## 4 Discussion  
Meta-analysis from 2020 concluded that breathing exercises may have positive effects on quality of life, hyperventilation symptoms and lung function in adults with mild to moderate asthma [41]. The aim of the study was to investigate the effects of breathing exercises and a combination of breathing exercises and an aerobic program on changes in basic spirometry parameters in standardized diagnostics in patients with bronchial asthma in the presence of a clinical immunologist. Figure 4: Peak expiratory flow. Figure 5: Average flow between 25% and 75% of the FVC. The British Thoracic Society guideline on rehabilitation of adult pulmonary functions suggests that people with chronic respiratory disorders should undergo respiratory rehabilitation and points out that routine exercise in asthma patients is not recommended based on inadequate clinical evidence [42]. Asthmatics are often careful when they hear about exercises that cause bronchoconstriction [43; 44; 45; 46], which is why some of them prefer a sedentary lifestyle and try to avoid physical activity and prevent exacerbations [29; 30; 31; 32; 33; 34; 35; 36; 37; 38; 39; 40; 41; 42; 43; 44; 45; 46; 47]. Our results showed in experimental group 1 (breathing exercises) significant improvements in two parameters (FEV1 (20.67%) and FEV1/FVC (16.06%)); and in experimental group 2 (aerobic program and breathing exercises), we found significant improvements in up to four parameters of spirometry examination (FEV1 (27.37%); FEV1/FVC (15.32%); PEF (30.66%); FEF25-75 (58.99%)) compared to the control group. Both experimental programs showed more effective improvements than the control group. A closer comparison of the experimental groups showed higher percentage increments for EX2 compared to EX1. The combination of breathing exercises with an aerobic program appeared to be a more effective means of improvement at the level of spirometry examination than others. However, among CG, EX1 and EX2, there was no significant difference. The effectiveness of aerobic exercise as a supportive treatment for asthma has also been confirmed by [37], which concluded that aerobic training reduced bronchial hyperresponsiveness and serumproinflammatory cytokines, and improved quality of life and asthma exacerbation in patients with moderate or severe asthma. These results suggest that adding exercise as an adjunct therapy to pharmacological treatment could improve the main features of asthma. Meta-analyses [48] which summarized effect of exercise-based pulmonary rehabilitation on adults with asthma found no significant improvement (MD = 0.10, 95% CI: \(-\)0.08 to 0.29) in forced expiratory volume in 1 s. Nonetheless, improvements in forced vital capacity (MD = 0.23, 95% CI: 0.08 to 0.38) and peak expiratory flow (MD = 0.39, 95% CI: 0.21 to 0.57) were significant. Effectiveness of breathing exercise was the main objective of this study [49]. The outcome measurement tools that we used were the Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), pulmonary function test (PFT), and the patient observation chart. Results show that the breathing exercise group had a significantly higher average ACT score, overall AQLQ score, and subscale scores than the relaxation group (\(p<0.05\)). However, there was no significant difference between the groups in terms of PFT parameters and peak expiratory flow values (\(p>0.05\)). We concluded that breathing exercise improved asthma control and asthma-related quality of life in people with asthma, but it did not show a significant difference in PFT values. Meta-analysis [41] which summarized effect of breathing exercises for adults with asthma found in lung functions low evidence of effectiveness breathing programs. Forced expiratory volume in 1 s measured at up to three months was inconclusive, MD \(-\)0.10 L, (95% CI: \(-\)0.32 to 0.12; 4 studies, 252 participants, very low-certainty evidence).