Nearly 300 million people around the world are suffering in the clutches of the dreaded disease called asthma. Moreover, asthma claims nearly 2,50,000 lives per annum globally.
According to WHO data, 20 million Indians are affected with asthma including 4-19% school children. Apart from being a challenge for the health sector, asthma also poses an economic burden on the country including direct cost, indirect cost as well as hidden cost. Data reveals that 1/3rd of the country’s total health expenditure are claimed by asthma which means Rs1200 per patient per month. Further, this disease is also having a grave socio-economic impact. It is the 4th leading cause of School absenteeism (2.66 days/month) and of absence from work (1.65 days/month).
Still further, the co-morbidities associated with this disease invite much concern considerably affecting the quality of life. These include immediate co-morbidities namely Rhinitis, Rhino-conjunctivitis, Sinusitis and remote viz. Heart disease, Stroke, Osteoporosis and Cancer. Moreover, asthma can lead to serious respiratory complications like Pneumonia, Collapse of part or all of the lung, Respiratory failure and Status asthmaticus.
Conventional asthma management includes anti inflammatory and broncho-dilator drugs. The most commonly used Anti inflammatory drugs are Corticosteroids either in the form of Metered dose inhaler (MDI) or Pill/Tablet or liquid form while both short acting and long acting broncho dilators are being prescribed widely. However, the safety and dependency of these drugs is highly debated. The most important drawbacks of this management are the high costs which poses a huge burden on already dwindling economy of a nation like ours. Besides, this approach offers only cure of the symptoms with a high chance of recurrence whenever a provoking factor is encountered. Apart from this, drug reliance and harmful side-effects are the greatest threats. The use of Inhaled corticosteroids often present with local effects like Oral candidiasis or thrush, Dysphonia, Reflex cough or bronchospasm and systemic effects such as Poor Growth, Decreased Bone Density, Disseminated Infection, Easy Bruising, Cataracts and Glaucoma, Adrenal Gland Suppression. The bronchodilators are reported to be causing Nausea, Vomiting, Headaches, Nervousness, Restlessness, Insomnia and Tremor.
In such a scenario, Ayurveda has an immense role to play. As the very aim of this science states health promotion is the prime focus to prevent the diseases.
What causes Asthma?
Understanding of the clinical condition is the key to successful prevention and treatment; most importantly the causes and clinical manifestations. The identified causes of asthma can be grouped into two: Inducing factors which can initiate the disease pathogenesis in a hitherto healthy individual like Genetic factors, Exposure to allergens, Viral infections and provoking factors which precipitates an episode of asthma in a known case like Allergy (including food), Environment, Occupation, Infections such as URTI, Exercise, Psychological factors. Asthma is diagnosed by four major symptoms namely Cough, Wheezing, Chest tightness and Shortness of breath.
In the Ayurveda purview, asthma (swasa) manifests when the etiological factors like Environment, Diet, Trauma, Iatrogenic, etc. leads to vitiation of vata vitiating mainly the pranavaha srotas. Besides, indulging in diet which can cause an excessive accumulation of kapha will initiate a pathology in the mahastrotas i.e. amasaya (GIT) percolating into the pranavaha, udakavaha and annavaha srotas leading to swasa. Thus, the highlights of swasa management revolves around the understanding that:
- Main doshas involved are Kapha and Vata
- Aim is to prevent further pranavaha stroto vaigunya (derangement of Pranavaha strotas) by Vata
- To prevent Kapha sanchaya (accumulation of Kapha) at amasaya
Integrated Preventive Protocol
A three tier prevention protocol can be implemented as follows
- Primary prevention
- Secondary prevention
- Tertiary prevention
Primary prevention includes prevention of factors which can contribute to development of asthma in an individual. These factors can affect before as well as after the birth. Thus, the foremost requisite is to identify pre-conceptional genetic predisposition and planning the regime of the pregnant lady. Relation between asthma and genetics is well recognized.
Ayurveda states that excessive indulgence in kapha provoking diet and regimes during the gestational period can lead to kapha predominant diseases in the baby.
Swasa being one among them a pregnant lady should be educated to avoid such factors. Likewise she should keep away from stress and infections. Further, the lifestyle of an individual should be framed to minimize the inducing factors. Statistically, Asthma exhibits a high incidence in children which may be understood in terms of eveloping anatomical structures (Aparipakwa dhatu), fragility (Sukumara), poor endurance (Akleshasaha), lack of immunity (Asampoorna bala), and Kapha predominant stage of life (Kapha pradhana vayas). Thus, Neonatal care is a benchmark which involves mainly preventing viral infections and fibrotic changes in the lungs. This can be achieved by promoting breast feeding, diet planning, parental care and physical strength improvement. Breast feeding strengthens the immune system, lowers incidence of respiratory illness, protect from allergies, lymphocytes and macrophages. In next years of growth, diet planning is an essential area of management. The nutritional requirements of the child should be assessed and guidelines should be followed for well-balanced nutritious diet, keeping off junk foods. The focus should be laid to maintain a good digestive function. Physical support and psychological support through adequate parental care ensure a healthy growth. Physical strength improvement can be attained through physical exercises and rasayanas like Chyavanaprasa, Kooshmanda rasayana , Haritaki along with ghee. Environmental hygiene must be ensured to prevent infections by decreasing sources of indoor pollution like kitchen smoke, parental smoking, etc. Regular domestic cleaning and disinfection and fumigation (Dhoopana) using Guggulu, Musta, Usira, Madhuka, Kunduruka, Haridra, maricha etc yields good results.
Secondary prevention concentrates on the provoking factors and predisposing mechanisms. These may be physical or psychological factors. 90% of cases present with Atopic asthma which indicates the physical causes of asthma are mainly Allergens. The remaining 10% are due to infections or unfavorable physical environment. So the possible solutions are avoiding the allergen or to strengthen the body to combat the allergen effectively. Practically the later seems to be the most appropriate. This can be achieved by immunotherapy at a hospital. However it is not an economical choice for the high cost and demand for absence from work involved in this. A better option proposed by Ayurveda is adopting healthy routines- diurnal (Dinacharya) and seasonal (Ritucharya)- which supports the immunological development. These are the unique contribution of Ayurveda in the field of public health promotion. The observance of the following daily routines can yield great results in improvement of the health status of an individual.
|Dantadhavana||Twice daily; kaphahara kashaya drugs like khadira, karanja, nyagrodha etc.|
|Ushna, rooksha drugs like Carum carvi, Oscimum sanctum, Allium cepa etc.|
|Vyaayama||Breathing exercises, Yoga, Pranayama|
|Snaana||Hot water with Oscimum sanctum, Cinnamomum camphora|
Breathing exercises like: Hands in and out breathing, Hands stretch breathing, Head up and down breathing, Ankle stretch breathing, Sasankasana breathing, Dog breathing and Tiger breathing, Chair breathing
Yogasanas like: Ardhakatichakrasana, Padahastasana, Ardhachakrasana, Trikonasana, Parivritta trikonasana, Vajrasana, Sasankasana, Sasankasana, Ushtrasana, Gomukhasana, Paschimottanasana, Supta Vajrasana, Makarasana, Bhujangasana, Salabhasana, Dhanurasana, Soorya namaskara
Pranayama like: Kapalabhati, Nadisudhhi pranayama, Sooryanuloma pranayama, Ujjayi pranayama, Bhramari pranayama
Sectional breathing techniques like: Abdominal breathing, Clavicular breathing, Chest breathing, Full yogic breathing
Sensitization or Conditioning is also a useful technique especially in atopic asthma. This can be achieved by practicing jala neti, sutra neti, pratimarsha nasya daily. Vamana dhouthi may be practiced once in a week to purify GIT especially the amasaya.
Diet planning must be done considering the relation between ahaara and disease. Swasa originates at GIT (Amasaya samudbhava) pathology being primarily initiated due to an inadequate digestive functioning (Agnimandya). Thus, diet should be planned in a way to maintain a healthy digestion. The diet should predominantly include articles possessing Laghu, ushna, rooksha, deepana, Kapha–vata hara, and Vishahara properties. An equal importance holds for Ayurveda principles of dietetics (ahaara vidhi vidhanam).
|Food item||Pathya for Swasa|
|Cereals||Yava, Sali, Shashtika, Godhuma|
|Vegetables||Vartaka, Balamoolaka, Karvellaka,
Kooshmanda, Sighru, Onion, Spinach, Turnip, Beetroot
|Spices & Condiments||Lasuna, Ardraka, Haridra, Ela, Maricha, Kalasaka, Jeeraka|
|Fruits||Draksha, Bimbi, Jambeera, Matulunga, Papaya|
|Milk & Milk products||Aja ksheera, Aja sarpi, Takra, Puraana ghrita|
The active principle in Yava, Hordenine and its methyl ether are effective bronchodilators. Lasuna possess Antiasthmatic, immunomodulatory action. Ardraka is known for its Expectorant, anti inflammatory action. Haridra is Anti inflammatory, immunomodulator while Kala–saka is Anti histamine, anti inflammatory. Jeeraka possess bronchodilator action. Kooshmanda is protective against bronchospasmic effect of histamine in bronchial asthma; Shigru especially its kernels has an Anti asthmatic action. The active principle in onion, Quercetin possess Anti histamine and Antiasthmatic effects. Draksha is a rich source of Anti-oxidants and Vit C. Bimbi has Anti oxidant, Expectorant actions. Papaya has Anti oxidant, immunobooster, anti inflammatory properties.
Drinking water should always be consumed lukewarm. It should be processed with Lajjalu (mimosa pudica), Khadir (Acacia catechu), Jeeraka (Cuminum ciminum), etc.
Non-conducive articles possessing Guru, seeta, vishtambhi, vidahi properties like Matsya, Kanda, Sarshapa , Maasha , Anupamaamsa , Dadhi must be avoided. Also practices like Atyashana (excessive food consumption) and Virudhhahara (intake of incompatible foods) should be avoided.
The following articles must be included in daily diet:
- Tea with maricha (black pepper) and ardraka (ginger)
- Takra (buttermilk) processed with turmeric and curry leaves
- Chutney-curry leaves, ginger, pepper, onion
- Steam cake -yava
- Milk with turmeric powder and honey
Identifying the aggravating seasons can help to chart out an appropriate seasonal routine. Atopic asthma shows high incidence in spring and summers while Non–atopic in winter (82.3%) and monsoons (75.8%) *. Symptoms are seen to worsen early morning and night.
Thus Hemanta and varsha ritucharya must be strictly followed with adequate ritusodhana (seasonal purification) in vasanta and sarat.
Oil massage (Abhyanga) with vatahara taila like Mahanarayana must be practiced daily followed by bath in hot water (Ushnodaka snaana). Steaming (Swedana) and fumigation (Dhoomapana) is also effective. One should keep the body covered with warm clothing.
Ensure good digestive function using Agnideepana drugs like Panchakola choorna. Avoid exposure to cold, practice indoor fumigation (Dhoopana) with appropriate drugs.
Ritu sodhana: In Vasanta (Vamana) and Sarat Ritu (Virechana)
Sadvruttam also plays an important role here. The following guidelines must be obeyed:
- Avoid vegadharana (suppressing the natural urges) which will help to maintain a normal anuloma vata gati especially Kasa (Coughing), sakrt (defecation), mutra (micturition), udgara (belching), chardi (vomiting), trishna (thirst) vegas
- Early to bed, early to rise: this will ensure an effective digestive mechanism and also the physiological rhythm of the body including neuro endocrine functions.
- Avoid excessive exposure to sun (aatapa), dust (rajas), haze (tushaara), dry wind (parushaanila)
- Maintain personal hygiene and environmental hygiene
- Avoid tight dressing
- Avoid visiting crowded places
- Avoid negative emotions and attitude
- Maintain mental harmony
Mental health promotion
Asthma is known to be a psychosomatic diseases and the role of mind-body relation in disease has been highlighted in Ayurveda. Thus adequate care must be taken of the mental status of the patient. Stress management techniques must be advocated including Relaxation techniques, Meditation , Psycho-analysis and Counseling.
Tertiary prevention aims at the Co-morbidities and Complications. Higher risk of oro-dental pathologies has been identified in asthma due to decreased salivary protection against extrinsic and intrinsic acids .So adequate oral hygiene is essential. Patient should be advised to practice
- Dantadhaavana with Khadira, Karanja, Nyagrodha etc
- Gandoosha using Hot water
- Dhoomapana with Guggulu, Haridra , Madhuka , Yava+ghee, etc.
Last but not the least, rasayana therapy to strengthen the body tissues must be practiced according to Naimittika rasayana vidhi.
- Agastya rasayana
Bronchial asthma is a global concern now a days. Prevention rather than cure must be the focus of medical health care to reduce economic burden and improving QOL. This can be effectively achieved through Primary prevention , Secondary prevention-modulating the routines and Tertiary prevention- prevent complications. The expected outcome of this preventive protocol is reduction of economic burden due to asthma since this requires only training and education using easily accessible low cost drugs without any hospitalization. Also an appreciable improvement in QOL without side effects can be expected.
[Featured Image credit: Patient Care Technician]
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