EFFECT OF YOGA PRACTICE WITH AND WITHOUT VARMA THERAPY

ON SELECTED RISK FACTORS AMONG MIDDLE AGED ASTHMA MEN

 

 

R. Durairaji Ph.D. Scholar [Full Time],

Faculty of Yoga Sciences & Therapy,

Meenakshi Academy of Higher Education and Research

[Deemed to Be University]

No 12, Vembuliamman Kovil Street, West K.K Nagar

Chennai-78, Tamilnadu, India.

Email: kccdurai@yahoo.com

 

Dr. S.Murugesan, Associate Professor,

Faculty of Yoga Sciences & Therapy,

Meenakshi Academy of Higher Education and Research

[Deemed to Be University]

No 12, Vembuliamman Kovil Street, West K.K Nagar

Chennai-78, Tamilnadu, India.

Email: muruugeshyoga@gmail.com

ABSTRACT

Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICSs) represent the standard of care for the majority of patients. Combination ICS/long-acting beta2-agonists (LABA) inhalers are preferred for most adults who fail to achieve control with ICS therapy. Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma, but should only be prescribed by physicians with appropriate training in allergy. Regular monitoring of asthma control, adherence to therapy and inhaler technique are also essential components of asthma management. This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma.

Introduction

Asthma remains the most common chronic respiratory disease in Canada, affecting approximately 10% of the population [1]. Although asthma is often believed to be a disorder localized to the lungs, current evidence indi- cates that it may represent a component of systemic air- way disease involving the entire respiratory tract, and this is supported by the fact that asthma frequently coexists with other atopic disorders, particularly allergic rhinitis [2].

Despite significant improvements in the diagnosis and management of asthma over the past decade, as well as the availability of comprehensive and widely-accepted national and international clinical practice guidelines for the disease, asthma control in Canada remains sub Opti- mal. Results from the recent Reality of Asthma Control (TRAC) in Canada study suggest that over 50% of Cana- dians with asthma have uncontrolled disease [3]. Poor asthma control contributes to unnecessary morbidity, limitations to daily activities and impairments in overall quality of life [1].

This article provides an overview of diagnostic and therapeutic guideline recommendations from the Global Initiative for Asthma (GINA) and the Canadian Thor- acic Society and as well as a review of current literature related to the pathophysiology, diagnosis, and appropriate- ate treatment of asthma.

Definition

Asthma is defined as a chronic inflammatory disease of the airways. The chronic inflammation is associated with airway hyperresponsiveness (an exaggerated airway- narrowing response to triggers, such as allergens and exercise), that leads to recurrent symptoms such as wheezing, dyspnea (shortness of breath), chest tightness and coughing. Symptom episodes are generally asso- ciated with widespread, but variable, airflow obstruction within the lungs that is usually reversible either sponta- neously or with appropriate asthma treatment [4].The mediators and cytokines released during the early phase of an immune response to an inciting allergen, trigger a further inflammatory response (late-phase asth- matic response) that leads to further airway inflamma- tion and bronchial hyperreactivity [5].

Evidence suggests that there may be a genetic predis- position for the development of asthma. A number of chromosomal regions associated with asthma suscept- ibility have been identified, such as those related to the production of IgE antibodies, expression of airway hyperresponsiveness, and the production of inflamma- tory mediators. However, further study is required to determine specific genes involved in asthma as well as the gene-environment interactions that may lead to expression of the disease [4,5].

Diagnosis

The diagnosis of asthma involves a thorough medical history, physical examination, and objective assessments of lung function (spirometry preferred) to confirm the diagnosis (see Table 1). Bronchoprovocation challenge testing and assessing for markers of airway inflammation may also be helpful for diagnosing the disease, particularly when objective measurements of lung func- tion are normal despite the presence of asthma symp- toms [4,6,7].

Medical history

The diagnosis of asthma should be suspected in patients with recurrent cough, wheeze, chest tightness and short- ness of breath. Symptoms that are variable, occur upon exposure to allergens or irritants, that worsen at night, and that respond to appropriate asthma therapy are strongly suggestive of asthma [4,7]. Alternative causes of suspected asthma symptoms should be excluded, such as chronic obstructive pulmonary disease (COPD), bron- chitis, chronic sinusitis, gastroesophageal reflux disease, recurrent respiratory infections, and heart disease.

A positive family history of asthma or other atopic diseases and/or a personal history of atopic disorders, particularly allergic rhinitis, can also be helpful in identi- fying patients with asthma. During the history, it is also important to examine for possible triggers of asthma symptoms, such as dust mites, cockroaches, animal dan- der, moulds, pollens, exercise, and exposure to tobacco smoke or cold air. Exposure to agents encountered in the work environment can also cause asthma. If work- related asthma is suspected, details of work exposures and improvements in asthma symptoms during holidays should be explored. It is also important to assess comorbidities that can aggravate asthma symptoms, such as allergic rhinitis, sinusitis, obstructive sleep apnea and gastroesophageal reflux disease [7].

 

The diagnosis of asthma in young children is often more difficult since episodic wheezing and cough are common in this patient population and spirometry is unreliable in patients under 6 years of age. A useful method of confirming the diagnosis in young children is a trial of treatment with short-acting bronchodilators and inhaled corticosteroids (ICSs). Marked clinical improvement during treatment and deterioration upon cessation of therapy supports a diagnosis of asthma [4,8,9].

 

Physical examination

Given the variability of asthma symptoms, the physical examination of patients with suspected asthma is often unremarkable. Physical findings are usually only evident if the patient is symptomatic. Therefore, the absence of physical findings does not rule out a diagnosis of asthma. The most common abnormal physical finding is wheezing on auscultation, which confirms the presence of airflow limitation [4]. Physicians should also examine the upper respiratory tract and skin for signs of concur- rent atopic conditions such as allergic rhinitis or derma- titis [7].

 

Objective measurements of lung function

Spirometry is the preferred objective measure to assess for reversible airway obstruction (i.e., rapid improve- ment in lung function after inhalation of a rapid-acting bronchodilator) and to confirm a diagnosis of asthma. It is recommended for all patients over 6 years of age who are able to undergo lung function testing [4,6].

Spirometry must be performed according to proper protocols. It is commonly performed in pulmonary function laboratories, but can also be performed in pri- mary-care offices. During spirometry, the patient is instructed to take the deepest breath possible and then to exhale as hard and as fully as possible into the mouthpiece of the spirometer.

Spirometry measures the forced vital capacity (FVC, the maximum volume of air that can be exhaled) and the forced expiratory volume in 1 second (FEV1). The ratio of FEV1 to FVC provides a measure of airflow obstruction. A diagnosis of asthma is confirmed when there is: (1) an improvement in FEV1 of at least 12% and at least 200 mL 15–20 minutes after administration of an inhaled rapid-acting bronchodilator, or (2) an improvement in FEV1 of at least 20% and at least 200 mL after 2 weeks of treatment with an anti-inflamma- tory agent. In the general population, the FEV1/FVC ratio is usually greater than 0.80 (and possibly greater than 0.90 in children) and, therefore, any values less than these suggest airflow limitation and also support a diagnosis of asthma. Because of the variability of asthma symptoms, patients will not exhibit reversible airway obstruction at every visit. Therefore, to increase sensitive- ity, spirometry should be repeated, particularly when patients are symptomatic [6,7].

 

Peak expiratory flow (PEF) monitoring is an accepta- ble alternative when spirometry is not available, and can also be useful for diagnosing occupational asthma and/ or monitoring response to asthma treatments. PEF is usually measured in the morning and in the evening. A diurnal variation in PEF of more than 20% or an improvement of at least 60 L/min or at least 20% after inhalation of a rapid-acting bronchodilator suggests asthma [6]. Although simpler to perform than spirome- try, PEF is not as reliable. Therefore, as mentioned ear- lier, spirometry is the preferred method of documenting airflow limitation and confirming the diagnosis of asthma.

Challenge testing

When lung function tests are normal, but symptoms suggest asthma, measurements of airway responsiveness using direct airway challenges to inhaled bronchocon- strictor stimuli (e.g., methacholine or histamine) or indirect challenges with mannitol or exercise may help confirm a diagnosis of asthma.

Challenge testing should be conducted in accor- dance with strict protocols in a laboratory or other facility equipped to manage acute bronchospasms. Testing involves the patient inhaling increasing doses or concentrations of a stimulus until a given level of bronchoconstriction is achieved, typically a 20% fall in FEV1. An inhaled rapid-acting bronchodilator is then provided to reverse the obstruction. Test results are usually expressed as the dose or concentration of the provoking agent that causes the FEV1 to drop by 20% (the PD20 or PC20, respectively). For methacholine, a PC20 value less than 8 mg/mL is considered a positive result indicative of airway hyperreactivity, and sup- ports a diagnosis of asthma. However, positive chal- lenge tests are not specific to asthma and may occur with other conditions such as allergic rhinitis and COPD. Therefore, challenge testing may be most use- ful for ruling out asthma. A negative test result in a symptomatic patient not receiving anti-inflammatory therapy is highly sensitive for ruling out the disease [7].

Challenge testing is contraindicated in patients with FEV1 values less than 60-70% of the normal predicted value (since bronchoprovocation could cause significant bronchospasms), in patients with uncontrolled hyperten- sion or in those who recently experienced a stroke or myocardial infarct.

 

Non-invasive markers of airway inflammation

The measurement of inflammatory markers such as spu- tum eosinophilia (amount of eosinophils in the sputum) or levels of exhaled nitric oxide (a gaseous molecule produced by some cells during an inflammatory response) can also be useful for diagnosing asthma. Evi- dence suggests that exhaled nitric oxide levels may be better able to identify asthmatic patients than basic lung function testing, and may also be useful for monitoring patient response to asthma therapy [7]. Although these tests have been studied in the diagnosis and monitoring of asthma, they are not yet widely used in Canada. With further clinical evidence and use, these markers of air- way inflammation will likely become more commonly available.

Allergy skin testing

Allergy skin testing is also recommended to determine the allergic status of the patient and to identify possible asthma triggers. Testing is typically performed using the allergens relevant to the patient’s geographic region. Although allergen-specific IgE tests that provide an in vitro measure of a patient’s specific IgE levels against particular allergens have been suggested as an alterna- tive to skin tests, these tests are less sensitive and more expensive than skin tests [4,6].

 

Asanas for Asthma

1. Sukasana pose (Easy pose)

This relaxing and simple pose is great for asthma relief. It focuses on your breathing and improves the lung function. It will also relieve stress. It is the pose you use for meditation. It is advisable to do this asana in the morning and sit in this pose for as long as possible

 

How to do it: Begin by sitting down on the floor with your legs crossed. You should be comfortable. You can use a towel for extra support by rolling it up and keeping it under your tailbone, being you hands in front of your chest in prayer position. You can also keep your left palm on your belly and right on your heart. Now, close your eyes and take deep breaths. Pay attention to your breathing. DO this for about five minutes.

 

2. Dandasana (Staff pose)

Dandasana or the staff pose stretches your chest and improves your posture. The pose is known to treat asthma. It also strengthens your core and back muscles.

 

How to do it: Start by sitting down with your legs in from of you and your hands at your side. Keep your legs together by joining your feet and the inner side of your legs. Your spine should be straight. Now, breathe deeply and hold this position for about one minute. Make sure your legs are together.

 

 

1. Upavistha Konasana (Seated Wide Angle Pose)

 

The seated wide angle pose or upanvistha Konasanma opens up your chest and stretches your upper body. It will help you breathe better. It is advisable to perform this asana on an empty stomach in the morning. You can also do it in the evening but make sure you do it four to six hours after your last meal.

 

How to do it: Start by sitting down on the floor with your back against a wall. Your back and shoulders should touch the wall. Keep your hands at your side with your palms on the floor. Push your upper body upward by pressing down your palms. Now, spread your legs as wide apart as possible. You can use your hands to push your legs apart. Keep your hands in front of you and take a deep breath. Hold this position for about a minutes and then return to the original position.

 

1. Uttanasana (Forward bend pose)

Uttanasana or the forward bend pose is a calming pose. It will help your relieve stress and will calm you. It is also a natural treatment for asthma as it will open up your lungs.

 

How to do it: Begin by standing straight with your legs hip-width apart and your hands at your side. Now, bend forward from your hips. Hold the opposite elbow and let your body loose and hanging. Hold this position for about five deep breaths and then come back to the original position.

 

 

5. Baddhakonasana (Butterfly pose)

Baddhakonasana or the butterfly asana is another relaxing pose. It will stretch your body and give relief from asthma.

 

How to do it: Start by sitting down with the soles of your feet together. Hold the toes with both your hand flap your legs like butterfly wings. Hold your body slightly bent forward. Do this for five deep breaths and then return to the original position.

 

Pranayamas For Asthma

Pranayama Can Help Asthma Patients

While doing yoga your ‘nadis’ or energy channels of your body open up. These channels help in circulating energy to each part of your system. This leads to healing of the mind and body which improves your well-being. It can also reduce the chances of getting an asthma attack and help you do physical activities with ease. Yoga helps with cholesterol and the poses are easy to learn and can be practiced at any time of the day even if you are at home with the help on online Yoga sessions.

Nadi Shodhana, commonly known as anulom vilom clears up the blocked energy channels in your body and helps it heal. It also relaxes your mind and helps you sleep better. Kapal bhati is a popular pranayama which has many benefits like speeding up the metabolism, improving blood circulation, energising the nervous system, and promoting energy flow throughout the body. Bhastrika pranayama is done along with Kapal Bhati to cleanse the airways of the body. It involves deep breathing with forceful exhaling that builds strength in your lungs and increases your stamina. These can be helpful to safeguard an asthma patient’s health, and yoga can also help in controlling chronic diseases but consult with your doctor before adding them to your routine.

YOGA THERAPY FOR ASTHMA

Jala Neti-Yogic Cleansing of the Nasal Passage

The practice of nasal cleansing purifies the air sinuses, invigorates the brain, tones up the optic nerves and thus improves sight.

-Hathayogapradipika, II, 30.

Jala Neti

A handy yogic technique useful for irrigation of nasal passage and sinusoidal cavities to make it free of dirt, debris, potential disease agents (bacteria & viruses) and excess mucus. The ordinary nasal infections such as the polyp, adenoid growth, deformities of the septum and the most common of all troubles – the recurring nasal catarrh – are also all mostly preventable and could be easily avoided by a little timely care of this organ.

The amount of dust we inhale and the adulterated food and poisonous drinks we are daily swallowing, clogging throughout biophysical mechanism is unavoidable. The nasal passage accordingly suffers from dust accumulation and stuffing. Handkerchiefs cannot remove all the dust and mucus accumulated. When one sleeps on one side the refuse begins to encrust in the nare of the other side, which during the period remains blocked. The slightest variation in the usual amount of air inhaled, as a result of morbid accumulation in the nasal canal, impairs the natural freedom in breathing, and this, in turn, produces deleterious effects upon the composition and oxygen quality of blood cells and also circulation is disturbed. Thereby, causing functional disturbances in the circulatory, digestive, nervous and other systems. The cumulative effect is the lowering of the vital index.

“In all problem solving or in problem prevention, we must have strong commitment to higher goals. The Kriyas take help of natural agencies and elements and build self-reliance.”

Method–

It is non-injurious, non-irritating and absolutely simple. The beginners in yoga and for that matter, even the layman could practice this yoga nasal douche not only without any misgiving but with positive benefits. So, just when you wash your teeth and mouth, both in the morning and in the evening, do not forget to cleanse your nose.

Put a quarter teaspoon of salt into one glass of warm water. Stir until dissolved.

Cup palm. Pour this salted warm water in it and suck through one nostril while blocking other nostril with index finger.

Allow water to escape through nostrils or mouth. Repeat twice.

Use each palm alternatively for each nostril.

Blow nose of all water, discharging water through one nostril at a time.

LIMITATIONS– NASAL OBSTRUCTIONS, COLD

JalaNeti Benefits-

Nasal passage hygiene is maintained. Dirt and bacteria trapped with the mucus in the nostril is easily and safely cleared.

Bouts of allergies or rhinitis are reduced.

Effective tool which helps immensely in pacifying asthmatic symptoms making breathing easier.

Helps to prevent tinnitus and middle ear infections.

Reduces sinusitis and migraine attack frequency.

Thoroughly cleanses the upper respiratory tract. Common complaints such as sore throats, tonsils and dry coughs are reduced.

Cleanses the eyes ducts and vision is improved

Sense of smell is improved and aids digestion.

Cleanses the nervous system and clams the mind, helps relieve stress built-up.

When done regularly irritation and anger reduction is experienced.

Ancient yogis used this technique to improve upon their meditation.

One of the important shatkarma’s which play a vital role in purification of the body and have manifold, wondrous results and are held in high esteem by eminent yogis. Hatha Yoga Pradipika 2:23

So try out this simple, do it yourself-DIY shatkarma and enjoy every rejuvenating breathe of fresh air.

 

Varma for Asthma

Asthma is a chronic lung disease that makes breathing difficult for millions of people across the globe. It is a condition in which the lining of the airways become swollen or inflamed, making them sensitive to irritations and allergic reactions. People suffering from this problem often experience symptoms like periodic attacks or episodes of tightness in the chest, wheezing, breathlessness, and coughing. The challenging thing about asthma is that it cannot be cured, it can only be managed. Moreover, it is not age-bound, even a small child can show symptoms ofasthma. Inhalers and medicines are considered to be the best way to handle the problem at hand but apart from that, massaging some acupressure points can also help ease the symptoms. Pressing acupressure points are harmless healing option to asthma. Collarbone pressure points
You will find these pressure points below your collarbone on the outer side of your chest. These points are located three fingers-width below the collar bone. Press these points with your fingers for 3 to 4 minutes regularly.

 

Applying pressure here will help you get relief from chest congestion, emotional distress, breathing difficulties and coughing problems
The base of the thumb pressure point
This point is located near the base of the thumb. It is the sore fleshy area below your thumb. Place the thumb of your other hand at the centre of the sore area and press it gently. Hold this point for 5 minutes. Doing this regularly will help you get relief from coughing, swollen throat and shallow breathing.
The wrist pressure points
You can locate this pressure point on the wrist below the base of your thumb. Place the thumb of your other hand on the small groove on your wrist and hold it for 3 to 4 minutes. Repeat the same with the other hand. Applying pressure will help you in reducing lung problems, coughing and other symptoms of asthma.

The throat pressure point
This point is located just below your Adam’s apple. Place your index finger on the grove, located 3-4 inches below your Adam's apple and apply slight pressure on it. Hold this point for 5 minutes for relief. Do this regularly thrice a day for easy breathing.

Elbow pressure points
This pressure point can be easily found on the elbow joint. Pressing this point for 5 minutes every day will provide relief from breathing and wheezing problems.

Conclusion

This study revealed that all the psychological and asthma control variables evaluated are independent predicters of asthma QoL,but the main variables are anxiety, depression and patient related asthma upto 56% of patients with severe asthma have severe anxiety and 19% have depression . traditionally, asthma-practice guidelines have focused on optimizing lung function and the US FDA has required increases in lung function and reduction of exacerbation has primary outcomes in clinical trials of asthma therapeutics.

 

References:

 

1. Yoga Beats Asthma, by Stella Weller

 

2. Asthma for Common Men, by Dr. Vikram Vineyek

 

3. Bronchial Asthma and Respiratory Disorders and it Management through Yoga, by Shri Parma and Aggarwal

 

 

4. Basic concept of Varmalogy , by Dr. Shanmugam