Targeted treatment for people with dysfunctional breathing and difficult asthma

The intervention involves participating in a 12 week program (3 weekly sessions, followed by 3 fortnightly sessions) excluding assessments. The assessments will be conducted in-person, and review sessions may be in-person or via telehealth (video or telephone) depending on patient preference. The assessments will take approximately 60mins and the review sessions will take approximately 30 minutes. Patients who choose to undergo review telehealth sessions will require their own device (phone, tablet or computer), and sufficient phone reception or internet. Where physical assessment is required, individuals will be invited to attend in-person. The intervention will be delivered by a physiotherapist and will be individually tailored based on the assessment findings. All participants will undertake breathing re-training and receive education. Breathing re-training may focus on slow breathing +/- controlled breath holds, and exercises to encourage nose and abdominal breathing patterns. Feedback tools may be used such as audio pacing, visual cures or proprioceptive cues. Participants will be provided with exercises to complete at home for approximately 10-20mins daily. All participants will receive education resources from Asthma Australia and Physiotherapy for Breathing Pattern Disorders. They may also receive exercise therapy, manual therapy (soft tissue massage, joint mobilisations and stretches), relaxation therapy (relaxation exercises and/or referral to mental health services). Participants who report excessive breathlessness with exercise will be prescribed a home-based exercise program designed to improve their exercise capacity. This will be an endurance based walking program, All patients will be provided with a home exercise diary to record their home exercises and progress. The diary will also include a checklist of sessions to attend with the physiotherapist.