Smog-Induced PneumoniaNCT07759583
Effects of Buteyko Breathing Versus Incentive Spirometry on Oxygen Saturation, Dyspnoea, Exercise Tolerance, and Sputum Clearance in Patients With Smog Induced Pneumonia
A study testing Buteyko Breathing Technique (BBT) and Incentive Spirometry (IS) in people with Smog-Induced Pneumonia and Pneumonia, run by Lahore University of Biological and Applied Sciences at 1 site in Pakistan.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 25 to 40 years
- Conditions the study is for
- Smog-Induced Pneumonia, Pneumonia
- What is being tested?
- Buteyko Breathing Technique (BBT) and Incentive Spirometry (IS)
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 62 participants
- Where
- 1 sitePakistan
- Study dates
- 1 May 2026to 15 Oct 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 25 to 40 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- 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 -
Who cannot join
- 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
- -
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Combined Military Hospital (CMH)
Lahore, Punjab Province
Shoaib Waqas, 03024552109, shoaib.waqas@ubad.edu.pk
About this study
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.
Read more
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.
Read the detailed description
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.
- Conditions
- Smog-Induced Pneumonia, Pneumonia
- Being tested
- Buteyko Breathing Technique (BBT), Incentive Spirometry (IS)
- Keywords
- Buteyko Breathing Technique, Incentive Spirometry, Oxygen saturation, Pulmonary Rehabilitation, Smog-induced Pneumonia
- Medical subject headings
- Pneumonia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
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.
| Study group | Role | What they receive |
|---|---|---|
| Buteyko Breathing Technique (BBT) | Experimental | Participants in this group will receive Buteyko Breathing Technique (BBT) along with standard medical care. The intervention aims to improve breathing control and respiratory efficiency in patients with pneumonia. The program includes nasal inhalation to promote nasal breathing instead of mouth breathing. Participants will practice reduced breathing volume to avoid hyperventilation and improve gas exchange. Controlled breathing rate will be used to maintain slow and regular breathing patterns. The intervention also includes breath-holding after exhalation to enhance breathing control. Patients will perform relaxed diaphragmatic breathing to reduce accessory muscle use. All exercises will be supervised by a trained physiotherapist to ensure safety and correct technique. Sessions will be conducted twice daily for 20-30 minutes. The intervention will continue for seven days or until hospital discharge. Receives: Other: Buteyko Breathing Technique (BBT) |
| Incentive Spirometry (IS) | Active comparator | Participants in this group will perform breathing exercises using an incentive spirometer along with standard medical care. The intervention aims to improve lung expansion and respiratory function in patients with pneumonia. Participants will perform slow maximal inhalation using the spirometer to encourage deep breathing and increase lung capacity. Each inhalation will be followed by breath holding for approximately 2-3 seconds to promote better air distribution in the lungs. After this, participants will perform controlled and slow exhalation. The exercise will be repeated several times to support lung expansion and airway clearance. The sessions will be conducted twice daily for 20-30 minutes, and participants will also perform 10 deep breaths every hour while awake. The intervention will continue for seven days or until hospital discharge. Receives: Device: Incentive Spirometry (IS) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Peripheral Oxygen Saturation (SpO₂)
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%.
Measured: Baseline (Day 0), Day 3, Week 2, and Week 4 follow-up.
Six-Minute Walk Distance (6MWD)
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.
Measured: Baseline (Day 0), Day 3, Week 2, and Week 4 follow-up.
Sputum Wet Weight
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.
Measured: Baseline (Day 0), Day 3, Week 2, and Week 4 follow-up.
Dyspnoea Severity Score (Modified Borg Dyspnoea Scale)
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.
Measured: Baseline (Day 0), Day 3, Week 2, and Week 4 follow-up.
Respiratory Symptom Severity Score (Breathlessness, Cough and Sputum Scale [BCSS])
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).
Measured: Baseline (Day 0), Day 3, Week 2, and Week 4 follow-up.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Aug 2026
- Study start1 May 2026
- Primary completion15 Aug 2026 (estimated)
- Study completion15 Oct 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Smog-Induced PneumoniaStudies of the same condition, open and under way.
- More trials run by Lahore University of Biological and Applied SciencesThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 62 participants (estimated)
Sponsor and investigators
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07759583
- Sponsor's protocol ID
- UBAS/ERB/26/04/025
- Status last verified
- Aug 2026
- First submitted
- 23 Jul 2026
- Last updated
- 12 Aug 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 12 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Buteyko Breathing Versus Incentive Spirometry on Oxygen Saturation, Dyspnoea, Exercise Tolerance, and Sputum Clearance in Patients With Smog Induced Pneumonia
- ClinicalTrials.gov ID
- NCT07759583
- Acronym / sponsor ID
- UBAS/ERB/26/04/025
- Conditions
- Smog-Induced Pneumonia, Pneumonia
- Keywords
- Buteyko Breathing Technique, Incentive Spirometry, Oxygen saturation, Pulmonary Rehabilitation, Smog-induced Pneumonia
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 62 participants (estimated)
- Lead sponsor
- Lahore University of Biological and Applied SciencesUniversity, hospital or other
- Study start
- 1 May 2026 (actual)
- Primary completion
- 15 Aug 2026 (estimated)
- Study completion
- 15 Oct 2026 (estimated)
- First posted
- 12 Aug 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
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.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Buteyko Breathing Technique (BBT) | Experimental | Other: Buteyko Breathing Technique (BBT)Participants in this group will receive Buteyko Breathing Technique (BBT) along with standard medical care. The intervention aims to improve breathing control and respiratory efficiency in patients with pneumonia. The program includes nasal inhalation to promote nasal breathing instead of mouth breathing. Participants will practice reduced breathing volume to avoid hyperventilation and improve gas exchange. Controlled breathing rate will be used to maintain slow and regular breathing patterns. The intervention also includes breath-holding after exhalation to enhance breathing control. Patients will perform relaxed diaphragmatic breathing to reduce accessory muscle use. All exercises will be supervised by a trained physiotherapist to ensure safety and correct technique. Sessions will be conducted twice daily for 20-30 minutes. The intervention will continue for seven days or until hospital discharge. |
| Incentive Spirometry (IS) | Active comparator | Device: Incentive Spirometry (IS)Participants in this group will perform breathing exercises using an incentive spirometer along with standard medical care. The intervention aims to improve lung expansion and respiratory function in patients with pneumonia. Participants will perform slow maximal inhalation using the spirometer to encourage deep breathing and increase lung capacity. Each inhalation will be followed by breath holding for approximately 2-3 seconds to promote better air distribution in the lungs. After this, participants will perform controlled and slow exhalation. The exercise will be repeated several times to support lung expansion and airway clearance. The sessions will be conducted twice daily for 20-30 minutes, and participants will also perform 10 deep breaths every hour while awake. The intervention will continue for seven days or until hospital discharge. |
Who may qualify
- Ages
- 25 to 40 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (1 listed)
- 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 -
Key exclusion criteria (2 listed)
- 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
- -
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Buteyko Breathing Technique (BBT)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. | Other | Buteyko Breathing Technique (BBT) |
| Incentive Spirometry (IS)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. | Device | Incentive Spirometry (IS) |
Primary outcome
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%.
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.
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.
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.
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).
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Aug 2026.
- Individual participant dataSharing planned: No
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Buteyko Breathing Technique (BBT) and Incentive Spirometry (IS) in people with Smog-Induced Pneumonia and Pneumonia, run by Lahore University of Biological and Applied Sciences at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 12 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Faizan Ahmad (03054741978, faizanxahmad21@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Peripheral Oxygen Saturation (SpO₂) (time frame: Baseline (Day 0), Day 3, Week 2, and Week 4 follow-up.). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Aug 2026.