Effects of Buteyko Breathing Versus Incentive Spirometry on Oxygen Saturation, Dyspnoea, Exercise Tolerance, and Sputum Clearance in Patients With Smog Induced Pneumonia

Overview

The current study will be a single-blind, parallel-group randomized controlled trial involving 62 patients diagnosed with smog-induced pneumonia. The study will compare the effects of Buteyko Breathing Technique (BBT) with Incentive Spirometry (IS) on respiratory outcomes. Participants will be randomly assigned to two groups using a concealed allocation method. The experimental group will receive Buteyko Breathing Technique along with standard medical care, while the control group will receive Incentive Spirometry along with standard medical care. Both interventions will be performed twice daily for approximately 20-30 minutes per session for seven days or until hospital discharge. Primary outcomes will include oxygen saturation (SpO₂), dyspnoea severity, exercise tolerance, sputum clearance, and respiratory symptom burden. Assessments will be conducted at baseline (Day 0), mid-intervention (Day 3), post-intervention (Week 2), and follow-up (Week 4). The study will be conducted at the pulmonary wards of Combined Military Hospital (CMH) and The Indus Hospital, Lahore. The hypothesis is that Buteyko Breathing Technique may produce greater improvements in oxygen saturation, dyspnoea reduction, exercise tolerance, and sputum clearance compared with Incentive Spirometry in patients with smog-induced pneumonia.

Smog and air pollution are major environmental health concerns in urban areas and are strongly associated with respiratory diseases, including pneumonia. Exposure to high concentrations of particulate matter and irritant gases can impair pulmonary defense mechanisms, leading to respiratory infections, reduced oxygen saturation, breathlessness, mucus retention, and reduced exercise tolerance . Physiotherapy plays an important role in pulmonary rehabilitation by improving ventilation, enhancing oxygenation, and facilitating airway clearance. Breathing techniques and respiratory exercises are commonly used supportive therapies to improve respiratory mechanics and promote recovery. The Buteyko Breathing Technique (BBT) is a breathing retraining method that emphasizes nasal breathing, reduced breathing volume, slow respiratory rate, and breath-holding exercises. The technique aims to normalize breathing patterns and improve oxygen delivery by maintaining optimal carbon dioxide levels in the blood. These physiological changes may improve ventilation efficiency, reduce dyspnoea, and enhance mucociliary clearance . In contrast, Incentive Spirometry (IS) is a widely used respiratory therapy device that encourages deep inspiration and sustained maximal inhalation. This intervention promotes lung expansion, prevents atelectasis, improves ventilation distribution, and assists in mobilizing pulmonary secretions. Incentive spirometry is frequently used in pulmonary rehabilitation and postoperative respiratory care to improve lung function and oxygenation . Although both breathing techniques are commonly used in respiratory rehabilitation, there is limited comparative evidence regarding their effectiveness in patients with pneumonia related to environmental pollution such as smog. Most existing research focuses on chronic respiratory diseases such as asthma or COPD. Therefore, this study aims to compare the effectiveness of Buteyko Breathing Technique and Incentive Spirometry in improving clinical outcomes including oxygen saturation, dyspnoea, exercise tolerance, and sputum clearance in patients with smog-induced pneumonia. The findings may help establish evidence-based physiotherapy protocols for managing respiratory complications associated with air pollution.