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Slow-paced breathing to stimulate the cholinergic anti-inflammatory pathway in moderate COVID-19 pneumonia (RCT)

Single-center RCT (n=46 hospitalized adults with moderate COVID-19 pneumonia): 4 s inhale / 6 s exhale (~6 breaths/min), 20 min, 3×/day on top of standard care produced a significantly lower longitudinal IL-6 trajectory versus controls (small-to-medium effect; ITT p=0.040, per-protocol p=0.022) without SpO2 compromise.

Design

  • Population: hospitalized SARS-CoV-2 patients with moderate pneumonia (single German center)
  • Intervention: slow-paced breathing — 4 s inhale / 6 s exhale (~6 breaths/min), 20 min, 3×/day for up to 10 days vs usual care
  • Primary statistical endpoint: IL-6 trajectories in multilevel mixed models adjusting age, comorbidities, and COVID medication burden
  • Registry: DRKS00023971

Quantitative highlights (authors)

  • IL-6: group×time interaction favoring breathing arm (Cohen f² = 0.11, LR p = 0.040 ITT; f² = 0.15, p = 0.022 per-protocol)
  • Exploratory dose: authors report extra benefit when total daily practice exceeded ~45 minutes
  • Safety: mean SpO2 stable around 95% during sessions

Evidence hygiene

  • Acute illness inpatient context—do not extrapolate numeric IL-6 deltas to healthy office workers without new trials
  • Mechanism framing in the paper emphasizes vagally mediated cholinergic anti-inflammatory reflex hypotheses; read cytokine figures alongside standard COVID care evolution during 2021–2022

Distinct rows on this wiki

  • Wim Hof / hyperventilation bundle innate-immune work lives under hof-2018-breathing (PMID 24799686)
  • Cyclic sighing vs mindfulness remote trial under balban-2023-cyclic-sighing-cell-rep-med

Outcomes

  • immune-modulation
    Significantly lower IL-6 trajectory in slow-paced breathing group vs controls (Cohen f² 0.11, p=0.040 ITT).
  • C-Reactive Protein
    Authors modeled ln(CRP) and ln(TNF-α) alongside IL-6—inspect Figure 2 for parallel biomarker trajectories.
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