Patients in this group will receive Alternate Nostril Breathing (ANB) along with standard pharmacological management as prescribed by the pulmonologist.

The breathing intervention will be performed for a duration of 4 weeks. Two sessions per week will be supervised by a physiotherapist, and five sessions per week will be performed at home. Each session will last 10-15 minutes, following a structured ANB protocol involving slow nasal inhalation and exhalation with brief breath holds.

A home exercise diary will be provided to ensure adherence and follow-up of breathing exercises performed at home.

Patients in this group will receive the Buteyko Breathing Technique (BBT) along with standard pharmacological management as prescribed by the pulmonologist. The intervention will be administered over a period of 4 weeks. Two sessions per week will be supervised by a physiotherapist, while five sessions per week will be carried out at home. Each session will last 10-15 minutes and will include controlled nasal breathing, relaxed exhalation, and breath holding (control pause) until the first sensation of air hunger.

A home diary will be provided to monitor compliance and ensure regular performance of breathing exercises at home.

Patients in this group will receive alternative nostril breathing technique along with standard pharmacological management.

A total 4 weeks protocol will be followed in which 2 seesions per week will be supervised by physiotherapist and 5 days at home.

Alternative nostril breathing will be performed in sitting position. The patient will be asked to place their right thumb to gently close their right nostril.

Inhale slowly for 4 sec deeply through left nostril and hold breath for 2-3 sec.

Release right nostril and use your right ring finger to close your left nostril.

Exhale slowly 6 sec and completely through right nostril.Inhale slowly 4 sec and deeply through right nostril.Then hold breath for 2-3 sec.

Patients will be asked to release the left nostril and use their right thumb to close their right nostril. Exhale slowly and completely through left nostril over 6 sec.Repeat the cycle.

Pharmacological management: Patient will receive medications as per prescribed by pulmonologist

Evaluation will be performed using the Control Pause test, defined as the duration (in seconds) a participant can comfortably hold their breath after a normal exhalation. The measurement will be recorded using a stopwatch.

Participants will be assessed in a seated position following normal tidal breathing, and breath-hold will be initiated after a normal exhalation without prior deep inspiration.

The Control Pause duration ranges from 0 seconds to the maximum voluntary breath-hold time.

Higher values indicate better breath control and improved respiratory function, whereas lower values indicate poorer respiratory status.

Evaluation will be performed using the Dyspnea-12 Questionnaire (D-12), a validated patient-reported outcome measure consisting of 12 items assessing both physical and affective components of breathlessness. The total score ranges from 0 to 36, with each item scored from 0 (none) to 3 (severe).

Higher scores indicate greater severity of dyspnea and worse symptom burden.

Evaluation will be performed using spirometry, conducted according to standard guidelines. The primary parameters assessed will include Forced Expiratory Volume in 1 second (FEV₁), Forced Vital Capacity (FVC), and FEV₁/FVC ratio. Values will be recorded in liters (L) and as percentage of predicted values (%) based on age, sex, height, and ethnicity.

Higher values of FEV₁ and FVC indicate better pulmonary function, while a higher FEV₁/FVC ratio indicates reduced airflow obstruction and improved respiratory status.

Evaluation will be performed using the Asthma Control Test (ACT), a validated patient-reported questionnaire consisting of 5 items assessing asthma symptoms and control over the past 4 weeks. Each item is scored on a 5-point scale (1-5), with a total score ranging from 5 to 25.

Higher scores indicate better asthma control, while lower scores indicate poorer control. A score of ≥20 suggests well-controlled asthma, whereas scores <20 indicate partially controlled or poorly controlled asthma.