteyko went alongside prescribed treatment. In none of them was it given instead of medication.

That isn’t a formality. You feel calmer, the breathing settles — and it starts to feel as though you need the inhaler less often. The asthma isn’t going anywhere. Doses are changed by a doctor.

And two things the school recommends that we won’t.

Taping your mouth shut overnight. The intention is clear enough: train yourself into nose breathing while you sleep. The price is out of proportion to it — with sleep apnoea, a blocked nose, or if you are sick in the night, a taped mouth becomes a danger of its own. For children more so.

Sitting with air hunger if you get panic attacks. A light shortage of air is the method’s working tool. It is also the exact sensation an attack opens with, and anyone who has had one knows it instantly. The manuals rarely mention this.

And COPD separately. The method doesn’t suit it, and the reason is physiological: in COPD carbon dioxide is already retained without any exercises, and the method is built on retaining more of it. Caution here costs less than finding out.

why asthma and panic often turn up together

This is worth a stop, because many people come to Buteyko from exactly this direction.

Asthma and panic attacks keep company more often than you’d expect. A Taiwanese study — a hundred and sixty-two thousand adolescents followed for seventeen years — found a markedly higher risk of panic disorder among people with asthma. More interesting still, there’s a dose effect: for those who ended up in hospital or A&E because of asthma, the risk was higher again.

But an association is not a cause. A New Zealand cohort followed from birth to twenty-one found a similar picture — until it adjusted for unobserved family and childhood factors. After that the association vanished. Their conclusion: shared ground rather than direct causation.

And here is what matters whichever side is right. An asthma attack and a panic attack feel alike: the chest tightens, there isn’t enough air, the heart pounds, it’s frightening. Confusing them is bad in both directions. Take panic for asthma and you reach for an inhaler that does nothing here; the racing heart it brings only confirms “something really is wrong.” Take an asthma attack for panic and treatment is delayed — and that is dangerous.

Telling them apart is a job for a doctor, not for an article. But it’s worth knowing in advance that this happens, and that one can look like the other.

if you came here to calm down

Buteyko is a method about asthma, and it was tested on people with asthma. If what you need a breathing practice for is anxiety, there’s no need to borrow someone else’s tool: slow breathing with a long exhale has its own evidence base, and it is about calming directly.

The two also work differently. Buteyko has you counting pauses and keeping the breathing down; slow breathing has nothing to count — a timer keeps the phases, and all you do is stretch the exhale. Start with resonance breathing at 5-5 — six breaths a minute, nothing to hold and nothing to count. The full catalogue is in breathing techniques.

short answers