Authors : Dr. Kashish; Dr. Manu Vishist

Volume/Issue : Volume 11 - 2026, Issue 1 - January

Google Scholar : https://tinyurl.com/yc83ty2j

Scribd : https://tinyurl.com/bdzzay35

DOI : https://doi.org/10.38124/ijisrt/26jan330

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Chronic mouth breathing in adolescents is associated with altered orofacial growth sleep disturbance and reduced quality of life yet evidence comparing breathing retraining approaches is limited. This single centre parallel group randomised controlled trial compared the effectiveness of the Buteyko breathing technique and diaphragmatic breathing in restoring nasal breathing and improving respiratory outcomes in adolescents with mouth breathing syndrome. Sixty four participants aged ten to seventeen years with clinically confirmed mouth breathing were randomly allocated to a four week intervention of either Buteyko breathing or diaphragmatic breathing. The primary outcome was conversion to nasal breathing assessed using the Glatzel Mirror and Water Holding tests while secondary outcomes included chest expansion measurements. Post intervention a markedly higher proportion of participants in the Buteyko group achieved nasal breathing compared with the diaphragmatic breathing group on both assessment tests with statistically significant between group differences. Chest expansion improved significantly in both groups with slightly greater absolute gains observed in the diaphragmatic breathing group. No adverse events were reported and adherence to both interventions exceeded ninety percent. These findings indicate that a short term Buteyko breathing programme is substantially more effective than diaphragmatic breathing in re establishing nasal breathing in adolescents with mouth breathing syndrome while both techniques contribute to improved thoracic mobility and respiratory function.

Keywords : Mouth Breathing, Adolescents, Buteyko Breathing Technique, Diaphragmatic Breathing, Nasal Breathing, Breathing Retraining.

References :

1. K. F. Schulz, D. G. Altman, and D. Moher, “CONSORT 2010 statement: Updated guidelines for reporting parallel-group randomised trials,” Ann. Intern. Med., vol. 152, no. 11, pp. 726–732, 2010.
2. J. Vagedes, E. Helmert, S. Kuderer, K. Vagedes, J. Wildhaber, and F. Andrasik, “The Buteyko breathing technique in children with asthma: A randomized controlled pilot study,” Complement. Ther. Med., vol. 56, Art. no. 102582, 2021.
3. H. Çelik and E. Yuruk, “Effect of the Buteyko breathing technique on asthma control and quality of life in children aged 7–12 years: A randomized controlled study,” PeerJ, vol. 13, Art. no. e19467, 2025.
4. S. Cooper, J. Oborne, S. Newton, et al., “Effect of two breathing exercises (Buteyko and pranayama) in asthma: A randomized controlled trial,” Thorax, vol. 58, no. 8, pp. 674–679, 2003.
5. A. J. Opat, M. M. Cohen, M. J. Bailey, and M. J. Abramson, “A clinical trial of the Buteyko breathing technique in asthma as taught by video,” J. Asthma, vol. 37, no. 7, pp. 557–564, 2000.
6. A. Bruton and G. T. Lewith, “The Buteyko breathing technique for asthma: A review,” Complement. Ther. Med., vol. 13, no. 1, pp. 41–46, 2005.
7. V. A. de Menezes, R. B. Leal, A. F. Granville-Garcia, et al., “Prevalence and factors related to mouth breathing in schoolchildren,” CODAS, vol. 27, no. 5, pp. 454–459, 2015.
8. R. B. Leal, M. C. Gomes, A. F. Granville-Garcia, P. S. Goes, and V. A. de Menezes, “Impact of breathing pattern on quality of life in 9- to 10-year-old schoolchildren,” Am. J. Rhinol. Allergy, vol. 30, no. 5, pp. 147–152, 2016.
9. D. de Lima e Melo, R. V. Santos, T. V. Perilo, H. M. G. Becker, and A. R. Motta, “Mouth-breathing evaluation: Use of Glatzel mirror and peak nasal inspiratory flow,” CODAS, vol. 25, no. 3, pp. 236–241, 2013.
10. J. O. N. Lundberg, E. Weitzberg, and J. M. Lundberg, “Nitric oxide in the paranasal sinuses: Relevance for airway physiology,” Anat. Rec., vol. 291, no. 11, pp. 1478–1484, 2008.
11. J. Duffin, “The role of CO₂ and central chemoreception in the regulation of breathing,” Clin. Investig. Med., vol. 13, no. 4, pp. 268–276, 1990.
12. S. Petersen, E. Van den Bosch, N. Stambulova, et al., “Acute effects of slow diaphragmatic breathing on heart-rate variability in adolescents,” Front. Psychol., vol. 11, Art. no. 921, 2020.
13. E. Fung, A. Lal, L. Kostecky, et al., “Persistence of mouth breathing after adenotonsillectomy in children,” Sleep Breath., vol. 25, no. 4, pp. 2149–2157, 2021.
14. E. S. Katz and C. M. D’Ambrosio, “Pathophysiology of upper-airway obstruction in children,” Proc. Am. Thorac. Soc., vol. 5, no. 2, pp. 247–252, 2008.
15. V. C. Goessl, J. E. Curtiss, and S. G. Hofmann, “The effect of heart-rate-variability biofeedback training on stress and anxiety: A meta-analysis,” Psychol. Med., vol. 47, no. 15, pp. 2578–2586, 2017.
16. M. Tsakona, G. Georgiadis, E. Papadopoulou, et al., “Diaphragmatic breathing interventions for paediatric health: An umbrella review of systematic reviews,” Physiother. Theory Pract., vol. 41, no. 4, pp. 365–376, 2025.
17. M. Antonelli, C. Donohue, and J. Yee, “Integrating diaphragmatic breathing into school wellness programmes: A controlled pilot study,” J. Sch. Health, vol. 95, no. 2, pp. 102–110, 2025.
18. J. M. Milanesi, L. C. Berwig, L. H. Schuch, et al., “Nasal patency and otorhinolaryngologic-orofacial features in children,” Braz. J. Otorhinolaryngol., vol. 85, no. 1, pp. 83–91, 2019.
19. A. C. Melo, A. O. Gomes, A. S. Cavalcanti, and H. J. Silva, “Acoustic rhinometry in mouth-breathing patients: A systematic review,” Braz. J. Otorhinolaryngol., vol. 81, no. 2, pp. 212–218, 2015.
20. K. Alving, E. Weitzberg, and J. M. Lundberg, “Increased nitric oxide in exhaled air of asthmatics,” Eur. Respir. J., vol. 6, no. 9, pp. 1368–1370, 1993
21. L. Lin, T. Zhao, D. Qin, F. Hua, and H. He,
    “The impact of mouth breathing on dentofacial development: A concise review,”
    Frontiers in Public Health, vol. 10, Art. no. 929165, Sep. 2022, doi: 10.3389/fpubh.2022.929165.
22. D. Feștilă, C. D. Ciobotaru, T. Suciu, C. D. Olteanu, and M. Ghergie,
    “Oral breathing effects on malocclusions and mandibular posture: Complex consequences on dentofacial development in pediatric orthodontics,”
    Children, vol. 12, no. 1, p. 72, Jan. 2025, doi: 10.3390/children12010072.
23. E. E. M. Hassan, F. E. Abusaad, and B. A. Mohammed,
    “Effect of the Buteyko breathing technique on asthma severity control among school-age children,” Egypt J. Bronchol., vol. 16, art. no. 45, Jul. 2022, doi: 10.1186/s43168-022-00149-3
24. H. Khan, G. Hussain, R. Majeed, A. Shafiq, and M. Mustafa,
    “Comparison of patient satisfaction and quality of life to Buteyko versus diaphragmatic breathing technique in patients with asthma,”
    J. Health Rehabil. Res., vol. 4, no. 2, pp. 1311–1317, Jun. 2024, doi: 10.61919/jhrr.v4i2.680.
25. T. G. K. Bentley, C. Seeber, E. Hightower, B. Mackenzie, R. Wilson, A. Velazquez, A. Cheng, N. N. Arce, and K. A. Lorenz,
    “Slow‑Breathing Curriculum for Stress Reduction in High School Students: Lessons Learned From a Feasibility Pilot,”
    Frontiers in Rehabilitation Sciences, vol. 3, art. 864079, Jul. 2022, doi: 10.3389/fresc.2022.864079
26. W. U. M. in Inhalation of nasally derived nitric oxide modulates pulmonary function in humans, PubMed, 1996. Available: https://pubmed.ncbi.nlm.nih.gov/8971255/
27. U. P. Singh,
    “Evidence‑based role of hypercapnia and exhalation phase in vagus nerve stimulation: Insights into hypercapnic yoga breathing exercises,” J. Yoga Phys. Ther., vol. 7, no. 3, art. no. 276, 2017, doi: 10.4172/2157‑7595.1000276.
28. S. Brescovici and R. Roithmann, “Modified Glatzel mirror test reproducibility in the evaluation of nasal patency,” Braz. J. Otorhinolaryngol., vol. 74, no. 2, pp. 215–222, 2008, doi: 10.1016/S1808-8694(15)31091-0.
29. C. De Loubens *et al.*, “A nomogram for assisting in diagnosing mouth breathing based on clinical tests including mirror and water retention tests,” PMCID: PMC11987270, 2010.
30. P. D. Wagner et al.,
    “Inhalation of nasally derived nitric oxide modulates pulmonary function in humans,”
    J. Appl. Physiol., vol. 81, no. 2, pp. 750–756, Aug. 1996, doi:10.1152/jappl.1996.81.2.750.