Skip to main content
OpenTrials
Recruiting

NCT Number: NCT07759583

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

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.

Recruiting

Interested in participating?

Request Info

Key information

Conditions

Smog-Induced Pneumonia Infections Lung Diseases Pneumonia Respiratory Tract Diseases Respiratory Tract Infections

Age range

25 year–40 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Combined Military Hospital (CMH)

Lahore, Punjab Province, Pakistan

Location status: Recruiting

Location contact

Shoaib Waqas

CONTACT

[email protected]

03024552109

About this study

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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Male and female participants Age between 25-40 years Clinically diagnosed pneumonia Recent exposure to high air pollution levels (AQI threshold exceeded within the past 7 days) Resting oxygen saturation between 86-95% Ability to understand and perform breathing exercises -

Exclusion criteria

Requirement for mechanical ventilation or ICU admission Hemodynamic instability Severe chronic respiratory disease such as COPD with hypercapnia Pneumothorax or massive hemoptysis Recent thoracic surgery or trauma Cognitive impairment affecting cooperation Pregnancy

-

Treatment and study plan

Buteyko Breathing Technique (BBT)

Other

Buteyko Breathing Technique involves controlled nasal breathing with breath-holding and relaxed exhalation. Participants perform slow nasal inhalation followed by relaxed exhalation at a rate of approximately 6 deep breaths per 30 seconds. Strategic breath-holds after exhalation are incorporated to reduce hyperventilation and increase physiological CO₂ levels. Sessions are supervised twice daily for 20-30 minutes over 7 days or until hospital discharge. Intensity is maintained within patient comfort limits. SpO₂ and Borg dyspnoea scores are monitored during sessions. Sputum volume is recorded post-session. Daily sputum diary is maintained. The goal is to improve breath control, reduce dyspnoea, and facilitate sputum clearance.

Incentive Spirometry (IS)

Device

This intervention uses an Incentive Spirometry device to promote deep lung inflation. Participants perform slow maximal inhalation to achieve target volume, followed by a 2-3 second breath hold, then slow exhalation. Sessions are supervised twice daily for 20-30 minutes, plus 10 deep breaths per hour while awake, over 7 days or until hospital discharge. Intensity is maintained at gentle maximal inhalation without discomfort. SpO₂ and Borg dyspnoea scores are monitored during sessions. Sputum volume is recorded post-session. Daily sputum diary is maintained. The goal is to improve lung expansion, oxygenation, and inspiratory capacity.

Primary outcomes

  1. Peripheral Oxygen Saturation (SpO₂)

    Time frame: Baseline (Day 0), Day 3, Week 2, and Week 4 follow-up.

    Peripheral oxygen saturation (SpO₂) will be measured at rest using a fingertip pulse oximeter. SpO₂ is reported as a percentage (%) ranging from 0% to 100%, with higher values indicating better oxygenation status. Normal resting values are typically 95%-100%.

  2. Six-Minute Walk Distance (6MWD)

    Time frame: Baseline (Day 0), Day 3, Week 2, and Week 4 follow-up.

    Functional exercise capacity will be assessed using the Six-Minute Walk Test (6MWT) according to the American Thoracic Society guidelines. The outcome will be reported as the total distance walked in six minutes, measured in meters (m). Greater walking distance indicates better functional exercise capacity.

  3. Sputum Wet Weight

    Time frame: Baseline (Day 0), Day 3, Week 2, and Week 4 follow-up.

    Sputum production will be measured as sputum wet weight (grams) using pre-weighed sterile collection containers and a calibrated digital weighing scale. Results will be reported in grams (g). Higher values indicate greater sputum production, whereas lower values indicate improvement.

  4. Dyspnoea Severity Score (Modified Borg Dyspnoea Scale)

    Time frame: Baseline (Day 0), Day 3, Week 2, and Week 4 follow-up.

    Dyspnoea severity will be assessed using the Modified Borg Dyspnoea Scale. The scale ranges from 0 (no breathlessness) to 10 (maximal breathlessness). Higher scores indicate worse breathlessness.

  5. Respiratory Symptom Severity Score (Breathlessness, Cough and Sputum Scale [BCSS])

    Time frame: Baseline (Day 0), Day 3, Week 2, and Week 4 follow-up.

    Respiratory symptom severity will be assessed using the Breathlessness, Cough and Sputum Scale (BCSS). The BCSS consists of three symptom domains (breathlessness, cough, and sputum), each scored from 0 to 4, giving a total score ranging from 0 to 12. Higher scores indicate greater respiratory symptom severity (worse outcome).

Study contacts

Contact information is provided by the study sponsor or research team.

Faizan Ahmad

CONTACT

[email protected]

03054741978

Sahar Fatima

CONTACT

[email protected]

03271202200

Sponsors and collaborators

Lead sponsor

Lahore University of Biological and Applied Sciences

Other

Registry information

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Aug 12, 2026
Registry last updated
Aug 12, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.