“LITERATURE REVIEW OF TREND AND ISSUE

IN ASTHMA COMPLEMENTARY CARE”

BAHASA INGGRIS DAN PENELURUSAN JURNAL

By :
GROUP 9 / KEPERAWATAN PROGRAM SARJANA

MEMBER NIM
1. Ni Made Mirah Maheswari (09 / 213213320)
2. Ni Luh Ayu Febriyanthi (10 / 213213321)
3. Komang Budi Kartika Sari Dewi (20 / 213213331)
4. Anak Agung Esha Waisyaka (38 / 213213349)
5. Maria Carvalho Sousa ( 45 / 213213356)

SEKOLAH TINGGI ILMU KESEHATAN

WIRA MEDIKA BALI
DENPASAR
2021
 PREFACE
Thank to Almighty God who has given His bless to the writer for finishing
the English paper assignment, because of His grace and blessings we can complete
a paper entitled “Literature Review of Trend and Issue in Asthma
Complementary Care” in a timely manner.
This paper was compiled with help from various parties. Both parties come
from outside as well as from parties concerned itself. And because the aid and help
of God Almighty, these papers can be finally resolved.
This is a paper about “Literature Review of Trend and Issue in Asthma
Complementary Care” and was selected because to find out what is asthma and
what are some complementary care that can be given to asthma patients.
In the compilation of this paper, the compiler realized that the compiler's
knowledge and insight were still very limited. Thus, the compilers were desperate
for criticism and competition from various parties to make the paper better and more
profitable.
Last, we would like to thank those who helped us in every way, so this
paper can be resolved. May God reward all their kindness. Thank you.

Denpasar, November 1st, 2021.

Compilers

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 TABLE OF CONTENTS

PREFACE ................................................................................................................ i

TABLE OF CONTENTS ........................................................................................ ii

CHAPTER I ............................................................................................................ 1

INTRODUCTION .................................................................................................. 1

1.1. Background of the paper .......................................................................... 1

1.2. Problem Formulation ................................................................................ 2

1.3. Objectives ................................................................................................. 2

CHAPTER II ........................................................................................................... 3

THEORY AND DISCUSSION .............................................................................. 3

2.1. Definition of Asthma. ............................................................................... 3

2.2. Definiton of Complementary Care ........................................................... 4

2.3. Research about Complementary Care for Asthma Patients. .................... 5

2.4. How Buteyko Breathing Technique help people with asthma ................. 8

2.5. How Pranayama Yoga help people with asthma .................................... 10

CHAPTER III ....................................................................................................... 11

CONCLUSION ..................................................................................................... 11

Bibliography.......................................................................................................... 12

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 CHAPTER I
INTRODUCTION
1.1.Background of the paper
Asthma is a disease of the respiratory tract that can be caused by
multifactor. According to WHO in 2011, the asthma case is about 235
million people. In developing countries the death toll from asthma bronkial
is over 8% (WHO, 2011). The National Center for Health Statistics (NCHS)
in 2011 says that the prevalence of child asthma is 9.5% and in adults by
8.2%, while gender in males is 7.2% and 9.7% in women (NCHS, 2011).
The incidence of bronchial asthma world over is on increase. The
disease is characterized by cough, wheezing, and breathlessness (expiratory
difficulty). It is exacerbated by various factors like environmental factors,
infections, occupational factors, cold exposure, exercises,etc. Presently,
disease management strategy includes pharmacological therapy
(inhaled/oral medicine). Initiallyt his therapy is helpful in management of
the disease, but later on there is increase in financial burden, morbidity
(more and more patients requiring oxygen therapy/respiratory support
therapy), and mortality.
Indonesia is one of the developing countries, where the asthma rate
is still high. Asthma prevalence in Indonesia in 2010 is 2.5% increased to
4.5% in 2013, this is suggest that asthma in Indonesia is increasing (DepKes
RI, 2014).
Because of that, there are two ways to treat asthma; in
pharmacological medicine and non-pharmacological or in nursing are
known as complementary therapies. Some complementary therapies that
can be done on asthma patients are buteyko therapy and pranayama yoga.

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1.2. Problem Formulation
From the bakcground created above, there are some problem formulation to
dicuss :
a. what is asthma ?
b. what is Trend and Issue in complementary care?
c. Is there some research about Trend and Issue Complementary Care
that can be given to asthma patient?
d. How Buteyko Breathing Technique help people with asthma?
e. How Pranayama Yoga help people with asthma?
1.3.Objectives
According to the problem formulation above, below is the purpose of this
paper :
a. In order to know the meaning asthma.
b. In order to know the definition of Trend and Issue in complementary
care
c. In order to know some complementary care that can be given to child
and adult patients who have asthma.
a. To find out How Buteyko Breathing Technique help people with
asthma
b. To find out How Pranayama Yoga help people with asthma

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 CHAPTER II
THEORY AND DISCUSSION
2.1.Definition of Asthma.
Asthma is a long-term condition affecting children and adults. The
air passages in the lungs become narrow due to inflammation and tightening
of the muscles around the small airways. This causes asthma symptoms:
cough, wheeze, shortness of breath and chest tightness. These symptoms are
intermittent and are often worse at night or during exercise. Other common
“triggers” can make asthma symptoms worse. Triggers vary from person to
person, but can include viral infections (colds), dust, smoke, fumes, changes
in the weather, grass and tree pollen, animal fur and feathers, strong soaps,
and perfume (WHO, 2021).
Asthma is often under-diagnosed and under-treated, particularly in low-
and middle-income countries. People with under-treated asthma can suffer sleep
disturbance, tiredness during the day, and poor concentration. Asthma sufferers
and their families may miss school and work, with financial impact on the family
and wider community. If symptoms are severe, people with asthma may need to
receive emergency health care and they may be admitted to hospital for treatment
and monitoring. In the most severe cases, asthma can lead to death.
Many different factors have been linked to an increased risk of
developing asthma, although it is often difficult to find a single, direct cause.
 Asthma is more likely if other family members also have asthma –
particularly a close relative, such as a parent or sibling.
 Asthma is more likely in people who have other allergic conditions,
such as eczema and rhinitis (hay fever).
 Urbanisation is associated with increased asthma prevalence,
probably due to multiple lifestyle factors.
 Events in early life affect the developing lungs and can increase the
risk of asthma. These include low-birth weight, prematurity,
exposure to tobacco smoke and other sources of air pollution, as well
as viral respiratory infections.
 Exposure to a range of environmental allergens and irritants are also
thought to increase the risk of asthma, including indoor and outdoor

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 air pollution, house dust mites, moulds, and occupational exposure
to chemicals, fumes, or dust.
 Children and adults who are overweight or obese are at a greater risk
of asthma

2.2.Definiton of Complementary Care

Complementary therapy is known by many different terms, including
complementary medicine, alternative therapy, alternative medicine, holistic
therapy and traditional medicine.
A wide range of treatments exist under the umbrella term ‘complementary
therapy’, which makes it difficult to offer a blanket definition. Complementary
therapies are used alongside conventional medicines or treatments. Alternative
therapies are sometimes grouped with complementary therapies, but they refer to
different concepts. Alternative therapies are used in place of conventional
medicines or treatments. Complementary therapies tend to share a few core beliefs,
including:

 Illness occurs if the body is out of balance.

 The body can heal itself and maintain a healthy state if given the right
conditions.
 The whole person should be treated, not just the disease or the
symptoms.
 The gentlest therapies must be tried first before harsher ones.
 There is no quick fix, since healing and balance take time.
 Natural products are preferable to synthetic ones
People may have more than one reason for trying a complementary
therapy. Some of the reasons include:
 achieving and maintaining good health
 helping them perform everyday tasks
 feeling dissatisfied with conventional medical practices
 feeling dissatisfied with their doctor–patient relationships
 wanting to take charge of their own health and medical problems
 having easy access to consumer health information on the internet

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 reading evidence of the benefits and safety of some complementary
medicines and therapies
 feeling dissatisfied with limited success rates or adverse side effects of
prescription medicines
 wanting to receive healthcare that treats the whole person and not just
their symptoms (Note: both complementary healthcare practitioners
and some conventional health professionals actively endorse holistic
care).
The most frequent users of complementary therapies in Australia are
women and those who are well educated. Many people use
complementary therapies and medicines because of their cultural
traditions and beliefs. Some of the more popular or trend complementary
therapies include: acupuncture, yoga, buteyko, pilates, meditation, reiki,
alexander technique, etc.

2.3. Research about Complementary Care for Asthma Patients.

Complementary care or as known as complementary therapies is
a therapy that is not part of current standard medical practice, which is use
d in addition to conventional treatments (Segen's Medical Dictionary,
2011) .Some complementary therapies that can be done on asthma patients
are Buteyko breathing technique and Pranayama yoga.
2.2.1. Buteyko Breathing Technique (BBT)
Buteyko Breathing Technique (BBT)—was introduced in Russia in
the 1950s by Dr Konstantin Buteyko. Buteyko identified various
dysfunctional breathing habits, such as mouth breathing and upper chest
breathing, as being among the major causes for chronic
hyperventilation. Consequentially, he introduced breathing exercises
based on breath-holding maneuvers and breath control to guide patients
back to the normal nasal/diaphragmatic breathing pattern, designed to
reduce breathing volumes and restore metabolic balance (Vagedes et
al., 2021)

5
 Vagedes et al. observed Thirty-two (32) outpatient children with
asthma (age 6-15 years, 66% male) that were randomized to either
Treatment as Usual (TAU) or TAU group combined with Buteyko
training (Buteyko group, BG).
Children in Treatment as Usual (TAU) group received routine care,
consisting of standard medication prescribed by the respective
attending physicians according to the severity of the symptoms. At the
same time Buteyko Group (BG) Children received routine care as
described above and additionally were provided a standard course of
BBT, comprised of three compo- nents: a five-day intensive course of
BBT, a booster session one week later, and a three-month period of
training at home.
Vagedes et al. conclude that for the primary outcome, no significant
between-group difference was found. Regarding the secondary
outcomes, children receiving treatment augmented with BBT revealed
significantly greater improvement at the follow-up than those receiving
TAU. No between-group differences were found for the remaining
secondary measures of outcome. Preliminary findings suggest that the
addition of BBT to treatment as usual for children with asthma enhances
outcomes with respect to spirometry and parental emotional function
but does not lead to reductions in medication, at least over the short
term.
Their results might give preliminary evidence that BBT could be an
effective intervention for children with partly controlled asthma, with
respect to spirometry (FEV1) and breath-hold parameters. Parental
emotional function, an important factor in child- hood asthma, could
also benefit when BBT is administered to their children. However,
given the pilot character of our study and a number of limitations, the
conclusions should be drawn with caution (Vagedes et al., 2021).

6
 2.2.2. Pranayama Yoga (Breathing Exercise)
The incidence of bronchial asthma world over is on increase.
The disease is characterized by cough, wheezing, and breathlessness
(expiratory difficulty). It is exacerbated by various factors like
environmental factors, infections, occupational factors, cold
exposure, exercises, etc. Presently, disease management strategy
includes pharmacological therapy (inhaled/oral medicine). Initially
this therapy is helpful in management of the disease, but later on
there is increase in financial burden, morbidity (more and more
patients requiring oxygen therapy/ respiratory support therapy), and
mortality (Saxena & Saxena, 2009).
Nonpharmacological therapy includes yogic techniques such
as breathing exercises (pranayama – the basic vitality necessary to
life is termed as prana and regulation of prana is pranayama.),
meditation, and asana (Saxena & Saxena, 2009).
Various studies have shown the effectiveness of these
techniques in asthma,hypertension, diabetes, and 22 ischemic heart
disease, but type, duration, and efficacy in asthma are not well
established. Besides, modification of conventional exercises
according to medical pathology has not been done yet; therefore, this
trial was conducted (Saxena & Saxena, 2009).
Saxena & Saxena has done research about Pranayama Yoga
with patients were randomly divided into two groups. Fifty cases of
bronchial asthma were chosen for the study following diagnostic
confirmation. Exclusion criteria were patients with symptoms
suggestive of disease other than bronchial asthma like ischemic heart
disease, bronchitis, and anemia and patients with history of smoking.
The Randomization was done by numbering the patients 1–
50 (25 men and 25 women), even numbered patients were allocated
to group A and odd numbered patients to group B. Both groups were
comparable in all the aspects including age, sex, symptoms, and lung
functions. Group A (n = 25) practiced breathing exercises/pranyama

7
 for 20 minutes twice daily for 12 weeks. Group B (n = 25, control
group) practiced meditation for 20 minutes twice daily for 12 weeks
(Saxena & Saxena, 2009).
In their research, they teach the steps to do Pranayama Yoga
that performed by group A and at the same time The control group
(Group B) patients practiced meditation in sitting posture with
closed eyes. Patients were advised first to confirm the side of the
nostril from wherein the air is coming maximum, then to concentrate
on the same nostril, to appreciate the sound of air along with inward
and outward movement of outer wall of nostril. Patients deeply
concentrated (meditated) at the same point twice daily for 20
minutes.
The results from their research is After 12 weeks, there was
significant reduction in symptoms in goup A as compared to group
B (control). This result is similar to other studies of Nagrathna et al.,
Goyeche et al., and McFadden where improvement was found after
yogic techniques. Reduction in psychosomatic factors was
considered as prime factor in these studies, but improvement in their
study was not due to any relaxation activity or decrease in
psychosomatic factors because meditation group did not show any
improvement. The results are also different from a few studies where
some other techniques were used(Saxena & Saxena, 2009).

2.4.How Buteyko Breathing Technique help people with asthma

The Buteyko (pronounced bu-TAY-koh) method, sometimes called
BBT for short, is a special way of breathing. It strives to control
the hyperventilation thought to be common in people who are struggling to
breathe with the symptoms of asthma. Buteyko claimed that this breathing
method would decrease the number and severity of asthma attacks. He also
sought to cut down on the need for asthma medication. This breathing
technique was designed to teach people with asthma how to adopt healthier

8
breathing patterns aimed at promoting the right ratio of these two blood
gases (MacNaughton, 2018).
Despite Buteyko's goals, it is important to note that this type of
breathing should only be seen as a complementary or alternative asthma
treatment method. BBT should not replace traditional asthma treatment. In
other words, don't count on being able to totally discontinue your inhaler or
other asthma medication prescription. This is the steps of Buteyko Breathing
Technique :

1. Measure your Control Pause.

2. Gently inhale, exhale, and firmly pinch your nostrils to stop
breathing. If your Control Pause is 6 seconds, stop breathing for 3
seconds. If this duration feels stressful, then switch to a shorter
Breath Holds – 1 or 2 seconds. Please keep in mind that stress is
counterproductive to breathing improvement; the Buteyko Breathing
exercises should create relaxation, not trauma and anxiety.
3. After completing the Breath Hold, open your nose and breathe
normally for 1 minute. Then, do another Breath Hold. You will need
to repeat this breathing exercise every minute.
4. When you complete the session of breathing exercises, wait for a
minute or two, and measure your Control Pause again. As usual, you
need to do it gently.
5. Then, compare this Control Pause with the one you took before the
session. If your Before-Control Pause was 6 seconds and your After-
Control Pause is 10 seconds, the result is positive. An increased
Control Pause indicates breathing improvement.

9
2.5.How Pranayama Yoga help people with asthma
Most of the asthma patients prefer complementary and integrative
applications as they continue to experience asthma symptoms despite
pharmacological treatment. Pranayama, one of these treatments, is a
breathing-based technique and is a part of yoga, an ancient Indian science.
The steps of doing Pranayama Yoga ;
1. Deep breathing (deep inspiration and deep expiration): subjects sit
in sukhasana and perform deep inspiration and expiration through
both nostrils.
2. Sasankasana breathing: subjects sit in vajrasana with their hands
back, holding the right wrist with the left arm, with inhalation the
person bends backward and with exhalation bends forward
touching his/her forehead to the ground.
3. Anuloma viloma: common breathing practice, in which subjects
breathe through alternate nostrils while sitting in sukhasana.
4. Bhramari chanting: sitting in sukhasana subjects inhale through
both nostrils and while exhaling produce sound of female humming
bee.
5. Omkara (modified): commonly used for meditation, but not
included in regular breathing exercises, is an important exhalation
exercise. Changes to this exercise, keeping in mind the asthmatic
expiratory difficulty with air trapping, were made so as to
strengthen expiration. Patients were advised to sit in sukhasana and
to inhale deeply and then while exhaling produce Omkara with
maximum force and to continue until further exhalation is not
possible. During conventional Omkara, Omkara is pronounced as
ooooo…mmm, but patients were advised to practice
OOOOOOOOO…MMM (high pitch/forceful) with prolonged
exhalation. (Saxena & Saxena, 2009).

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 CHAPTER III
CONCLUSION
Asthma is one of the major medical challenges worldwide and the most
common chronic disease in childhood. Children with asthma are not only
confronted with potentially life-threatening exacerbations, but also with school
absenteeism impairing educational progress and further amplifying socioeconomic
disparities. Moreover, they are at increased risk of psychosocial problems resulting
from the inability to participate in age-appropriate activities important for the
development of self-esteem and social skills. Such disease related impairments and
a reduced quality of life can also adversely impact the families.
Because of that, there are two ways to treat asthma; in pharmacological
medicine and non-pharmacological or in nursing are known as complementary
therapies. Some complementary therapies that can be done on asthma patients are
buteyko therapy and pranayama yoga.
Buteyko Breathing Technique (BBT) could be an effective intervention for
children with partly controlled asthma, with respect to spirometry (FEV1) and
breath-hold parameters. Parental emotional function, an important factor in child-
hood asthma, could also benefit when BBT is administered to their children.
However, given the pilot character of our study and a number of limitations, the
conclusions should be drawn with caution (Vagedes et al., 2021).
Various studies also have shown the effectiveness of Pranayama Yoga in
asthma,hypertension, diabetes, and 22 ischemic heart disease, but type, duration,
and efficacy in asthma are not well established. Besides, modification of
conventional exercises according to medical pathology has not been done yet;
therefore, this trial was conducted (Saxena & Saxena, 2009).

11
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rch-action&pgnumber=3&charindex=&strucid=&fullcontent=&C-
ALL=1&C1=1&C2=1&C3=1&C4=1&C5=1
MacNaughton, K. (2018, may 16). Retrieved from asthma.net:
https://asthma.net/living/buteyko-breathing
Saxena, T., & Saxena, M. (2009). The effect of various breathing exercises
(pranayama) in patients with bronchial asthma of mild to moderate severity.
International Journal of Yoga, 2(1), 22. https://doi.org/10.4103/0973-
6131.53838
Segen's Medical Dictionary. (2011). Retrieved from Farlex, Inc: https://medical-
dictionary.thefreedictionary.com/complementary+therapy
Vagedes, J., Helmert, E., Kuderer, S., Vagedes, K., Wildhaber, J., & Andrasik, F.
(2021). The Buteyko breathing technique in children with asthma: a
randomized controlled pilot study. Complementary Therapies in Medicine, 56,
102582. https://doi.org/10.1016/j.ctim.2020.102582
WHO. (2011). Retrieved from World Health Organization Web Site:
https://www.who.int/en/news-room/fact-sheets/detail/asthma
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https://www.who.int/en/news-room/fact-sheets/detail/asthma

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