Effects of Yoga on Bronchial Asthma

G.B.Gupta (Lecturer), G.C. Sepaha (Prof. and Head of Department), I. Menon (Post graduate student), S.K. Tiwari (Reader) Department of Medicine, J.N.M. Medical College, Raipur.

Yogic practices are very ancient and provide the practitioner with control over certain functions of the body including the autonomic nervous system. It is claimed that one can also control certain metabolic-endocrine processes so as to enter the state of superconsciousness. Though yoga is basically not a method of treating disease, one can find citations in literature advocating its curative and prophylactic values in certain diseases like hypertension, diabetes mellitus, bronchial asthma, peptic ulcer, etc.

Normally sensory perception of external episodes leads to emotional and mental responses. As a result there are hypothalamic-pituitary-autonomic-adrenal axis responses which are often times reflected in physiological changes manifested by sweating, tachycardia, palpitation, raised blood pressure, etc. and in some patients broncho constriction (possibly only in asthmatics). Yogic technique's can be used to bring about relaxation. Relaxation means non-perception and or non-responsiveness to external sensory inputs. By yogic techniques, if they bring about relaxation, the above mentioned physiochemical changes may be intercepted. Thus yoga helps in modifying the emotional and mental responses, mediated through the hypothalamic etc. axis, which may normalise disturbed homeostasis.

Recently a study was planned to observe the effects of some yogic practices (advocated for bronchial asthma) on ventilatory function tests and clinical features in cases of bronchial asthma.

Material and methods

Twenty seven cases of both sexes, 19 extrinsic and 8 intrinsic were divided into 3 groups:

  • Group I: Included 12 patients taking drugs only at the time of an attack.
  • Group II: Comprised of 11 patients controlled with bronchodilators and having recurrence on omission of drugs.
  • Group III: Consisted of 4 patients whose attacks were not controlled with adequate doses of bronchodilators.

All cases were trained in yogic practices by specialist yoga teachers at Raipur Yogavidyalaya for a period of 6 weeks after which they continued these practices in their homes. Yogic practices included jala neti kriya, kunjal kriya, vastra dhauti and pranayama. During yogic practices patients were not taking any medicines. Bronchodilators were given only at the time of acute attack.

Forced vital capacity (FVC), forced expiratory volume in one second (FEV), FEV1/FVC ratio, and maximum breathing capacity (MBC) were studied prior to, at weekly intervals during yogic practices and at the termination of the study on the 6th week. Expirograph curve was used to estimate these ventilatory function tests. Clinical assessment of improvement was done by arbitrary grading of relief in symptoms and signs before and after yogic practices.

Observation and discussion

Three cases discontinued the practices within one week, hence are excluded from further report. 90% (9 cases) of group I and 60% (6 cases) of group II did not get any attack of asthma during the program. They showed some symptomatic and ventilatory function improvement. These 15 patients showing improvement had a history of recurrent coryza with asthma. They had subsequent reduction in the frequency and duration of asthmatic attacks. Doses of drugs required to control these attacks were reduced by 30 to 40% at the end of the 6 week course of yogic practices. Patients described certain additional advantages like gain in stamina, capacity to concentrate, more desire to work and feeling at ease.

Similar benefits like subjective feelings of well-being, confidence and ability to accomplish modest but previously impossible tasks were reported in exercise programs by Nicholos et al, 1970. Significant physical and emotional benefits have also been reported in a swimming training program for asthmatics by Fitch et al, 1976.

Twenty nine percent (7 out of 24) cases had persistence of bronchospasm during the practice period for which bronchodilators had to be given. Two cases in group III didn't show any improvement and they went into status asthmaticus requiring hospital management.

Seventeen patients had extrinsic and seven patients had intrinsic type of asthma. No difference was detected in the degree of improvement in these two types of asthmatics.

Patients of group 1 showed 34.23% and 15% improvement in FEV1 and FVC values respectively at the end of the trial period. FEV1/FVC ratio changed from 64.33 to 67.33. Group II patients had 20% improvement in FVC and 9% improvement in FEV1 at the end of 6 weeks. Group III patients showed no significant improvement in VFT (ventilatory function test) during or at the end of the trial period.

Nicholos et al, 1970, also reported insignificant changes in pulmonary function tests of similar cases after the exercise program.

Cases belonging to group I included early cases with mild asthma and group II included later cases with moderate severity of asthma. These had some symptomatic and ventilatory function improvement with yogic practices. This suggests that yogic practices are generally beneficial only in the early cases with mild or moderate severity of the disease rather than in severe, persistent forms of asthma. To obtain maximum benefits from these practices, it is therefore advisable to start them at the earliest stage.

The precise way in which these yogic practices exert their effects are not known. Some of them possibly act by altering the reflex response of the vagus nerve. Amongst the 4 practices, kunjal kriya and vastra dhauti seem to have greater reflex effect on the respiratory system. Pranayama involves breath retention during which alteration in pco2 and pH occurs. This might be acting in one way or another. These yogic practices possibly exert some effects (which are not yet understood) on the hypothalamus.

Yogic techniques do not involve muscular exercises, neither do they cause increase in oxygen consumption. On the other hand, it is found that there is a fall of temperature. This may be enhanced by perspiration which commonly accompanies kunjal kriya. It is well known that reduced muscular activity, hypothermia, and decreased oxygen consumption lead to reduction in metabolic processes. Whether these could contribute towards some beneficial effects in asthma can only be decided by experimental designs. Amongst the 4 yogic practices, which one proves to be superior can only be said when studies on individual practices are conducted. Work on this is under progress in our department.

Two features observed in these patients deserve, mention. Firstly, those who performed yogic practices in groups were more benefited than those who did it alone. It seems that being in a group helps the patient to forget all his problems which are important psychological precipitating factors. A person gets some sort of psychological satisfaction when he knows that he is not the only one suffering, or there may be a sense of well being derived from mutual sympathy. Secondly, those who accepted yoga keenly and easily were benefited more than those who resisted and did not show much interest in it. Motivation, especially when senior physicians prescribe and encourage, has an indirect reassuring effect. Additional benefits dependent on placebo effects, easy acceptability, group therapy and religious beliefs, etc. of a psychological nature cannot be lost sight of.

Asthma is an episodic syndrome. To draw firm conclusions from a short range study of 6 to 12 weeks only, is not possible, especially considering the chances for spontaneous and natural remissions in early and moderate cases. Though spectacular improvement did not occur in any case, it is obvious that the yogic practices are useful in the early cases with mild to moderate severity of the disease. Persons chosen for yogic practices should have a high degree of motivation, easy acceptability and no other associated illness. As far as possible yogic practices should be done in a group, preferably by forming small clubs for asthmatics.

Benefits in the respiratory functions, additional symptomatic advantages like sense of well-being, comradeship of group therapy, and training for better exercise tolerance gives support to the idea that if these practices are done early and persistently, benefits may accrue. Whether a chronic disabling state can thereby be prevented cannot be said at present, but is a distinct possibility.

Summary

Ventilatory function test (VFT) in 27 cases of bronchial asthma was studied before, during and at the end of a 6 week course of yogic practices. 3 patients left the study. 62.5% of the patients showed some improvement in VFT and clinical features. These were cases of early disease with mild to moderate severity. Patients with severe and persistent asthma showed no improvement. No difference in the improvement was observed between extrinsic and intrinsic types.