Pulmonary Function Tests in Patients of Bronchial Asthma - Yoga ...

Available online at www.ijpras.com“something” that transcends Physiology &Psychology 5 . Yoga is one such approach whichwas widely practiced in ancient India. Yogainvolves physical, mental, social, spiritual aspectof human existence 6 . Today in India as well asmany other countries there are many institutionsusing yoga as part of therapy for patients sufferingfrom a variety of diseases. Mear popularity of asystem however, can not be a measure of itsreliability. It was therefore felt the efficacy of theyogatherapy needs to be assessed by someobjective tests such as pulmonary function tests.Hence the study was undertaken to evaluate therole of yoga therapy in the treatment of bronchialasthma as an adjunct to the conventional drugtherapy.Materials & methods:A group of 30 patients of bronchial asthma wasselected from the OPD of Kabirbaug mathsamatha, Narayan peth, Pune-30Since age, sex, height & weight affect thepulmonary function tests following criteria wereused for selection of subject 7 .The selection criteria:1) The patients were chosen from the age groupof 30-40 years.2) Only male patients who were having history ofbronchial asthma since minimum four tomaximum six years, were selected. They wereon conventional drug therapy for the sameperiod.3) The heights of all the patients ranged from160-170 cm.4) The weights of all the patients ranged from 55-60 kgThe exclusion criteria:1) The patients who showed only seasonalattacks2) The patients who were hospitalised in the last5 years due to severe attacks of bronchialasthma which had required ventilator support.3) The patients who were having history of anyother major illness viz: hypertension, diabetesmellitus, heart disease etc.4) The patients who had history of smoking.The following pulmonary function tests wereperformed at the time of enrolment in the yogatherapy class. They were repeated again after 3months & 6 months of yoga therapy.i] Forced vital capacity [FVC]ii]Forced expiratopry volume1 [FEV1]iii] Forced expiratopry volume1/ Forced vitalcapacity% [FEV1/ FVC%]iv] Peak expiratory flow rate [PEFR]v] Maximum voluntary ventilation [MVV]All the above tests were done at the same time ofthe day i.e. between 7 to 8 a.m. to avoid diurnalvariation. The patients were advised to continuewith their conventional drug therapy. The resultsof pulmonary function tests before & after yogatherapy were compared & statistically analyzed.Patients used to perform yogasana for one hour aday. The yogic curriculum included prayersfollowed by chanting ‘om’, pranayama,meditation & different asanas i.e. differentphysical postures.The asanas performed in the yoga therapy classwere as follows.1] Suptaveerasana2] Suptabaddhakonasana3] Vipareetdandasana4] Merudandasana5] Kapotasana6] Sarvangasana7] Shavasana.Details about the Equipment:The instrument used for performing thepulmonary function tests was a computerisedspirometer ‘medispiror’. [ Recorders & MedicareSystems: 181/5, phase-1, industrial area,Chandigarh-160002] Specifications:Flow detection: Volume differential methodOverall accuracy: within+ 1%59

Available online at www.ijpras.comRange: 0-7 LitresFlow: 0-16 Litres/secPrinter type : thermalA] For Forced Capacity measurement:The subject is asked to sit comfortably in an erectposture in a chair. He was made to inhale asdeeply as possible & expire forcefully in themachine, with nose clip applied in its place. Thethree readings are taken at an interval of 5 minutes& the best record showing maximum efforts bythe subject is selected. FVC, FEV1, FEV1/FVC%, PEFR are recorded simultaneously.B] For Maximum Ventilatory Volume: Thesubjects were asked to breath in & out through themouthpiece as rapidly & as deeply as possible for12 seconds. After the test is complete the readingsof MVV is expressed in Litres / Minute. All themeasured values are at BTPS (Body Temperature& Pressure Saturated with water vapour).Results & Discussion:Table I: Showing mean & standard deviation of observations before & after 3 months & after 6months of YogatherapyParameters Before After 3 months After 6 monthsMean S.D. Mean S.D. Mean S.D.FVC (L) 2.51 0.23 2.57 0.19 2.74 0.36FEV1 (L) 1.52 0.15 1.57 0.17 1.80 031FEV1/ FVC % 60.20 2.21 60.85 3.77 63.46 3.98PEFR (L/Sec) 5.59 0.26 5.70 0.35 5.97 0.36MVV (L/Min) 85.99 2.79 88.02 6.72 91.03 5.69Table II: Showing results of paired‘t’ testBefore & After 3 SignificanceParameters months of yoga therapy‘t’ value p valueFVC (L) 1.31 >0.005 Not significantFEV1 (L) 1.56 >0.005 Not significantFEV1/ FVC % 1.23 >0.005 Not significantPEFR (L/Sec) 1.93 >0.005 Not significantMVV (L/Min) 1.80 >0.005 Not significantTable III: Showing results of paired‘t’ testBefore & After 6 SignificanceParameters months of yoga therapy‘t’ value p valueFVC (L) 2.89

Available online at www.ijpras.comDiscussion:Our results after 6 months of yoga therapy aresimilar to those of the work of the done byAnilkumar 8 et al, Nagendra & Nagarathna 9 , jainS.C. 10 et al. It may be due to similar techniquesof yoga therapy, similar number of patientsselected & severity of the diseases in patientsselected. Our results after 6 months ofyogatherpy are not similar to those of KhanamA.A 11 . et al, Tandan M.K 12 . et al, Bhole M.V 13 .Virendrasingh 14 et al. It may be due to thedifferent age groups, different asanas used,smaller number of sample size & higher severityof of the diseases in their studies as compared toour study. In our study the beneficial effects ofyoga therapy in patients of bronchial asthma areprobably through various mechanisms asfollows.In pranayama there is prolongedinspiration as well as expiration. This stretchesthe elastin & collagen fibres. Hence afterpranayama practice these fibres elongate to agreater extent there by increasing the complianceof the lungs 15 . The surface tension of the fluidlining of the inside walls of the alveoli tends tocollapse the alveoli. The surface tension isgreatly reduced by surfactant 16 . It is claimed thatthe lungs inflation near to the total lung capacitywhich occurs during pranayama is a majorPhysiological stimulus for release of surfactanthence increase in lung compliance 16 .Also it is observed that yoga practicesfor long periods cause decrease in oxygenconsumption per unit work & blood lactatelevels 17 . It indicates better oxygen delivery &improved oxygen utilization due to improvedcellular respiration. Hence there is decreaseddemand for oxygen. As shown by Nagendra &Nagarathna, yoga therapy acts by reducing theresponsiveness of the tracheo-bronchial tree 18 .As there is decreased responsiveness of thetracheo-bronchial tree there is less frequency ofattacks in patients of Bronchial asthma 11 .Asanas involved in yoga therapy aredifferent types of postures. Certain postures suchas inverted postures (e.g. Sarvangasana) facilitateexhalation. Because of weight of the abdominalcontents on the diaphgram & / or compression ofthe chest. Backward bending asanas (e.g.Kapotasana) facilitate inhalation because of thenature of the expansion of the chest. Certaintwisting asanas (e.g. Merudandasana) facilitateunilateral expansion of one side of the chest &concomittent compression of the other side. Alsoasanas with inverted postures (e.g.Sarvangasana) help in increased expulsion of themucus by postural drainage 19 . After regular yogapractices there is improvement in skeletal musclestrength including inspiratory, expiratorymuscles & abdominal muscles. So there isincrease in the results of the pulmonary functiontests 16,20 .Udupa K.N., has studied the excretionpattern of the neurohormons in the urine of thepatients of bronchial asthma in the yoga clinic.Amongst the neurohormons of urinary excretionof choline , adrenaline-noradrenaline & 17hydroxy corticosteroids were studied. Theyroughly indicate the turnover of Ach,catecholamines & cortisol respectively. It wasfound that with the clinical improvement in thepatients of bronchial asthma there was decreasedcholine content but increased adrenalinnoradrenaline& 17 hydroxy corticosteroidscontent of the urine. It was concluded from theobservations that yoga training given to thepatients are Physiological procedures withoutany drug which fully correct the Biochemicaldeficiencies & bring them towards normal levels.In earlier studies it was shown that yogatraining helps to establish parasympatheticdominance in people practicing yoga. While thestudy done by Gharote M.L. et al, indicated thatthere was increased tendency of the patients ofbronchial asthma towards sympatheticdominance after yoga therapy. According tothem it may be due to the different nature of theyoga techniques practiced. Also the effects ofyoga depend on the subjects chosen for the studybecause yoga is said to improve the functioningof the depressed system either sympathetic orparasympathetic. Thus yoga therapy helps torestore the autonomic balance throughstimulating effect on internal organs.It was also observed that there werecorresponding changes in the levels ofneurohormons of sympathetic & parasympatheticsystem. Antistress effect of yoga has beenalready demonstrated by many workers, showingincreased rate of appearance of alpha waves inEEG, indicating a relaxed wakeful state of body& mind during meditation. This points to yoga’sstabilizing effects on the nervous system. The61

Available online at www.ijpras.commeditation & Shavasana are clearly associatedwith reduced metabolic rate. According toNagendra & Nagarathna this deep physical &mental relaxation helps in decreasing theexcessive efferent vagal activity in patients ofBronchial asthma which is recognized as themediator of the psychosomatic mechanisms inasthma. Also because of the regular practice ofyoga the subjective feeling of well being helpedin improving compliance of the patients whichmade them to take their medicines regularly.That also helped in better control of the diseasein later half of the period. The variousmechanisms which might be working in yogatherapy are: stretching of elastin & collagenfibres, decreased surface tension, increasedcompliance of lungs, decreased oxygenconsumption, decreased responsiveness oftrachea-bronchial tree, postural advantage,improved skeletal muscle strength, increasedsecretion of corticosteroids, psychosomaticadvantages etc. All these effects resulted indecreased frequency of attacks of asthma,thereby decreased compromising of thepulmonary function tests over the period.Conclusion:It was concluded from the present study thatyoga has a beneficial effect on the patients ofbronchial asthma & hence yoga therapy can besuggested as an adjunct to the conventional drugtherapy for the patients of bronchial asthma.Yoga therapy may help to reduce the dosages ofthe drugs. This further study needs to beundertaken.Acknoledgement:Kabirbaug Mathsamstha, Narayan Peth, Pune-411030.“Cite this article”D. P. Pandit, S. M. Vaidya “Effect of Yogaon Pulmonary Function Tests in Patients ofBronchial Asthma” Int. J. of Pharm. Res. &All. Sci.2013; Volume 2, Issue 3,58-63References:1] Slonim N.B. & Hamilton H.RespiratoryPhysiology: 5 th ed, The CV Mosby company,Missouri; PN 2312] Harrisons Principles of Internal Medicine:14 th ed, Vol 2: Mc Graw Hill, Inc. HealthProfession Division3] Szentivany A.: The beta adrenergic theory ofthe autonomic abnormality in bronchial asthma,J. Asthma,1986;23:123-1374] Park K.: Textbook of Preventive & socialMedicine: 15 th ed, M/s Banarasidas Bhanot:125] Eberst R.N.: Jr. School of Health, (1984);54(3): 99-1096] Kuvalayanand swami: Yoga therapy, 1 st ed,Central health education bureau, Directorategeneral of health services, Ministry of health,Govt of India,New Delhi7] Cotes J. E.: ‘Lung Function: Assessment &Application’: 5 th ed, 1979; Blackwell ScientificPublication8] Anilkumar P.K., Gnankumari K. et.al:Immediate effects of pranayama in airwayobstruction: Lung India, 1985: III, No.2: 77-819] Nagendra H.R., Nagarathna R.: Yoga forbronchial asthma- A controlled study: BritishMedical journal, 19 th Oct 1985: vol291: [1077-1079]10] Jain S.C., Talukdar, B., Evaluation ofyogatherapy programme for patients of bronchialasthma, Singapore medical journal, 1993, 34[4];306-30811] Khanam Ayesha Akthar, Sachdeva Usha etal, study of pulmonary Autonomic functions ofasthma patients after yoga training: IndianJournal of Physiology & Pharmacology, 1996:40(4) : 318-32412] Tandon M. K., Adjunct treatment with yogachronic severe airway obstruction, Thorax, 1978;33:514-51713] Bhole M. V., Effects of yogic treatment onvarious lung functions of asthma patients: Apilot study; yogamimansa, Jan, !982: volXX,No.4:43-5014] Virendrsingh, Antoni Wisniewski,et al,Effect of yoga breathing exercises on airway62

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