Ayurvedic Perspective of Asthma 💨

“The inhale offers itself to the exhale, the exhale offers itself to the inhale.” Bhagavad Gita 4.29

A Western Perspective of Asthma:

Bronchial Asthma is a reversible, chronic inflammatory disease of the airways. It leads to recurrent episodes of wheezing, breathlessness tightness of chest and cough particularly at night or early morning. Asthma is a Greek word meaning “ noisy breathing that we first see Homer use in the Iliad when Ajax strikes Hector with a boulder in the chest. Hector collapses as he is “ gripped by asthma, vomiting, and blood.”  

Pathophysiology and clinical symptoms:

During an asthma attack, airflow to the lungs is obstructed by edema and congestion in the respiratory tracts, which in turn causes narrowing of the pathway resulting in a person’s inability to exhale the required volume of air. As a result, residual air gets trapped in the lungs, preventing fresh air from entering during inhalation. The bronchioles become inflamed and the mucus coating the airways thickens narrowing the airways further. Muscle cells around the airways may hypertrophy as well also causing the respiratory tracts to narrow. The diaphragm and intercostal muscles weaken, and the shoulder muscles, the abduction scapula muscle and the approximating scapula muscle and neck muscles stiffen. 

An asthma attack is characterized by symptoms such as non –productive cough, tightening in the chest, shortness of breath, wheezing, coughing fits, difficulty filling the lungs and expectorating mucus, rapid heart rate, and sweating. The end of the attack is often characterized by a productive cough with thick, stringy mucus. After an acute attack, inflammation may persist for weeks without symptoms. The severity of an attack may differ from one attack to the next, from person to person ,may be life threatening and could require immediate emergency medical attention. Chronic reoccurrences of asthma may result in permanent damage to the lungs caused by narrowing of the bronchi leading to poor cardiovascular endurance and general fatigue.

Types of Asthma

Acute asthma is sudden attack cause by an inflammation of the air sacs of the lungs, that further  causes the narrowing and contraction of the  bronchioles  causing a restriction of   airflow making breathing  difficult. 

Chronic asthma is characterized by frequent asthma attacks which required medical management to prevent and minimize acute attacks. 

Exercise-induced asthma is triggered by exercise and is characterized by coughing, wheezing, or difficulty breathing. . It is most common in children and young adults, occurring mostly while during exercising in cold, dry conditions. Intense symptoms usually last for 10 minutes after exercising and gradually subside over time whereas allergic asthma produces a long duration of airway activity. 

Cause of Asthma 

Asthma triggers may vary from person to person. The most common things in the environment that trigger asthma attacks are exercise, allergens, irritants, and viral infections. While those that have a parent or a sibling may be more likely to be affected by asthma, there is no one single cause of asthma, and there may be many contributing factors including:

Allergens: Pollen from trees, grass, indoor and outdoor mold, dander from the skin, hair, or feathers of animals, dust mites found in household dust cockroaches.

Irritants: Cold air and changes in weather, air pollutants, cigarette smoke, chemical fumes in household products and paint, odors from cooking, scented products, 

Diet: Dietary habits that include junk food, fast foods, foods such as shrimp, dried fruits, processed potatoes, beer and wine that may include sulfites, preservatives and additives, a diet with insufficient fruits, vegetables, fiber, minerals, and other nutrients. Gastro esophageal reflux disease may also worsen asthma symptoms, especially at night. 

Others: Medicines such as aspirin and beta-blockers. Other triggers may include crying, laughing hard, emotions such as fear or anger, physical exercise, menstrual cycle in some women and general stress. 

Facts About Asthma

• • According to the Centers for Disease Control, 1 in 13 people in the Unites States have asthma.  
• • About 24 million Americans have asthma. 17.71 million (7.4%) adults and 6.29 million (8.6%) children.  
• • From 2001 to 2011, the CDC says the number of Americans with asthma grew by 28 percent. 
• • Amongst children, asthma is the leading chronic disease. It is more common amongst women than men and 47 percent higher in African Americans than in whites. 
• • The annual cost of asthma is about $56 billion with hospital stays accounting for the majority of the direct costs. 

Modern Medicine and Asthma

While there is no medication that can fully cure asthma, there are two general classes of asthma medications: quick-relief and long-term control medications. Generally short-acting, inhaled bronchodilators and anti-inflammatories are used to relieve occasional mild asthma symptoms as they occur. Bronchodilators work by opening up or dilating constricted airways, while anti-inflammatories reduce inflammation. The strategy behind taking anti-inflammatories is to reduce the underlying inflammation of the airways so that the bronchi may become less hyper-reactive, making future attacks less likely. Such anti-inflammatory therapy, however, must regularly be taken to be effective. Anti-inflammatory medications function mainly by interfering with the activity and chemistry of immune cells, which cause the inflammation of the airways. Anti-inflammatory medications work by relaxing the muscles in the airways that constrict during a bronchospasm. Corticosteroids suppress the immune response. “Side effects of long-term use of oral corticosteroids include weakening of bones, cataracts, and clouding of the lens of the eye.”   

Ayurveda and Asthma

Ayurvedic Perspective of Asthma & Pathogenisis

Asthma is well documented in the ancient Ayurvedic texts. In Sanskrit, asthma is known as svasa roga. Svasa means “breathing in and out, ” and roga means “ disease.” According to the ancient Ayurvedic text, the Charak Samhita, there are five types of asthma: maha svasa, urdhva svasa, chinna svasa, tamaka svasa and ksudra svasa. Among these five types first three are not curable. ‘Tamak-shwas is controllable and is difficult to cure. The last one is curable.  

In the 17th chapter of the Charak Samhita, there is a detailed description of svasa and its five varieties. Included is an elaborate explanation of the etiological factors, pathogenesis, prodromal symptoms, and clinical manifestations as well as treatment of svasa. According to the Charaka Samhita, “There are several deadly diseases which can kill a patient. But none of these is as deadly as asthma and hiccup that can kill a patient instantaneously ”   The Charak Samhita goes on to describe the origin of svasa, “ Both of these diseases originate at the site of Pitta, (in the stomach) and are caused by  the simultaneous aggravation of Kapha and vayu. They adversely affect the cardiac region and all the tissue elements.”   Kledaka Kapha accumulates and moves to the lungs. Kapha is cold, heavy, slimy and unctuous in nature and Vata has dry, cold rough and mobile qualities. In the lungs, the two intermix and the mucous in the lungs becomes sticky and thick, adhering to the walls of the bronchi, causing narrowing of the bronchial tubes, leading to breathlessness or an asthmatic attack. The Charak Samhita notes, “ If vata predominantly associated with Kapha obstructs the channels of circulation, and circulates all over the body, then being obstructed (in the circulatory course), this aggravated vayu causes svasa.”   The text describes retrograde vata, “ moving in reverse pervades the channels of vital breath, afflicts the neck and head and stimulates phlegm to cause rhinitis.”  

In “Ashtanga Hrdayam”, the description of asthma is similar to that in the Charak Samhita. noting that Vata is obstructed in its movement by Kapha, spreading in all direction, vitiates the channels of Prana ( respiration), udaka ( water) and anna ( food), located in the chest and produces svasa, arising from the stomach.”  The prodromal symptoms are “ pain in the region of the heart and flanks, upward movement of prana (respiration), flatulence and splitting pain in the temples”  

Ayurvedic Perspective on the Etiological Causes of Asthma

The Charak Samhita describes etiological factors similar to those described from a modern perspective. While the environmental factors such as dust, smoke, the wind, cold weather are listed, most of the etiological factors described are due to lifestyle and dietary habits; exercise, walk beyond one’s capacity, vitiated metabolism, dryness in the body, improper food combining. Habitual intake of unhealthy foods, intake of food in excessive or deficient quantities, dense foods, pastries, certain types of meat, unboiled milk and curds and Kapha aggravating foods in general.

We cannot ignore the fundamental cause of disease according to Ayurveda. According to the Charak Samhita, all diseases have their origin in mind. All diseases are due to prajnaparadha (failure of the intellect). Disease begins when we forget our true nature as spirit. When we forget our true nature as spirit, we understand ourselves only as body and mind and become wrapped up in the dramas of the world and stories associated with it. Forgetting our true nature of spirit , our peace of mind and tranquility leads to emotional disturbances. The deficient and unwholesome conjunction of the senses with their objects (Asatmyendriyartha) also has its influence on prajnaparadha. 

Asthma and the Koshas

“Body, mind, and spirit are interconnected, interrelated and interpenetrating.” The Taittiriya Upanishad describes the five koshas. The first is the anamaya kosha, the physical body. The second is the pranaymaya kosha, the breath body. The third is the manomaya kosha, the mind. The fourth is the vijnanamaya kosha, the psyche and the fifth is the  anandamaykosha, the bliss body. Once we understand imbalances and health through the five kosha systems, it provides us with a model and a road map through the interrelationship between the body, mind, emotional, energetic, psycho-neuro-physiological, and belief system and of the processes of disease and healing. Not only does it provides a road map, but  a truly holistic view of health that is focused on all aspects of our being: the physical body, the mental and spiritual Once we bring these aspects into balance, we can truly experience profound healing and the full expression of our higher divine nature. 

Anamayakosha – The person with asthma has trouble breathing, and the breath becomes very shallow. The lungs tighten up, and the air sacs do not expand.

Pranamayakosha – Contrary to popular belief, an asthmatic’s main problem is not inhalation but exhalation. It is the entrapment of carbon dioxide in the lungs that leads to the asthmatic’s inability to breathe. During an asthmatic attack, the muscles encircling the smallest bronchial tubes in the lungs begin to constrict. This occurs as a result of emotional upset or exposure to allergenic substances in the blood or air. This tightening process constricts the neck of the air sacs and prevents air from escaping fully. When this happens, the natural reaction is fear, often bordering on panic, which only causes further spasms and tightening of the small bronchial muscles.  One of the major separations occurs in the energy. A person with Asthma cannot take in much prana. The flow of prana is restricted, and the exhalations are short. Both the Manipura located it the solar plexus and Anahata Chakras located at the heart center are affected. The Manipura chakra’s role is to absorb and assimilate prana from the sun. It gives us a sense of purpose, vitality, and self –motivation. Indications of the Manipura chakra being out of balance are low self-esteem, difficulty making decisions, and anger or control issue. 

Manomayakosha – Another major separation occurs in the emotional body. Fear, anger, and stress can cause an imbalance. Hypersensitivity, depression, and anger often occur in people with Asthma. The hypersensitivity in the lungs is also reflected in the personality of asthmatics. “Groen, a pioneer worker in the field, has described the personality “Core” of asthmatic patients as follows:

• 1. An “egocentric” personality
• 2. A tendency towards impulsive behavior
• 3. A diminished capacity for adaptation to unfavorable life situations
• 4. A tendency towards developing a dominating personality
• 5. A greater emotional hypersensitivity
• 6. A greater demand for love and affection
• 7. Stubbornness which may lead to conflict with the key members in the social environment
• 8. Strong reactions of jealousy and rivalry which make these patients somewhat unpopular
• 9. Refusal to solve interpersonal conflicts by “talking it over” or by adopting give-and-take policy
• 10. Disturbed psychosexual development and sexual inhibition” 

Vijnyanamayakosha and Anandamayakosha – It is difficult for an asthmatic person to become a witness or deeply rooted in the self because there is such a separation with the vital life force. 

Ayurvedic Interpretation of Symptoms

In Ayurveda, no two people are treated in the same way, so it is important to understand the different characteristics, which may manifest according to Vata type, Pitta type, and Kapha type symptoms. 

Vata Type Asthma presents itself with dryness and wheezing. Other symptoms may include thirst, dry mouth, dry skin, constipation, anxiety, and craving warm drinks. Vata type attacks occur during Vata times at dawn and dusk

Pitta Type Asthma: presents itself with coughing, wheezing, but with yellow phlegm. There may be fever, sweating, irritability and need for cold air. Attacks occur during the Pitta times of day, noon and midnight.

Kapha Type Asthma presents itself with coughing and wheezing with abundant white or clear phlegm or mucous. Instead of wheezing, there will be a railing sound produced by fluid in the lungs. Attacks occur during the Kapha time of day, morning and evening.

In summary, Ayurveda views asthma as a disease affecting a number of bodily systems characterized by the blockage of prana (life force) where it is difficult and in more severe cases, impossible to get air into the lungs.  The Ayurvedic theory holds it to be life-threatening. If prana cannot enter the body, the systems of the body cannot function, will provoke great fear, anxiety and may cause death. The main causative factors listed reflect a poor diet causing weakened digestion and the creation of ama in the body.  

Ayurvedic treatment of Asthma

The treatment for asthma in Ayurveda involves determining the doshic imbalance. The patient needs to be willing to be an active participant in the healing process, making lifestyle and dietary changes, eliminating the causative factors looking at emotional and mental factors, increasing immunity, disease resistance, and harmonious living. While Panchakarma is the main line of treatment of asthma to eliminate the impurities and cleanse the body, many individuals may not have enough energy nor be healthy enough for a panchakarma treatment so a palliative treatment would be indicated.

“Food to be avoided includes lassi, rice, sour fruits, ice, beer, cool drinks, egg, meat, fish, and groundnuts. Excess of food intake must be avoided. Care should be taken to avoid exposures to cold, smoke, dust, polluted environment, excessive exercise, excessive walking, daytime sleep and overindulgence in sex.”   

Treatment for Vata Type Asthma: a Vata pacifying diet with warming spices. Include the sour juices from lime or lemon to hydrate the tissues. Include tonic bronchodilators such as bala. Nervine tonics and sedatives to aid with anxiety along with relaxation practices and regular routines. 

Treatment for Pitta Type Asthma: a pitta pacifying diet along with cooling herbs such as coriander, Gotu Kola, and burdock, Vasa is particularly good for Pitta type asthma.

Treatment for Kapha Type Asthma: a Kapha-pacifying diet, avoiding mucous forming foods such as milk, cheese, and yogurt. The use of pungent spices such as pepper, ginger, cayenne, mustard is particularly good to include in the diet. A mustard or ginger paste can be applied to the chest. Ayurveda herbs for Kapha include stimulating bronchodilators such as ephedra, thyme, and vasa. An effective treatment includes a milk decoction with pippali taken daily can correct chronic asthma.

Important Chines herbs for this condition are ma huang and apricot seeds. A typical formula is Major Blue Dragon. Western herbs include thyme, sage, bayberry, and mullein. 

Dietary Supplements

Fish Oil: Omega-3 fatty acids found in cold water fish have been found to reduce inflammation in the airway of asthmatics and reduce asthmatic attacks.  

Enzymes: Studies have shown that a CoQ supplementation of 100 mg daily for 4 weeks has beneficial anti-oxidants and anti-inflammatory effect and improvement in airflow in asthmatic patients.   

Vitamins: Animal studies suggest that Vitamin B and Vitamin C supplementation may be associated with a 30% lower incidence of active bronchitis and wheezing.    

The Benefits of Yoga and Meditation for Asthma

Yoga improves strength, flexibility, and capacity of the lungs, the three necessary components of overall fitness. Yogic practices serve to expand awareness, giving insight into the cause and effect.  It has been shown in clinical trials with asthmatic patients, that yoga therapy improves lung function and reduces frequency of exacerbations It is ideal for people with exercise-induced asthma, in which more rigorous exercises cause asthma to flare. It emphasizes conscious breathing and includes relaxation. Yoga is taught along with pranayama, which emphasizes the awareness and control of breath. Pranayama develops respiratory capacity by moving and strengthening the diaphragm, increasing the lung air capacity, flexibility of lung tissue, pleura, and trachea.   

There are four primary objectives in Pranayama therapy for asthma: a stepwise reduction in breath frequency, attaining a 1:2 ratio between the duration of inspiration and expiration, a breath suspension at the end of inspiration that is twice as long as the expiration, and mental concentration on breathing.  

Meditation: Meditation has beneficial effects on personality, emotions, and the psyche. The practice of Yoga Nidra itself is a deeply relaxing practice which systematically relaxes the physical, mental, emotional and psychic bodies..  After a variety of gentle asanas to prepare the body for relaxation and meditation, the asthmatic person can learn to come to a place of peace and stillness.  

The beneficial effects of yoga on asthma are evidenced in research findings from the Yoga Institute in Bombay, India. The lung function of 70 Asthmatic patients was measured before and after three to six months of Yoga practice. At the end of the 6-month study, patients with mild asthma responded completely reporting no attacks in 6 months and were off bronchodilators. Those with moderate attacks reported a considerable reduction in the frequency and severity [of attacks], and their requirement of medicine had dropped considerably. Patients with severe asthma too reported a reduction in the severity of their attacks. Even though they could not withdraw completely from medication, almost 90% with acute attacks were able to discontinue steroid use.   

Also the following research findings from the Banaras Hind University indicate that the effects of yoga benefit asthma patients . A 25-year-old woman with a history of recurrent attacks of severe bronchial asthma for the last four years was put on a course of yogic practices as a trial measure. She appeared to be of strong will but also trying to adjust to her husband by suppressing her views. From her history, it became obvious that this suppressed emotional distress probably played an important role in causing attacks of bronchial asthma.

It was thought that the yoga would help her much in view if the fact that there was a hidden yet strong psychological conflict between herself and her husband in various matters of life. 

She was put on the usual eight yogic exercises and also on the breathing exercises daily. To their great satisfaction, the frequency of the attacks gradually became less and so did the requirement of medicines. Gradually in six months, her attacks were very few and lasted for a short period. Within a year her health improved considerably. In fact, it had been observed that if persons who are the likely or susceptible candidate for the development of asthma start practicing yoga from the very beginning, they could completely prevent the development of the disease. They noted that the effect of yogic exercises remains in the body only for 24 hours. Hence they have to be practiced regularly at least once a day. Further, it was noted that mere meditative type of yogic practice would not be of much value and so they recommended a Hatha Yoga type of practice of eight standard yogic postures and exercise of breath (Pranayama)   The postures recommended for bronchial asthma, as a result of this study are:  Shirshasana, Dhanurasana, Chakrasana, Sarvangasana, Matsyasana, Shalabhasana, Bhujangasana, Halasana, Paschimottanasana, Matsendrasana, Yogamudra, Mahamudra, Supta Vajrasana, and Padahastasana.  

Aromatherapy: While aromatherapy cannot cure asthma, it may relieve symptoms. Suitable essential oils include Eucalyptus radiata and Ravensare aromatic which not only have expectorant qualities but due to the presence of terpineol also anti-asthmatic effects. Best results are achieved by applying these essential oils to wet skin during or after a shower. For those whose asthma is attributed to nervous, allergic and spasmolytic reactions, a mixture of tarragon, mandarin and rosemary ( verbenone type) are recommended. This mixture can be inhaled using a diffusor or taken orally in a gelatin capsule. Depending on the personality of the asthmatic cypress, ylang ylang and Roman chamomile are other possibilities. For chronic asthma that combines with bronchitis, it is often advantageous to use stimulating oils such as oregano for strengthening the system. For acute attacks a mixture of these two essential oils is suitable: 1 milliliter Khella ( Ammi visnaga) and 2 milliliters creeping hyssop ( Hyssopus officinalis var. decumbens). Ten suppositories are made with 3 milliliters essential oil mixture in a 30 cocoa butter base. 

Conclusion: 

The conventional medical approach for treating asthma is predominantly symptom oriented and fairly useless with respect to the real cause of the illness. With an exclusive treatment of symptoms approach to asthma, more often than not, patients find themselves trapped in the vicious cycle of symptom relief and the negative side effects. Corticosteroids and other steroids, for example create a physical dependence. Successful treatment of asthma requires improvement in lifestyle and diet. The process of creating the optimal lifestyle is in and of itself not an easy feat, however as health improves it leads to a desire to remain and continue along such a harmonious path.

Notes

1. K, Saunders. “The origin of the word ‘ asthma.’” Thorax. Volume 48, Issue 6 (1993): 647.

2. Mel, Robin. A Physiological Handbook for Teachers of Yogasana. (Tucson, AZ: Fenestra Books, US, 2002), 372-373.

3. Sateesh Kumar Vemula, et al. “Asthma: Alternative Management Approaches, ”Asian Journal of Pharmaceutical and Clinical Research, Volume  4(1)(2011) 1-8. 

4. Ibid.

5. Mayo Clinic Staff, “Asthma Causes,” Mayoclinic August 30, 2016, accessed November 28, 2016, http://www.mayoclinic.org/diseases-conditions/asthma/basics/causes/con-20026992.

6. CDC. “Asthma.” May 3, 2016. Accessed December 9, 2016. http://www.cdc.gov/asthma/default.htm.

7. Ibid.

8. CDC. National Health Interview Survey (NHIS) data: 2011 lifetime and current asthma. Atlanta, GA: US Department of Health and Human Services, CDC: 2012. Available at http://www.cdc.gov/asthma/nhis/2011/data.htm.

9. CDC. “Asthma.” May 3, 2016. Accessed December 9, 2016. http://www.cdc.gov/asthma/default.htm.

10. Dr. Sayeed Ahmad “Bronchial Asthma..” Accessed December 8, 2016.   http://www.homeoint.org/site/ahmad/bronchialasthma.htm.

11. Dr. Ram Karan Sharma and Vaidya Bhagawan Dash, Caraka Samhitā (Chowkhamba Sanskrit Series Office, 2014) Vol. 4 chXVII 121.

12. Ibid.,118.

13. Ibid.,118.

14. Ibid.,128-129.

15. Ibid.,132.

16. Prof. K.R. Srikantha Murthy, Vāgbhatha’s Ashthāñga Hrrdayam (Chowkhamba Krishnadas Academy, 2013) Vol. 2 Chapter 4, 3-4a.

17. Ibid.,4b-5.a.

18. Bihar. “The Five Koshas.” Accessed December 9, 2016.  http://www.yogamag.net/archives/2008/dapr08/5kosh.shtml.

19. Kenneth R. Pellitier. Mind as Healer, Mind as Slayer: A Holistic Approach to Preventing Stress Disorders ( New York: Delta/Seymour Lawrence, 1992), 184-185.

20. K.N. Udupa and R. C. Prasad,Stress and Its Management by Yoga (Delhi: Motilal Banarsidass,1989)  233-234.

21. David Frawley, Ayurvedic Healing: A Comprehensive Guide (Twin Lakes, Wisc.: Lotus, 2000), 204-205.

22. K Sadhna et al.,”Holistic Approach To Managment Of Asthma.” International Journal of Research in Ayurveda & Pharmacy (2010): 367-83. 

23. Frawley, Ayurvedic Healing: A Comprehensive Guide,204-205.

24. J.P., Arm,  et al. “Effect of Dietary Supplementation with Fish Oil Lipids on Mild Asthma.” Thorax 43.2 (1988): 84–92. 

25. Suzy A. A.Comhair, et al.,“Coenzyme Q in Asthma.” American Journal of Respiratory and Critical Care Medicine 191.11 (2015): 1336–1338.

26. Sandra L. Tecklenburg et al., “Ascorbic acid supplementation attenuates exercise-induced bronchoconstriction in patients with asthma” Respiratory Medicine, Volume 101, Issue 8 (2007):1770 – 1778.

27. K Sadhna,”HOLISTIC APPROACH TO MANAGEMENT OF ASTHMA.” 367-83. 

28. S.R. Vedala, et al.,“Pulmonary Functions in Yogic and Sedentary Population.” International Journal of Yoga 7.2 (2014): 155–159. 

29. Edna Davidson, “Treatment of Asthma and Respiratory Ailments According to The Principles of Vijnana Yoga.” N.p., n.d. Web. 8 Dec. 2016.

30. K Sadhna,”HOLISTIC APPROACH TO MANAGEMENT OF ASTHMA.” 367-83.

31. Accessed December 9, 2016. http://www.arogyadham-seva.com/Editorials_PDF/Articles_Effects_of_Yoga_on_Asthma.pdf.

32. Udupa, Stress and Its Management by Yoga.,250.

33. Ibid.,367

34. Kurt Schnaubelt. Advanced Aromatherapy: The Science of Essential Oil Therapy(Rochester, VT: Healing Arts, 1998), 122-123.

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