Bronchial Asthma

Bronchial Asthma (Tamaka Swasa)

Bronchial asthma or Asthma is a chronic, long term inflammatory disease of the airways called bronchioles of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction and bronchospasm (inflammation)

According to the Ayurvedic philosphy, Asthma is considered as one of the Swas Roga and is characterized by the inflammation of the bronchial airways leading to increased mucus production. Allergic reactions are not considered as the prime triggers in ayurveda, infect prime factors are wrong food habits, mental strain and bad weather. Allergic factors are only secondary causes which precipitate the disease. In the preliminary stage of asthma the patient may complain of indigestion, constipation and tightness in the chest, later on manifests sneezing, coughing, and wheezing with respiratory distress.

The main Doshas involved in the pathogenesis of bronchial asthma are Vata and Kapha. The vitiated ‘Prana vayu’ combines with deranged ‘Kapha dosha’ in the lungs causing obstruction in the Respiratory passage. This results in obstructed breathing. This condition is known as ‘Swasa Roga’. It is classified into five types in ayurveda.

  • Maha-shwasa
  • Urdhva-shwasa
  • Chinna-shwasa
  • Tamak-shwasa
  • Kshudra-shwasa

Among these five types first three are severe conditions and are considered incurable. Tamak-shwasa is the condition which can be correlated with the Bronchial Asthma disease. In Ayurveda Tamaka Swasa is considered as Yapya means difficult to cure and the last one kshudra swasa is easily curable. More than 75% of the cases of respiratory problems belong to last two categories.

According to ayurveda, an individual’s body is composed of seven categories of tissue elements and the functions of the entire body are regulated by three factors called vata, pitta and kapha. These three factors taken together are called tri doshas. According to Ayurveda increased in kapha dosha in the stomach is the underlying cause of asthma. The imbalances of these doshas are mainly due to various reasons such as wrong diet and life style regimens, injudicious medication as well as psychic and disturbed mental state, leads to diseases. In order to transport nourishment from the intestines to the tissues and the excretion of waste products from these tissues to different exterior openings such as the rectum, the urinary bladder and sweat glands, there are millions of micro channels inside the body. These micro channels are called srotas. When the vitiated doshas get lodged in a particular organ, then causes obstruction to the srotas of that particular organ system and a disease may be manifested in that particular organ of the’ body, exhibits symptoms related to that particular pathogenesis.

Due to the vitiating factors first vata dosha gets vitiated and the kapha dosha starts accumulating. Accumulated kapha gets lodged in the pranavaha srotas (blockage in the respiratory systems) causes obstruction to the vitiated vata dosha, hence natural direction of the Vata is blocked and this blocked Vata dosha is reversely directed (Pratilom Vayu). Due to Vata dosha, dryness is increased and natural lubrication is gets decreased, causes breathing discomfort. Breathing becomes stressful and patient feels difficulty in natural process of breathing.

It is mainly a kapha syndrome, though differentiation of humoural types also exists. In other words, bronchial asthma can be from any of the three humours—vaata, pitta or kapha. Most often, the disease is kapha in nature.

Vaata type asthma, is characterised by dry cough and wheezing. Additional symptoms are thirst, dry mouth, dry skin, constipation, anxiety and craving for warm drinks. Attacks occurs more when vata kala is predominant—dawn and dusk.

Pitta type asthma is characterised by cough and wheezing with yellow phlegm. Other symptoms are fever, sweating, irritability and need for cool air. Attacks are at pitta predominant time—noon and midnight.

Kapha type asthma is characterised by cough and wheezing with abundant clear or white phlegm. The lungs are often congested producing a whistling sound called wheezings.

Attacks are at kapha predominant time—morning and evening.

Cause:

Ayurveda states that asthma is influenced by the following factors

a)Adi-bala-pravritta:- Defect in the spermatozoon or the ovum of the respective parents (Genetic inheritance)

  1. b) Dosha-bala-pravritta:- That which is originated due to improper diet, unhealthy habits,those which originates from the stomach or intestines.
  2. c) Kala-bala-pravritta:- This is a seasonal type, produced by the variation in the atmospheric temperature or humidity.
  3. d) Daiya-bala-parvritta:- This is a providential type. Brought about by malignant influence such as infection, allergens and emotional stress.
  4. e) Swabhava-bala-pravritta:- The natural type that which comes with old age.

Bronchial asthma is therefore caused by genetic factor, improper digestion and diet, environmental stress in the form of allergens and weather changes.Asthma is thought to be caused by a combination of genetic and environmental factors. Environmental factors include exposure to air pollution and allergens. Other potential triggers include medications such as aspirin and beta blockers.

Many environmental factors have been associated with asthma’s development and exacerbation including allergens, air pollution, and other environmental chemicals. Smoking during pregnancy and after delivery is associated with a greater risk of asthma-like symptoms. Low air quality from factors such as traffic pollution or high ozone levels has been associated with both asthma development and increased asthma severity.

There is an association between certain medicines use and asthma like the use of paracetamol a medicine for fever.

Asthma is associated with exposure to indoor allergens like dust mites, cockroaches, animal wastes etc.

Certain viral respiratory infections, such as rhinovirus may increase the risk of developing asthma when acquired as young children.

Family history of asthma is a risk factor for asthma on the genetic basis.

Symptoms: include episodes of wheezing, coughing, chest tightness, and shortness of breath. These episodes may occur a few times a day or a few times per week. Depending on the person they may become worse at night or with exercise.

Sputum may be produced from the lung by coughing but is often hard to bring up, to spit it out. During recovery from an attack, it may appear pus-like due to high levels of white blood cells called eosinophils.

Symptoms are usually worse at night and in the early morning or in response to exercise or cold air. Some people with asthma rarely experience symptoms, usually in response to triggers, whereas others may have marked and persistent symptoms.

So Symptoms of asthma include:

  • Wheezing
  • Coughing, especially early in the morning or at night
  • Chest tightness
  • Shortness of breath

Not all people who have asthma have these symptoms; on the other hand having these symptoms doesn’t always mean that you have asthma.

An acute asthma exacerbation is commonly referred to as an asthma attack. The classic symptoms are shortness of breath, wheezing, and chest tightness. The wheezing is most often when breathing out. While these are the primary symptoms of asthma, some people present primarily with coughing, and in severe cases, air motion may be significantly impaired such that no wheezing is heard. In children, chest pain is often present.

Signs which occur during an asthma attack include the use of accessory muscles of respiration (sternocleidomastoid and scalene muscles of the neck), there may be a paradoxical pulse (a pulse that is weaker during inhalation and stronger during exhalation), and over-inflation of the chest. A blue color of the skin and nails may occur from lack of oxygen.

Acute severe asthma, known as status Asthmatics, is an acute exacerbation of asthma that does not respond to standard treatments of bronchodilators and corticosteroids. Half of cases are due to infections with others caused by allergen, air pollution, or insufficient or inappropriate medication use.

Diagnosis:

There is currently no precise test for the diagnosis, which is typically based on the pattern of symptoms and response to therapy. A diagnosis of asthma should be suspected if there is a history of recurrent wheezing, coughing or difficulty breathing and these symptoms occur or worsen due to exercise, viral infections, allergens or air pollution. Spirometry is then used to confirm the diagnosis. In children under the age of six the diagnosis is more difficult as they are too young for spirometry.

Differential diagnosis

Many other conditions can cause symptoms similar to those of asthma like:

Allergic rhinitis and Sinusitis- like upper respiratory diseases especially in children, can mimic like asthma.

Due to any obstruction in the Airways like: foreign body aspiration, tracheal stenosis, laryngotracheomalacia, enlarged lymph nodes or neck masses can cause symptoms like asthma.

Bronchiactaesis and other viral infections may also produce wheezing.

Especially in adult’s conditions like COPD, congestive heart failure, airway masses, as well as drug-induced due to ACE inhibitors etc. should be considered.

 

Treatment

According to Ayurveda, the asthma of recent origin can be treated effectively but if it becomes chronic, it can only be managed. It is not the drug alone that can give relief from asthma but regulation of diet and the change of conceptual thinking can also play a great role. Along with proper medication and control over eating and living, asthmatics can get better and quick results.

There are two types of treatment available in ayurveda of asthma:

Panchakarma or sodhana chikitsa

Shamana or oral chikitsa

In the patient having long history of asthma and other complications are present, the panchakarma therapy of Ayurveda gives satisfactory results. In panchakarma chikitsa procedures done will be:

  • Vamana karma, induced vomiting with medicines like vacha, pipalli, madanaphala etc.
  • Virechana karma, induced purgations mild in nature with nimbaamrutaadi eranda taila etc.
  • Potali swedana with saindhava, haridra, lavana etc.
  • Abhyanga or massage particularly over the chest region with specially designed oils like saindhavadi taila, bhritsaindhavadi taila etc.
  • Dhoompana or dhoomnasya- inhaling medicated smoke prepared from herbs like haridra, ajmoda, kalaunji etc

Shamana chhikitsa: includes certain herbal prepared medications available in ayurveda,

  • Chitrak haritaki
  • Kanakaasava
  • Dashamoolarista
  • vasarista
  • Chyavanaprasha
  • Agastya rasaayana
  • Sitopalaadi choorna
  • Talisadi choorna
  • Pipplyasava
  • Apamarga kshara
  • Swaasakaasa chintaamanee rasa
  • Swaasa kuthaara rasa

Ayurvedic home remedies for asthma:

  • Only the use of pippali (Piper longum) powder along with pure honey and hot water, makes an attack of asthma subside.
  • Turmeric powder 3 grams twice a day with sugar followed by ingestion of hot milk .
  • During an acute attack of asthma, drink some hot water with the juice of one clove of garlic.
  • Juice of the whole plant of Solanum surattense (chote kateri)—5-10 ml with Trikatu choorna (equal parts of dried ginger, long pepper and black pepper)—2-3 gm twice a day.
  • Powder of Terminalia bellirica (Baheda)—3 to 6 grams with 4 to 6 grams honey twice a day.
  • Mustard oil (sarason taila) 10 ml with jaggery 10 gm empty stomach twice a day give good result.
  • Equal parts of root of Adhatoda vasica (adoosaa or vasa), Rhizome of turmeric ( haldi), Stem of Tinospora cordifolia (giloya), and the fruit of Solanum surattense (chote kateri). Prepare decoction from these about 20 ml. Take this decoction internally with one gram of powdered black pepper and pippali twice a day.
  • Inhale Smoke of leaf of Dhatura. This gives instant relief from the symptoms.

Yoga benefits asthmatics. The integral yoga approach to asthma includes correction of distorted posture and faulty breathing habits, methods for the expectoration of mucous, teaching a system of general muscle relaxation, techniques for the release of suppressed emotion and for reducing anxiety.

In yoga, the purpose of functional breathing exercise is to learn to engage both abdominal muscles and the diaphragm in breathing. The duration of exhalation should double the inhalation.

Asanas effective in asthmasuch as:

  • Suryanamaskaara
  • Shashankaasana
  • Pranamaasana
  • Sarvangaasana
  • Supta vajraasana
  • Ushtraasana
  • Matsyaaasana are helpful.

Pranaayaamas like Naadi-shodhana, Bhastrika, Kapaala-bhaati are beneficial.Shat karmas such as Vastradhauti, Shankha-prakshaalana, Jalaneti are considered therapeutic. Other yoga related aspects like yoga-nidra, antar-mouna, meditation and relaxation techniques are useful to remove the source of nervousness.

Avoidable things:

Curd, buttermilk, bananas, guavas and fried foods are to be avoided. All sour substances should be banned. Smoking—both active and passive, should be strictly prohibited.