呼吸训练作为成人哮喘的辅助治疗：一项系统评价。
完整摘要 · 中文译文
背景：尽管采用了最佳药物治疗，仍有相当大比例的成人哮喘患者存在症状。呼吸锻炼作为一种非药物辅助手段出现，专门针对药物治疗无法充分解决的功能性呼吸模式异常（慢性过度通气、呼吸过速和异常通气力学）。其在各项结局和不同实施形式中的疗效证据值得进行系统评价。 方法：我们检索了五个数据库（Cochrane Library、PubMed/MEDLINE、Scopus、Web of Science、PEDro），纳入2013年1月至2025年3月发表的随机对照试验（RCT）、对照准实验研究和非对照前后对照预试验研究，这些研究中呼吸锻炼是确诊哮喘成人的主要干预措施。采用PEDro量表评估方法学质量；采用Cochrane RoB 2工具评估随机试验的偏倚风险，对非随机研究进行描述性评估。由于存在显著的临床、方法学和统计学异质性，采用叙述性综合进行总结。 结果：共纳入六项原始研究（n = 1,098；PEDro评分3-6）：四项随机对照试验（RCT）和两项非对照前后对照/预试验研究。若干纳入研究报告呼吸再训练在健康相关生活质量（AQLQ、Mini-AQLQ、SGRQ）和哮喘控制评分（ACT、ACQ）方面有显著改善。在所研究的各种方法中，Buteyko方法显示出相对一致的获益，包括急救支气管扩张剂和吸入性糖皮质激素用量减少约20% 使用。在一项大型随机对照试验（RCT）中，数字化自我引导方式与面对面物理治疗师指导效果相当。静态肺量计容积（FEV₁、FVC）及气道炎症标志物（FeNO）未见显著改变。重度急性发作率无变化。 结论：现有证据表明，结构化呼吸训练是成人哮喘安全且可能有效的辅助干预措施，通过纠正功能障碍性呼吸模式改善患者报告结局（健康相关生活质量及哮喘控制），而不改变潜在的气道炎症过程。对于尽管已优化药物治疗但仍存在症状的成人患者，呼吸训练可作为多学科哮喘管理的一部分予以考虑。
完整摘要 · 英文原文
BACKGROUND: Despite optimal pharmacological treatment, a substantial proportion of adult asthma patients remain symptomatic. Breathing exercises have emerged as a non-pharmacological adjunct specifically targeting dysfunctional breathing patterns (chronic hyperventilation, tachypnea, and aberrant ventilatory mechanics) that pharmacotherapy does not adequately address. Evidence for their efficacy across outcomes and delivery formats warrants systematic evaluation. METHODS: We searched five databases (Cochrane Library, PubMed/MEDLINE, Scopus, Web of Science, PEDro) for RCTs, controlled quasi-experimental studies, and uncontrolled pre-post pilot studies in which breathing exercises were the primary intervention for adults with confirmed asthma, published between January 2013 and March 2025. Methodological quality was assessed using the PEDro scale; risk of bias was assessed using the Cochrane RoB 2 tool for randomised trials and descriptively for non-randomised studies. A narrative synthesis was performed due to significant clinical, methodological, and statistical heterogeneity. RESULTS: Six primary studies (n = 1,098; PEDro scores 3-6) were included: four randomised controlled trials (RCTs) and two uncontrolled pre-post/pilot studies. Several included studies reported significant improvements with breathing retraining in health-related quality of life (AQLQ, Mini-AQLQ, SGRQ) and asthma control scores (ACT, ACQ). Among the modalities studied, the Buteyko method showed relatively consistent benefits, including a ~ 20% reduction in rescue bronchodilator and inhaled corticosteroid use. In one large RCT, digital self-guided delivery was equivalent to face-to-face physiotherapist instruction. Static spirometric volumes (FEV₁, FVC) and airway inflammation markers (FeNO) were not significantly modified. Severe exacerbation rates were unchanged. CONCLUSIONS: Available evidence suggests that structured breathing exercises are safe and potentially effective adjunctive interventions in adult asthma, improving patient-reported outcomes (health-related quality of life and asthma control) by correcting dysfunctional breathing patterns, without altering the underlying airway inflammatory process. Breathing exercises may be considered as part of multidisciplinary asthma management for adults who remain symptomatic despite optimised pharmacological therapy.