BRONCHIAL ASTHMA ((Tamaka Swasa, Dama)
BRONCHIAL ASTHMA
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| Bronchial Asthma, दमा , सांस फूलना, तमक श्वास, |
- 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
Environmental
- Many environmental factors have been associated with asthmas' development and exacerbation, including allergens, air pollution, and other environmental chemicals. There are some substances that are known to cause asthma in exposed people and they are called asthmagens. Some common asthmagens include ammonia, latex, pesticides, solder and welding fumes, metal or wood dusts, spraying of isocyanate paint in vehicle repair, formaldehyde, glutaraldehyde, anhydrides, glues, dyes, metal working fluids, oil mists, molds.
- Smoking during pregnancy and after delivery is associated with a greater risk of asthma-like symptoms.
- Low air- quality from environmental factors such as traffic pollution or high ozone levels has been associated with both asthma development and increased asthma severity. Over half of cases in children in the United States occur in areas when air quality is low.
- Exposure to indoor volatile organic compounds may be a trigger for asthma; formaldehyde exposure, for example, has a positive association. Phthalates in certain types of PVC are associated with asthma in both children and adults. While exposure to pesticides is linked to the development of asthma, a cause and effect relationship has yet to be established. A meta analysis concluded gas stoves are a major risk factor for asthma, finding around one in eight cases in the U.S. could be attributed to these.
- The majority of the evidence does not support a causal role between paracetamol (acetaminophen) or antibiotic use and asthma. A 2014 systematic review found that the association between paracetamol use and asthma disappeared when respiratory infections were taken into account. Maternal psychological stress during pregnancy is a risk factor for the child to develop asthma.
- Asthma is associated with exposure to indoor allergens. Common indoor allergens include dust mites, cockroaches, animal dander (fragments of fur or feathers), and mold. Efforts to decrease dust mites have been found to be ineffective on symptoms in sensitized subjects.Weak evidence suggests that efforts to decrease mold by repairing buildings may help improve asthma symptoms in adults. Certain viral respiratory infections, such as respiratory syncytial virus and rhinovirus may increase the risk of developing asthma when acquired as young children. Certain other infections, however, may decrease the risk.
- Hygiene hypothesis
Use of antibiotics in early life has been linked to the development of asthma Also, delivery via caesarean section is associated with an increased risk (estimated at 20–80%) of asthma – this increased risk is attributed to the lack of healthy bacterial colonization that the newborn would have acquired from passage through the birth canal. There is a link between asthma and the degree of affluence which may be related to the hygiene hypothesis as less affluent individuals often have more exposure to bacteria and viruses.
Genetic
Family history is a risk factor for asthma, with many different genes being implicated. If one identical twin is affected, the probability of the other having the disease is approximately 25%. By the end of 2005, 25 genes had been associated with asthma in six or more separate populations, including GSTM1,IL10,CTLA,SPINK5-4,LTC45,IL4R AND ADAM33, among others. Many of these genes are related to the immune system or modulating inflammation. Even among this list of genes supported by highly replicated studies, results have not been consistent among all populations tested. In 2006 over 100 genes were associated with asthma in one genetic association study alone; more continue to be found.
Some genetic variants may only cause asthma when they are combined with specific environmental exposures. An example is a specific single nucleotide polymorphism in the CD14 region and exposure to endotoxin (a bacterial product). Endotoxin exposure can come from several environmental sources including tobacco smoke, dogs, and farms. Risk for asthma, then, is determined by both a person's genetics and the level of endotoxin exposure.
| Endotoxin levels | CC genotype | TT genotype |
|---|---|---|
| High exposure | Low risk | High risk |
| Low exposure | High risk | Low risk |
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| Atopic eczema |
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| Atrophic rhinitis |
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There is a correlation between obesity and the risk of asthma with both having increased in recent years. Several factors may be at play including decreased respiratory function due to a buildup of fat and the fact that adipose tissue leads to a pro-inflammatory state.
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| Obesity |
Beta blocker medications such as propranolol can trigger asthma in those who are susceptible. Cardioselective beta-blockers, however, appear safe in those with mild or moderate disease. Other medications that can cause problems in asthmatics are angiotensin-converting enzyme inhibitors, aspirin and NSAIDs. Use of acid suppressing medication (proton pump inhibitors and H2 blockers) during pregnancy is associated with an increased risk of asthma in the child.
- Recurring episodes of wheezing, coughing, chest tightness, shortness of breath.
- These may occur a few times a day or a few times per week. Depending on the person, asthma symptoms may become worse at night or with exercise.
- Sputum may be produced from the lung by coughing but is often hard to bring up.
- During recovery from an asthma attack (exacerbation), 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 react frequently and readily and experience persistent symptoms.
Home factors that can lead to exacerbation of asthma include dust, animal dander (especially cat and dog hair), cockroach allergens and mold. Perfumes are a common cause of acute attacks in women and children. Both viral and bacterial infections of the upper respiratory tract can worsen the disease. Psychological stress may worsen symptoms – it is thought that stress alters the immune system and thus increases the airway inflammatory response to allergens and irritants.
Asthma exacerbations in school‐aged children peak in autumn, shortly after children return to school. This might reflect a combination of factors, including poor treatment adherence, increased allergen and viral exposure, and altered immune tolerance. There is limited evidence to guide possible approaches to reducing autumn exacerbations, but while costly, seasonal omalizumab treatment from four to six weeks before school return may reduce autumn asthma exacerbations.
Asthma Obstruction of the lumen of the bronchiole by mucoid exudate, goblet cell metaplasia, epithelial basement membrane thickening and severe inflammation of bronchiole.
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| Diagram of Asthma |
Asthma is the result of chronic inflammation of the conducting zone of the airways (most especially the bronchi and bronchioles), which subsequently results in increased contractability of the surrounding smooth muscles. This among other factors leads to bouts of narrowing of the airway and the classic symptoms of wheezing. The narrowing is typically reversible with or without treatment.
Occasionally the airways themselves change. Typical changes in the airways include an increase in eosinophils and thickening of the lamina reticularis . Chronically the airways' smooth muscle may increase in size along with an increase in the numbers of mucous glands. Other cell types involved include T lymphocytes, macrophages and neutrophils, and neutrophils. There may also be involvement of other components of the immune system, including cytokines, chemokines, histamines, and leukotrienes among others.
- Sinusitis
- Obstructive sleep apnea
- Chest bilateral Rhonchi +++
- Weight - Overweight
- BMI -More than 30
- Pulse
- BP
Arterial blood gas test : A blood gas test measures the amount of oxygen and carbon dioxide in the blood. It may also be used to determine the pH of the blood, or how acidic it is. The test is commonly known as a blood gas analysis or arterial blood gas (ABG) test. Your red blood cells transport oxygen and carbon dioxide
* Skin testing - To find out type of allergy
There is currently no precise test for the diagnosis, which is typically based on the pattern of symptoms and response to therapy over time. Asthma may 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.
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Spirometry A lung function test. (to measure breathing capacity and how well you breathe. You will breathe into a device called a spirometer.) It is recommended to aid in diagnosis and management. It is the single best test for asthma. If the FEV1 measured by this technique improves more than 12% and increases by at least 200 milliliters following administration of a bronchodilator such as salbutamol, this is supportive of the diagnosis. It however may be normal in those with a history of mild asthma, not currently acting up. As caffeine is a bronchodilator in people with asthma, the use of caffeine before a lung function test may interfere with the results. A single -breath diffusing capacity can help differentiate asthma from COPD. It is reasonable to perform spirometry every one or two years to follow how well a person's asthma is controlled.
SPO2
- Asthma is often clinically classified according to the frequency of symptoms, forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate.
Other supportive evidence includes: a ≥20% difference in peak expiratory flow rate on at least three days in a week for at least two weeks, a ≥20% improvement of peak flow following treatment with either salbutamol, inhaled corticosteroids or prednisone, or a ≥20% decrease in peak flow following exposure to a trigger. Testing peak expiratory flow is more variable than spirometry, however, and thus not recommended for routine diagnosis. It may be useful for daily self-monitoring in those with moderate to severe disease and for checking the effectiveness of new medications. It may also be helpful in guiding treatment in those with acute exacerbations.
- Asthma is classified according to the frequency of symptoms, forced expiratory volume in one second (FEV1), and peak expiratory flow rate. (PEFR)
- It may also be classified as atopic or non-atopic, where atopy refers to a predisposition toward developing a type-1 hypersensitivity reaction reaction.
| Severity | Symptom frequency | Night-time symptoms | %FEV1 of predicted | FEV1 variability | SABA use |
|---|---|---|---|---|---|
| Intermittent | ≤2/week | ≤2/month | ≥80% | <20% | ≤2 days/week |
| Mild persistent | >2/week | 3–4/month | ≥80% | 20–30% | >2 days/week |
| Moderate persistent | Daily | >1/week | 60–80% | >30% | daily |
| Severe persistent | Continuously | Frequent (7/week) | <60% | >30% | ≥twice/day |
Asthma is clinically classified according to the frequency of symptoms, forced expiratory volume in one second (FEV1), and peak expiratory flow rate. Asthma may also be classified as atopic (extrinsic) or non-atopic (intrinsic), based on whether symptoms are precipitated by allergens (atopic) or not (non-atopic). While asthma is classified based on severity, at the moment there is no clear method for classifying different subgroups of asthma beyond this system. Finding ways to identify subgroups that respond well to different types of treatments is a current critical goal of asthma research.
Although asthma is a chronic obstructive condition, it is not considered as a part of chronic obstructive pulmonary disease, as this term refers specifically to combinations of disease that are irreversible such as bronchiectasis and emphysema. Unlike these diseases, the airway obstruction in asthma is usually reversible; however, if left untreated, the chronic inflammation from asthma can lead the lungs to become irreversibly obstructed due to airway remodeling. In contrast to emphysema, asthma affects the bronchi, not the alveoli. The combination of asthma with a component of irreversible airway obstruction has been termed the asthma-chronic obstructive disease (COPD) overlap syndrome (ACOS). Compared to other people with "pure" asthma or COPD, people with ACOS exhibit increased morbidity, mortality and possibly more comorbidities.
| Near-fatal | High PaCo2, or requiring mechanical ventilation, or both | |
|---|---|---|
| Life-threatening (any one of) | ||
| Clinical signs | Measurements | |
| Altered level of conciousness | Peak flow < 33% | |
| Exhaustion | Oxygen saturation < 92% | |
| Arrhythmia | PaO2 < 8 kPa | |
| Low blood pressure | "Normal" PaCO2 | |
| Cyanosis | ||
| Silent chest | ||
| Poor respiratory effort | ||
| Acute severe (any one of) | ||
| Peak flow 33–50% | ||
| Respiratory rate ≥ 25 breaths per minute | ||
| Heart rate ≥ 110 beats per minute | ||
| Unable to complete sentences in one breath | ||
| Moderate | Worsening symptoms | |
| Peak flow 50–80% best or predicted | ||
| No features of acute severe 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 occurring 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.
In a mild exacerbation the peak expiratory flow rate (PEFR) is ≥200 L/min, or ≥50% of the predicted best. Moderate is defined as between 80 and 200 L/min, or 25% and 50% of the predicted best, while severe is defined as ≤ 80 L/min, or ≤25% of the predicted best.
Acute severe asthma, previously known as status asthmaticus, 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.
Brittle asthma is a kind of asthma distinguishable by recurrent, severe attacks. Type 1 brittle asthma is a disease with wide peak flow variability, despite intense medication. Type 2 brittle asthma is background well-controlled asthma with sudden severe exacerbations.
Exercise-induced
Exercise can trigger bronchoconstriction both in people with or without asthma. It occurs in most people with asthma and up to 20% of people without asthma. Exercise-induced bronchoconstriction is common in professional athletes. The highest rates are among cyclists (up to 45%), swimmers, and cross-country skiers. While it may occur with any weather conditions, it is more common when it is dry and cold. Inhaled beta2-agonists do not appear to improve athletic performance among those without asthma, however, oral doses may improve endurance and strength.
Occupational
Asthma as a result of (or worsened by) workplace exposures is a commonly reported occupational disease. Many cases, however, are not reported or recognized as such. It is estimated that 5–25% of asthma cases in adults are work-related. A few hundred different agents have been implicated, with the most common being: isocyanates, grain and wood dust, colophony, soldering flux, latex, animals, and aldehydes. The employment associated with the highest risk of problems include: those who spray paint, bakers and those who process food, nurses, chemical workers, those who work with animals, welders, hairdressers and timber workers.
Aspirin-exacerbated respiratory disease
Alcohol may worsen asthmatic symptoms in up to a third of people.This may be even more common in some ethnic groups such as the Japanese and those with aspirin-exacerbated respiratory disease. Other studies have found improvement in asthmatic symptoms from alcohol.
Non-atopic asthma
Non-atopic asthma, also known as intrinsic or non-allergic, makes up between 10 and 33% of cases. There is negative skin test to common inhalant allergens. Often it starts later in life, and women are more commonly affected than men. Usual treatments may not work as well. The concept that "non-atopic" is synonymous with "non-allergic" is called into question by epidemiological data that the prevalence of asthma is closely related to the serum IgE level standardized for age and sex (P<0.0001), indicating that asthma is almost always associated with some sort of IgE-related reaction and therefore has an allergic basis, although not all the allergic stimuli that cause asthma appear to have been included in the battery of aeroallergens studied (the "missing antigen(s)" hypothesis). For example, an updated systematic review and meta-analysis of population-attributable risk (PAR) of Chlamydia pneumoniae biomarkers in chronic asthma found that the PAR for C. pneumoniae-specific IgE was 47%.
Infectious asthma
When queried, asthma patients may report that their first asthma symptoms began after an acute lower respiratory tract illness. This type of history has been labelled the "infectious asthma" (IA) syndrome, or as "asthma associated with infection" (AAWI) to distinguish infection-associated asthma initiation from the well known association of respiratory infections with asthma exacerbations. Reported prevalences of IA for adults range from around 40% in a primary care practice to 70% in a specialty practice treating mainly severe asthma patients. The true population prevalence of IA in adult-onset asthma is unknown because clinicians are not trained to elicit this type of history routinely, and recollection in child-onset asthma is challenging.
- Childhood
- Pulmonology
- Air pollution and allergens
- Long term
Many other conditions can cause symptoms similar to those of asthma. In children, symptoms may be due to other upper airway diseases such as allergic rhinitis and sinusitis, as well as other causes of airway obstruction including foreign body aspiration, tracheal stenosis, laryngotracheomalacia, vascular rings, enlarged lymph nodes or neck masses. Bronchiolitis and other viral infections may also produce wheezing. According to European Respiratory society, it may not be suitable to label wheezing preschool children with the term "asthma" because there is lack of clinical data on inflammation in airways. In adults, COPD, congestive heart failure, airway masses, as well as drug-induced coughing due to ACE inhibitors may cause similar symptoms. In both populations vocal cord disfunction may present similarly.
Chronic obstructive airway disease can coexist with asthma and can occur as a complication of chronic asthma. After the age of 65, most people with obstructive airway disease will have asthma and COPD. In this setting, COPD can be differentiated by increased airway neutrophils, abnormally increased wall thickness, and increased smooth muscle in the bronchi. However, this level of investigation is not performed due to COPD and asthma sharing similar principles of management: corticosteroids, long-acting beta-agonists, and smoking cessation. It closely resembles asthma in symptoms, is correlated with more exposure to cigarette smoke, an older age, less symptom reversibility after bronchodilator administration, and decreased likelihood of family history of atopy.
- Take light food at night.
- Keep room well ventilated
- Drink boiled water
- Mite-proof bedding may help stop Asthma attack
- Change the bed sheet frequently and reverse the bed sheet before sleeping at night.
- Taking bath in hot water with a few drops of Eucalyptus oil added to it. After a bath, external application of few drops of oil over forehead, nose and chest.
- Should not expose to cold wind or cold water
- Avoid taking head bath for few days
- Early to bed and early to rise keeps a man healthy wealthy and wise.
- Get out of bed, do not cough in sleeping position
- No stuff toys in room.
- Take an extra puff of aerosol inhaler
- Sip hot tea or beverage or sip a glass of warm water
- Coffee is good, it act as a bronchodilators
- Use natural preservatives such as salt, sugar and honey.
- Sleep in prone position : back facing the ceiling and stomach facing the floor.
- The Routine
- On waking up, a glass of warm water with half a teaspoon of honey.
- A half hour's walk
- Ayurvedic body massage with herbal oils
- A warm water bath followed by a steam inhalation using peppermint essential oil
- Two bowls of warm spinach and corn soup with ginger and black pepper for lunch.
- Black pepper and long pepper decoction with a teaspoon of pure honey after lunch
- Light yoga exercises in the evening, followed by a foot massage and a dip of your feet in warm water
- Steam inhalation and a chest massage with sesame oil and a pinch of rock salt.
- Two bowl of lentil soup for dinner.
- One teaspoon Triphala with warm water at bedtime.
- Dairy products : milk, curd, paneer, butter milk
- Rice, banana and Maida based foods (noodles, pasta, naan, bread, biscuit, rusk)
- Cold water or drinks.
- All kinds of melon, especially water melons.
- All kinds of fried foods.
- Heavy dinners
- All dry fruits, except almonds.
- Al sour foods including chili chutneys, achars, tomato ketchups etc.
- Alcohol.
- Spicy food
- Fruit with curd and dairy product
- Hot and cold food together such as ice cream with gulab jamun and cold coffee with hot wafers.
Benefits:
- It is the good yoga pose treating the symptoms of Asthma
- It helps to control the symptoms of Asthma
- Lion's breath releases the tension in your face and helps you blow off some steam. You can do it anytime during a yoga practice.
- Simhasana -Lion Pose- sitting pose, Vajrasana but body be 45 degrees, keep leg separated lean forward place palm on floor, look upwards, open mouth and forcefully exhale.
- Start on your knees than sit back into your heels.
- Spread your fingers out and press your palm into your knees.
- Take a deep breath in through your nose.
- Open your mouth, stretch out your tongue, open your eyes wide, and let your breath out through your mouth.
- Repeat a few times.
- Stretches hips, thighs and ankle, calms the mind, relieves stress and fatigue.
- Relaxes the neck muscles, back pains, and releases stress from the chest, face and mind.
- It is known as the 'best face exercise' as it increases blood flow to the face and reduces thin lines to the face.
- Helps to keep away from respiratory infections and halitosis.
- Keeps the eyes healthy by stimulating the nerves.
- Stimulates thyroid gland.
- Extension of spinal-cord releases tension and stress and improves blood supply.
- Open the mouth and stretch the tongue out towards the chin as far as you can and gaze at the center of the eyebrow for 30 seconds
- Breathe through the mouth. The strong stimulation during forceful exhalation helps in clearing carbon dioxide so that fresh air can enter the lungs.
- It is good for throat problems.
- The posture is dedicated to Matsya the fish. Incarnation of Vishnu, the source and maintainer of the universe and all things.
- Sit in a Padmasana
- Lie flat on the back with the legs on the floor.
- Exhale, arch the back by lifting the neck and the chest, take the head back and rest the crown on the floor. Drag the head further back by holding the crossed legs with hands and increase the back arch
- Now take the hands from the legs, bend the arms, hold the elbows, with the hands and rest the forearm on the floor behind the head.
- Stay in this position for 30 seconds while breathing deeply.
- Rest the back of the head on the floor, lie flat on the back, inhale then come up to Padmasana, release the legs and relax.
- Recross the legs the other way and repeat the pose for the same way. length of time.
- The stretched upper body allows unrestricted airflow, thus providing extra oxygen into the lungs.
- It expands the bronchial tubes to permit easier breathing. This is especially useful for asthma patients.
- The dorsal region is fully extended in this pose and the chest is well expanded. Breathing becomes fuller
Pranayama (Breathing Exercises)
- Sit in a comfortable meditative asana.
- Block your left nostril. and inhale through your right, which is partially open.
- Perform Moola Bandha and Jalandhar bandha with kumbhaka.
- Than close the right right and exhale through the left. nostril.which is partially open.
- Continue this manner inhale right and exhale left for 1-3 minutes.
- All the inhalations in Suryabhedi are from the right nostril and all the exhalations from the left nostril.
- In Suryabhedi the lungs are filled more slowly, steadily, and fuller than in Ujjayi.
- Repeat the Pranayama 3,5,7,9, times.
- When the nostril are partially open the respiration is pierced through, that is why this Pranayama is called Surya Bhedi Pranayama.
- When doing meditate on solar system and see the lustre.
- In summer Reduce the number of Surya Bhedi Pranayama.
- This Pranayama increases body heat.
- When you inhale solely through the right nostril you generate heat energy, which is sent out, through your body.
- It helps your immune system and reduces mucus thus beneficial in Asthma.
- This is beneficial in curing diseases caused by Vata and Kapha Doshas
- fGoodor worms, leprosy, contagious disease, indigestion and diseases of female.
- This Pranayama removes dullness and lethargy.
- This helps in Kundalini awakening, retards the process of aging and reduces weight.
- For increasing the activity of heart perform this Pranayama without Kumbhaka.. This should be done 20-30 times twice a day to reduce weight.
- Increases digestive power
- Soothes and invigorates the nerves
- Cleans the sinuses.
- Good for depression
- Asthma
- Excessive Sleepiness
- Hypothyroidism
- Obesity
- Syncope
- Never practice Surya Bhedi Pranayama after taking food.
- People suffering from heart disease.
- Person suffering from low BP will derive benefit but those with high BP or heart trouble, epilepsy should not hold their breath after inhalation (antara kumbha) whilst practicing this pranayama
- Bhastrika means a bellows used in a furnace. Here the air is forcibly drawn in and out as in a blacksmith's bellows. Hence the name. Rapid forceful breathing
- Take a fast vigorous breath and exhale fast and forcefully. One inhalation and one exhalation completes a cycle of Bhastrika. The sound made resembles air rushing through bellows.
- Complete at a stretch 10-12 cycles. Then take a slow deep breath.
- Sacred Vow : While inhaling in the process of doing Bhastrika we have to think that the divine powers are getting filled in us.
- Disease like cold, cough, allergy, asthma and respiratory are cured. Health is improved because of the fresh air provided to the body.
- Improves the lung capacity hence good for asthma.
- Disease of throat, tonsillitis are cured.
- Vata, pitta, kapha the three doshas get balanced. So blood is purified. This helps in the awakening of kundalini power.
- Bhastrika activates and invigorate the liver, spleen, pancreas and abdominal muscle
- Thus digestion is improved,
- The sinuses are drained,
- The eyes feel cool and one has a general sense of exhilaration.
- Improves low energy levels.
- Good for Thyroid Problems
- Improves lungs health
- Blood purifier
- Fat burner
- Neurological balance.
- Strengthens immunity
- Good for cold & Flu
- As a locomotive engine is stoked with coal to generate steam to pull the train, so Bhastrika generates Prana to activate the entire body.
- Too much stoking burns out the boiler of the engine, so also too long a practice of Bhastrika wears out the system as the breathing process is forceful.
- Person with a weak constitution and poor lung capacity should not attempt Bhastrika.
- Those suffering from ear or eye complaints (pus in the ear, detachment of the retina) should not attempt them either.
- If the nose starts to bleed or the ears to throb and ache, immediately stop Bhastrika..
- Bhastrika should not be done by pregnant women.
- Uncontrolled Hypertension or low BP
- Cardiovascular disease
- Major surgery.
- Glaucoma.
- Pitta constitution people, (Inner fire element dosha)
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| Boost your immunity with your breath |
Kapal - Forehead, and ; Bhati - means light, luster. Kapalbhati is also a -cleansing techniques. It is a milder form of Bhastrika Pranayama. So with this pranayama one becomes luminous and lustrous.. In Kapalbhati inhalation (Pooraka) is to be done with normal force but the expiration (Rechaka) has to be done with as much force as possible. In doing so, all abdominal area gets inward and outward movements.This pranayama can be done for five minutes. In between one can rest for a while.
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| Kapal Bhati |
- As it involves breathing in specific ways, some think it is a form of Pranayama. This is advanced breathing exercise should ideally be learned from an experienced teacher., as it is possible to become lightheaded if it is done incorrectly. Once mastered, this breath generates heat and clears the nasal passages.
- Sacred Vow :Think that we are throwing all diseases out, mental problems of anger, greed, ego, attachments are also getting cleared. Hence we feel peace.
- In this, you inhale passively and exhale actively and forcefully.
- Inhalation is slow but the exhalation is vigorous.
- There is a split second of retention after each exhalation.
- Face becomes lustrous and attractive. Diseases like asthma, respiratory troubles, allergies, sinus are cured. Disease of heart brain and lungs get cured.
- This relieves constipation. obesity, diabetes, acidity, and kidney problems.
- Organs in abdominal cavity viz intestine, prostrate and kidney, functions more efficiently and develop immunity towards disease.
- The sinuses are drained,
- The eyes feel cool and one has a general sense of exhilaration.
- The most effective for detoxifying the body and clearing the energy channels.
- Additionally, it is believed to increase one’s intuition.
- Kapal bhati generates Prana to activate the entire body.
- Those suffering from ear or eye complaints (pus in the ear, detachment of the retina) should not attempt them either.
- Kapalbhati should not be done by pregnant women.
- Uncontrolled Hypertension and low BP.
- Cardiovascular disease
- Major surgery
- Glaucoma.
- Pitta constitution people.(Inner fire element dosha)
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| Coming into Balance |
- To practice Nadi Shodhana, sit in a comfortable meditation position. Make a fist with your right hand, then partially re-extend your ring and little fingers. Lightly place the pad of the thumb on your nose just to the right and below the bridge; lightly place the pads of your ring and little fingers on the corresponding flesh on the left side of your nose. Gently pressing with the ring and little fingers to close the left nostril, exhale fully through the right. Then inhale fully through the right, close it with the thumb, release the left nostril, and exhale through it. Inhale through the left nostril, close it with the fingers, release the right nostril, and exhale through it. This completes one round of Nadi Shodhana.
- Sit comfortably in an erect position. Keep the head, neck and the spine straight.
- Rest the left hand on the left knee.
- Close the right nostril with the tip of right thumb.
- Now breath out slowly through the left nostril.
- Keeping the right nostril closed breathe in slowly and deeply through the left nostril.
- Now close the left nostril with ring finger and little finger of the right hand and slowly breathe out through the right nostril.
- Now keeping the right nostril still closed, breathe in through the right nostril.
- This completes one entire round of Anuloma - Viloma.
- Repeat the entire process
- Remember that breathing in and breathing out should be done very slowly without any noise
- a Exhale through the right nostril.
- b Inhale through the right nostril.
- c Exhale through the left nostril.
- d Inhale through the left nostril.
- e Exhale through the the right nostril
- f Inhale through the right nostril.
- g Exhale through the left nostril.
- h Inhale through the left nostril
- i Exhale through the right nostril
- j Inhale through the right nostril...and so on
- Anuloma -Vilom Pranayama cleanses all Nadis which makes the body lustrous and healthy. Diseases occurring due to the disturbances of Vata Dosha like Rheumatism, gout, disease pertaining to urinary and reproductive organs are cured.
- Disease like cold, cataract, sinus are cured.
- The three doshas assume proper proportion
- Blockages of the arteries are removed and blood circulation get improved. The practice of this Pranayama regularly for month together removes major blockages preventing the phenomenon of heart attack.
- Pathogenic cholesterol, triglycerides, H.D.L and L.D.L also get controlled making the arterial channels clean for effective and unimpeded flow of blood in the heart.
- Increases enthusiasm, fearlessness, thus improving positive approach to life.
- This Pranayama has the effect on cleansing the body and the mind and cures almost all the diseases.
- Infuses the body with oxygen
- Clears and releases toxins
- Reduces stress and anxiety
- Calms and rejuvenates the nervous system
- Helps to balance hormones
- Supports clear and balanced respiratory channels
- Helps to alleviate respiratory allergies that cause hay fever, sneezing, or wheezing
- Balances solar and lunar, masculine and feminine energies
- Fosters mental clarity and an alert mind
- Enhances the ability to concentrate
- Brings balance to the left and right hemispheres of the brain
- The blood receives a larger supply of oxygen in Nadi Sodhana than in normal breathing, so that one feels refreshed and the nerves are calmed and purified. The mind becomes still and lucid.
- Sacred Vow :The result of friction and churning of breath in ida and Pingla Nadis, there is awakening n Sushumna nadi. A divine light may rise upwards to the Sahasrara Chakra ; A feeling of divine light pervades the whole of the body. We feel that with the Mantra 'Om Brahma' the supreme power is filling us with divine energy. Anuloma-Vilom Pranayama done with this kind of divine feeling gives better results.
- Persons suffering from high blood pressure or heart trouble should never attempt to hold their breath (kumbhaka).They can practice Nadi Sodhana Pranayama without retention (kumbhaka) with beneficial effect.
- Person suffering from low blood pressure can do this pranayama with retention after inhalation (antara kumbhaka) only with beneficial effect.
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| Pranayama For Cough & Cold |
More than any technique, Ujjayi (also called Victorious Breath) is a clear demonstration of the connection between our breath and emotions.
- Ujjayi breath is really interesting because it acts to calm the sympathetic nervous system at the same time as it boosts your oxygen consumption. It is the primary breath used in vinyasa yoga because it is powerful enough to support a vigorous flow.
Ujjayi The prefix ud attached to verbs and nouns, means upwards or superiority in rank.It also means blowing or expanding. It conveys the sense of pre-eminence and power. Jaya means conquest, victory, triumph or success.Looked at from another view point it implies restraint or curbing. Ujjayi is the process in which the lungs are fully expanded and the chest puffed out like that of a proud conqueror.
- Sit in any meditative pose.
- Contract the muscles of the throat as much as possible. Perform Pooraka and do a sound like snoring.
- In this, we create a snore like sound in the throat as we inhale and exhale. Many use Ujjayi breathing during their asana practice.
- In this Pranayama partially close the back of your throat, which covers the windpipe so that as you inhale and exhale through your nose.
- The air passes through a narrow air passage in your throat, creating the sound made by your breath.
- Inhale air through both nostrils. On doing so the air should touch muscles of the contracted throat.
- Through constricted glottis, exhale through left nostril.
- In the later stage of practice, one can perform Jalandhar banda and Moola bandha simultaneously and exhale only through left nostril, and exhale only through left nostril..
- The chronic problems of cough, cold and bronchitis are cured. Tonsilitis, thyroid problem, insomnia, tensions,and high blood pressure.
- This pranayama gives sweet voice with regular practice cures lisping in children. Helps in Kundalini awakening. Any mantra can be chanted in mind.
- It is quite beneficial in enhancing memory.
- It infuses body and mind with fresh Prana which is the vital life force.
- Relief of sinus pressure.
- Diminish pain due to headache.
- Strengthening of digestive as well as nervous system.
- This pranayama aerates the lungs, removes phlegm, gives endurance, soothes the nerves and tones the entire system.
- Ujjayi without kumbhaka, done in a reclining position, is ideal for persons suffering from high blood pressure or coronary trouble
- This technique partially close the back of your throat, which covers the windpipe so that as you inIn hale and exhale through your nose.
- The air passes through a narrow air passage in your throat, creating the sound made by your breathing.
- It is good for the throat.
Bhramari is derived from the Sanskrit word 'Bhramar' ( भ्रमर )which means large black bee. While practicing Bhramari Pranayama, a bee like sound is produced and hence the name "Bhramari Pranayama".
- Inhale deeply :
- Breath in till the lungs are full of air
- Close your eyes with fingers
- Close your ears with the help of thumb
- Press the forehead with the index fingers lightly
- Then press the nose bridge with remaining fingers.
- Concentrate on Ajna Chakra, Close the mouth. Begin slowly, exhale making humming sound like a bee while reciting Om mentally.
- Exhale slowly with humming sound
- Feel vibration in head region
- Repeat 11-21 times
- Sacred Vow :Think that our individual consciousness is merging with the divine cosmic consciousness and divine blessings is descending on us and wisdom fills our entire being.
- With this Pranayama the mind becomes steady, mental tensions, agitation, high blood pressure, heart disease are affected for better.This is also useful in meditation.
- The humming sound in Bhramari Pranayama is helpful in cases of insomnia.
- This breathing technique is especially useful for those with hypertension.
- Calms and quiets the mind
- It provides relief to a person in case he is feeling hot or have a mild headache.
- Releases cerebral tension
- Stimulates the Pineal and pituitary glands, supporting their proper functioning
- Soothes the nerves
- Relieves stress and anxiety
- Dissipates anger
- Lowers blood pressure
- Bolsters the health of the throat
- Strengthens and improves the voice
- Supports the healing of bodily tissues
- Induces sound sleep
- It is quite beneficial for the people suffering from Alzheimer.
- Keep your lip gently closed throughout, inhale deeply
- Then hum as you exhale, extending the exhalation as long as possible
- Use your abdominal muscles to control the evenness of your breath on exhalation, repeat this three times
- It is good for respiratory problems.
- It is known as "Omkar Japa" means chanting of 'Om'. Udgeet Pranayama is a simple breathing exercise, should be practiced on daily basis like other recommended Pranayama. Meditate on sacred mantra om. The body and the universal cosmic body are filled with this mantra. Om is the divine energy. It is more beneficial to start asanas and Pranayama practices with om Japa. Breath in and out very slowly with Omkar Japa in mind. The breath is to be slow slow that inhalation and exhalation is to be limited to 1 minute. The breath should be felt deep inside. This state leads to concentration. Gayitri mantra can also be chanted in the same way.This way we can enjoy the state of Samadhi.
- Sit in a comfortable posture and keep your spine, neck and head straight with relaxed shoulders.
- Place your both hands and knees and keep your fingers in Gyana mudra.
- Take a deep inhale through your nose, till your diaphragms get filled with air completely.
- Then slowly exhale the breath from your nose during the exhalation chant the word 'OM'.
- While chanting the OM sound of O should be longer than M.
- Repeat it 3-5 times. Slowly you can increase the count.
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| Udgeet Pranayam |
- It improves memory power and concentration.
- It controls high blood pressure and the disorder of kidneys.
- It helps to improve problem related to sleep and bad dreams.
- Its good for acidity.
- It relieves tension, anger and anxiety.
- It calms the mind and brings stability.
- It improves the digestive system.
- It reduces falling of hair, premature graying and appearance of wrinkles and diminution of eye sight.
- Chanting breathing : Chanting of OUM mantra while breathing. Take a deep breath and simultaneously pronouncing OUM.
Exercise
- Playing bansuri (a musical instrument), mouth organ or blowing Shankha (Conch) or filling the air in a balloon.
- Filling air in air pillow with mouth daily before going to bed.
- Blowing the balloon by mouth
- Playing mouthorgan instrument.
- At first breath out slowly through slightly parted lips. Breathe in quietly through the nose, taking a short breath while allowing only the lower part of the chest to fill.
- Sitting erect on the side of bed, inhale deeply allowing the abdomen to expand against the small pillow or book, press the book or pillow firmly as you exhale. This helps elevate the diaphragm, improves aeration and encourages a cough to dislodge accumulated sputum.
- Lie down flat on your back and raise each leg alternately as you exhale. This improves the tone of abdominal muscle.
- Lying down on your back, place a book on the abdomen. Puff out the abdomen as far as possible while inhaling. As you exhale pull in the abdomen, bring the book as close as possible to the spinal column. This brings about synchronization of diaphragmatic and abdominal muscle with breathing.
Carry home messageWhen the breath wondersThe mind is also unsteadyBut when the breath is calmed,The mind too will be still, andThe aspirant achieve long lifeTherefore one should learnTo control the breath
Acupressure point
- Kapalbhati
- Kunjal Kriya (water purification) / Therapeutic vomiting
- Jal Neti (Nasal Cleansing)
- Linga mudra is formed by interlocking the palm but keeping the left thumb erect pointing upwards. This mudra can be done by reversing the hand too,
- The fire in the thumb is activated and is able to increase uninhibited.
- Asthma, bronchitis, T.B Pleurisy are cured.
- Hypothermia : Shivering and chills due to cold weather can be controlled.
- Discomfort experienced in air conditioned room is relieved by this mudra.
- Ailments caused by over production of mucus such as wet asthma cold sinusitis etc can be cured.
- Increased digestive powers and also melts excess of fat in the body. Give better results when performed together with Soorya Mudra- both 15 minutes each, one after the other.
- Difficulty in breathing can be relieved by this mudra.
- Congested nose can be relieved by this mudra immediately and one can get good sleep.
- Regulates the flow of menstrual cycle. Give better results when performed together with surya mudra.- both 15 minutes each , one after other.
- When naval center is shifted from the original place, comes back to its place by this mudra.
- Formation- Hold the left-hand palm facing outwards in front of the chest and bend fingers. Hook the right-hand fingers in the left-hand fingers. Exhale and pull both the hands in opposite directions without releasing the grip. Then inhale let go the tension. Repeat. Then place both the hands on the sternum. Now change the hand position with the right palm facing outward, repeat the steps.
- Effect-This Mudra activates the lungs.
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| Jalandhar Bandha |
Sit in any comfortable meditative Asana Padmasana, Sukhasana or Vajrasana. The head is bent forward so that chin is pressing the neck. Concentrate on Vishudha Chakra. This is performed with external breath retention, it should be held as long as the practitioner is able to retain the breath.
- Follow a disciplined life
- Get away from trigger
- Start your medications without waiting for the conditions to aggravate
- Always prefer your own bedspread
- Half an hour walk daily will reduce the effect of triggers.
- Immunomodulation the drug like pippali (piper longum), Haridra (Turmeric), Tulsi (Holy Basil), Neem, Guduchi (Tinospora cardifolia) have proved to correct deranged immune system when administered in a specific way.
- Manage the conditions i.e. if the room is locked for a long time, then open all the doors and windows of the rooms, keep the bedspread in the sun and room should be cleaned.
- Do not feel shy to explain your condition, while visiting friends or relatives. The guest always provided with fresh linen from the storage box. This is definite asthma causing a trigger.
- For food, you should be very specific and say “I take only this”. Mind you, your health is your personal asset and it should remain under your control.
- If alcohol acts as a trigger say no to it.
- Wall cleaning should be done routinely like monthly mopping
- No wall hanging and carpets, Bamboo mat is preferred.
- Install electronic chimney in the kitchen.
- Can have air filter inside room.
- Avoid air-conditioned theaters
- If obese than weight reduction.
- Decreasing risk factors such as tobacco smoke, air pollution, chemical irritants including perfume, and the number of lower respiratory infections.
- Other efforts that show promise include: limiting smoke exposure.
- Early pet exposure may be useful. Results from exposure to pets at other times are inconclusive and it is only recommended that pets be removed from the home if a person has allergic symptoms to said pet.
- It is not clear if annual influenza vaccinations affects the risk of exacerbations. Immunization, however, is recommended by the World Health Organization. Smoking bans are effective in decreasing exacerbations of asthma.
- Symptoms can be prevented by avoiding triggers, such as allergens and respiratory irritants.
- Take Asthma Medications as Prescribed.
- Identify Asthma Triggers. ...
- Stay Away From Allergens. ...
- Avoid Smoke of Any Type. ...
- Prevent Colds. ...
- Allergy-Proof Your Home. ...
- Get Your Vaccinations. ...
- Consider Immunotherapy Allergy Shots. ...
While there is no cure for asthma, symptoms can typically be improved. The most effective treatment for asthma is identifying triggers, such as cigarette smoke, pets or other allergens, and eliminating exposure to them. If trigger avoidance is insufficient, the use of medication is recommended. Pharmaceutical drugs are selected based on, among other things, the severity of illness and the frequency of symptoms. Specific medications for asthma are broadly classified into fast-acting and long-acting categories. The medications listed below have demonstrated efficacy in improving asthma symptoms, however "real world" use-effectiveness is limited as around half of people with asthma worldwide remain sub-optimally controlled, even when treated. People with asthma may remain sub-optimally controlled either because optimum doses of asthma medications do not work (called "refractory" asthma) or because individuals are either unable (e.g. inability to afford treatment, poor inhaler technique) or unwilling (e.g., wish to avoid side effects of corticosteroids) to take optimum doses of prescribed asthma medications (called "difficult to treat" asthma). In practice, it is not possible to distinguish "refractory" from "difficult to treat" categories for patients who have never taken optimum doses of asthma medications. A related issue is that the asthma efficacy trials upon which the pharmacological treatment guidelines are based have systematically excluded the majority of people with asthma. For example, asthma efficacy treatment trials always exclude otherwise eligible people who smoke, and smoking blunts the efficacy of inhaled corticosteroids, the mainstay of asthma control management.
Bronchodilators are recommended for short-term relief of symptoms. In those with occasional attacks, no other medication is needed. If mild persistent disease is present (more than two attacks a week), low-dose inhaled corticosteroids or alternatively, a leukotriene antagonist or a mast cell stabilizer by mouth is recommended. For those who have daily attacks, a higher dose of inhaled corticosteroids is used. In a moderate or severe exacerbation, corticosteroids by mouth are added to these treatments.
People with asthma have higher rates of anxiety, psychological stress, and depression. This is associated with poorer asthma control. Cognitive behavioral therapy may improve quality of life, asthma control, and anxiety levels in people with asthma.
Improving people's knowledge about asthma and using a written action plan has been identified as an important component of managing asthma. Providing educational sessions that include information specific to a person's culture is likely effective. More research is necessary to determine if increasing preparedness and knowledge of asthma among school staff and families using home-based and school interventions results in long term improvements in safety for children with asthma. School-based asthma self-management interventions, which attempt to improve knowledge of asthma, its triggers and the importance of regular practitioner review, may reduce hospital admissions and emergency department visits. These interventions may also reduce the number of days children experience asthma symptoms and may lead to small improvements in asthma-related quality of life. More research is necessary to determine if shared decision making is helpful for managing adults with asthma or if a personalized asthma action plan is effective and necessary. Some people with asthma use pulse oximeters to monitor their own blood oxygen levels during an asthma attack. However, there is no evidence regarding the use in these instances.
Bronchial Asthma
- Get out of bed. Do not lie on bed and cough.
- Take an extra puff of aerosol inhaler.
- Sip some hot tea/ Coffee or beverage or sip a glass of warm water.
- Initiate a short term (5 day) course of Prednisolone 5 mg tablet 2 tab three times a day. If Bronchodilator aerosol is in effective, prolong repeated attacks at night, morning tightness lasts beyond midday, Asthma causes immobilisation even briefly., there is often day to day worsening of the condition. Reduce dose of Prednisolone gradually.
- Send for the doctor if attack is severe.
- Aerosol Inhaler. Technique :
- The aerosol inhaler should be placed between the lips. A slow inhalation of total lung capacity is then taken, the canister been depressed once during early part of the inhalation.
- The more the patient empties his lung before inhalation, the bigger the dose reaching the lungs and greater the bronchodilation. Unfortunately, breathing out hard causes many asthmatics to start coughing and can induce bronchospasm and a comprimized should be reached between efficiency and comfort.
- Holding the breath after inhalation increases the delivery of the drug to the bronchi.
- Lack of response to normal medication.
- Inability to talk or complete a sentence.
- Increasing tachycardia and respiratory rate.
- Pulses paradoxes
- Hypotension
- Silent chest (breath sounds faint and wheeze hardly audible),
- Increase distress and audible.
- Respiratory muscle fatigue (periodical apnea and respiratory alternans)
- Cyanosis (If PaO2 falls below 50 mm below Hg)
- Hospitalize
- Full assessment including PEFR or FEV, and arterial blood gas estimation. Chest X-Ray to rule out pneumothorax.
- Oxygen at high flow rate (6-8 lit /min) through nasal prongs or O2 Mask with regular monitoring to prevent hypercapnia
- Inj Hydrocortisone 5mg/kg IV 6 hourly Dose may be doubles if no significant improvement in 8 hours.
- Tab Prednisolone 40-60 mg PO
- If β2 agonist have not been given relief through metered dose inhaler, use of nebulizer.
- If infection (fever, purulent sputum) or ineffective Cough and retention of secretions.
Note : Avoid sedatives and aspirin, and aspirine related drugs.
- Avoidance of provoking factors when possible.
- Selection of best inhaler device.
- Treatment stepped up as neccessary to achieve control.
- Treatment stepped down if control of asthma is good.
- A rescue course of prednisolone may be needed at any time and at any step.
- Asthalin (as required)
- Beclate or Budecort inhaled 800-2000 micro g/day or Fluticasone 400-1000 micro g/day through volume spacer
- Fluticasone plus salmeterol (Seroflo or Seretide accuhaler) BD.
Step 4
High dose inhaled corticosteroids and regular bronchodilator
- Inhaled Asthalin or Ventolin as required
- Beclomethasone or Budesonide 800-2000 micro g/day, via volume spacer.
- Sequential trial of one or more of the following:
Inhaled long acting Beta-agonist
Acebrophylline 100 mg
- Inhaled Asthalin or Ventolin as required
- Beclomethasone or Budesonide 800-2000 micro g/day or Fluticasone 400-1000 micro g /day.
- One or more of long acting bronchodilators
- Prednisolone tab in single large dose
- Sitting erect on the side of the bed, inhale deeply, allowing the abdomen to expand against a small pillow or book. press the book or pillow firmly as you exhale. These help elevate the diaphragm, improves aeration, and encourages cough to dislodge accumulated sputum.
- Lie down flat on your back and raise each leg alternately as you exhale. This improves tone of abdominal muscle.
- Lying down on your back place a book on your abdomen. Puff out the abdomen, as far as possible while inhaling. As you exhale pull in the abdomen, bring the book as close as possible to the spinal column. This brings about synchronization of diaphragmatic and abdominal muscles with breathing.
- Avoid exposure to dust/ Pollens / PETS / Pigeons /Smoke
- Regular Walking/ Exercise/ yoga
- Weight reduction/ BMI.
- Plenty of oral fluids.
- Salt water Gargling thrice daily (for sore throat)
- Steam inhalation thrice a day
- Avoid spicy and cold food
- Asthma medication include Asthma inhalers and pills and life style changes to treat and prevent asthma attacks.
- Long acting anti- inflammatory asthma inhalers . These inhalers deliver low doses of steroids to the lungs with minimal side effects if used properly.
- The fast acting or "rescue" bronchodilators inhaler works immediately on opening airways during an asthma attack.
- If you have bronchial asthma, make sure your doctor shows you how to use the inhalers properly. Be sure to keep your rescue inhaler with you in case of an asthma emergency.
- Asthma support group are also available to help you better cope with your asthma.
- Initiate a short course of steroid Tab prednisolone.
- Relaxation of airway smooth muscle..
- Use of Bronchodilator. Tab salbutamol or Terbutaline
- Aerosol inhalers (Asthalin, Ventorlin) or Beclomethasone(Beclate). It is advisable to gargle with plain water after use of an inhaler.
- The inhaler should be placed between the lips. A slow inhalation of total lung capacity is then taken. Holding the breath after inhalation increases the delivery of the drug to the bronchi. An interval of one minute is recommended between puffs.
- Nebulizer Ipratropium bromide. Add inhalation aerosol 18 mcg per puff.
- Inj Aminophylline
- Antibiotics if infection
- Desensitization is done. Immuno-therapy is given.
- If the patient does not respond, Ventilator support.
- Advised cessation of smoking
Bronchoprovocation provoked by AMP could be effectively inhibited by the mast cell stabilizing agents sodium cromoglycate and nedocromil sodium .
In addition, the β2-agonist salbutamol, which is a potent mast cell inhibitor, attenuates AMP-induced bronchoconstriction to a greater extent
Approved indications for omalizumab
- There is no known cure for asthma, but it can be controlled.
- Suppressed with the use of inhaled corticosteroids, long acting beta agonists (LABA) or
- Antileukotriene agents may be used in addition to inhaled corticosteroids if asthma symptoms remain uncontrolled.
- Treatment of rapidly worsening symptoms is usually with an inhaled short-acting beta 2 agonist such as salbutamol and corticosteroids taken by mouth.
- In very severe cases, intravenous corticosteroids, magnesium sulphate, and hospitalization may be required.
In 2019 asthma affected approximately 262 million people and caused approximately 461,000 deaths. Most of the deaths occurred in the developing world . Asthma often begins in childhood, and the rates have increased significantly since the 1960s. Asthma was recognized as early as Ancient Egypt. The word "asthma" is from the Greek ἆσθμα, âsthma, which means "panting".
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| Salbutamol metered dose inhaler commonly used to treat asthma attacks. |
Medications for asthma exacerbations
- Short-acting beta2- adrenoceptors agonist (SABA), such as salbutamol (albuterol ) are the first line treatment for asthma symptoms.They are recommended before exercise in those with exercise induced symptoms.
- Anticholinergic medications, such as ipratropium, provide additional benefit when used in combination with SABA in those with moderate or severe symptoms and may prevent hospitalizations. Anticholinergic bronchodilators can also be used if a person cannot tolerate a SABA. If a child requires admission to hospital additional ipratropium does not appear to help over a SABA.For children over 2 years old with acute asthma symptoms, inhaled anticholinergic medications taken alone is safe but is not as effective as inhaled SABA or SABA combined with inhaled anticholinergic medication. Adults who receive combined inhaled medications that includes short-acting anticholinergics and SABA may be at risk for increased adverse effects such as experiencing a tremor, agitation, and heart beat palpitations compared to people who are treated with SABA by itself.
- Older, less selective adrenergic agonists, such as inhaled epinephrine, have similar efficacy to SABAs. They are however not recommended due to concerns regarding excessive cardiac stimulation.
- Corticosteroids can also help with the acute phase of an exacerbation because of their anti-inflammatory properties. The benefit of systemic and oral corticosteroids is well established. Inhaled or nebulized corticosteroids can also be used. For adults and children who are in the hospital due to acute asthma, systemic (IV) corticosteroids improve symptoms. A short course of corticosteroids after an acute asthma exacerbation may help prevent relapses and reduce hospitalizations.
- Other remedies, less established, are intravenous or nebulized magnesium sulfate and helium mixed with oxygen. Aminophylline could be used with caution as well.
- Mechanical ventilation is the last resort in case of severe hypoxemia.
- Intravenous administration of the drug aminophylline does not provide an improvement in bronchodilation when compared to standard inhaled beta-2 agonist treatment. Aminophylline treatment is associated with more adverse effects compared to inhaled beta-2 agonist treatment.
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| Fluticasone propionate metered dose inhaler commonly used for long term control. |
- Corticosteroids are generally considered the most effective treatment available for long-term control. Inhaled forms are usually used except in the case of severe persistent disease, in which oral corticosteroids may be needed. Dosage depends on the severity of symptoms. High dosage and long term use might lead to the appearance of common adverse effects which are growth delay, adrenal suppression, and osteoporosis. Continuous (daily) use of an inhaled corticosteroid, rather than its intermitted use, seems to provide better results in controlling asthma exacerbations. Commonly used corticosteroids are budesonide,fluticasone,mometasone and ciclesonide.
- Long-acting beta-adrenoceptor agonists (LABA) such as salmeterol and formoterol can improve asthma control, at least in adults, when given in combination with inhaled corticosteroids. In children this benefit is uncertain. When used without steroids they increase the risk of severe side effects, and with corticosteroids they may slightly increase the risk. Evidence suggests that for children who have persistent asthma, a treatment regime that includes LABA added to inhaled corticosteroids may improve lung function but does not reduce the amount of serious exacerbations. Children who require LABA as part of their asthma treatment may need to go to the hospital more frequently.
- Leukotriene receptor antagonists (anti-leukotriene agents such as montelukast and zafirlukast) may be used in addition to inhaled corticosteroids, typically also in conjunction with a LABA. For adults or adolescents who have persistent asthma that is not controlled very well, the addition of anti-leukotriene agents along with daily inhaled corticosteroids improves lung function and reduces the risk of moderate and severe asthma exacerbations. Anti-leukotriene agents may be effective alone for adolescents and adults, however there is no clear research suggesting which people with asthma would benefit from anti-leukotriene receptor alone. In those under five years of age, anti-leukotriene agents were the preferred add-on therapy after inhaled corticosteroids. A 2013 Cochrane systematic review concluded that anti-leukotriene agents appear to be of little benefit when added to inhaled steroids for treating children. A similar class of drugs, 5-LOX inhibitors, may be used as an alternative in the chronic treatment of mild to moderate asthma among older children and adults. As of 2013 there is one medication in this family known as zileuton.
- Mast cell stabilizers (such as cromolyn sodium ) are safe alternatives to corticosteroids but not preferred because they have to be administered frequently.
- Oral Theophyllines are sometimes used for controlling chronic asthma, but their used is minimized because of their side effects.
- Omalizumab, a monoclonal Antibody Against IgE, is a novel way to lessen exacerbations by lessening the levels of circulating IgE that play a significant role at allergic asthma.
- Anticholinergic medications such as ipratropium bromide have not been shown to be beneficial for treating chronic asthma in children over 2 years old, but is not suggested for routine treatment of chronic asthma in adults.
- There is no strong evidence to recommend chloroquine medication as a replacement for taking corticosteroids by mouth (for those who are not able to tolerate inhaled steroids). Methotrexate is not suggested as a replacement for taking corticosteroids by mouth ("steroid sparing") due to the adverse effects associated with taking methotrexate and the minimal relief provided for asthma symptoms.
- Macrolide antibiotics, particularly the azalide macrolide azithromycin, are a recently added GINA-recommended treatment option for both eosinophilic and non-eosinophilic severe, refractory asthma based on azithromycin's efficacy in reducing moderate and severe exacerbations combined. Azithromycin's mechanism of action is not established, and could involve pathogen- and/or host-directed anti-inflammatory activities. Limited clinical observations suggest that some patients with new-onset asthma and with "difficult-to-treat" asthma (including those with the asthma-COPD overlap syndrome - ACOS) may respond dramatically to azithromycin. However, these groups of asthma patients have not been studied in randomized treatment trials and patient selection needs to be carefully individualized.
For children with asthma which is well-controlled on combination therapy of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABA), the benefits and harms of stopping LABA and stepping down to ICS-only therapy are uncertain. In adults who have stable asthma while they are taking a combination of LABA and inhaled corticosteroids (ICS), stopping LABA may increase the risk of asthma exacerbations that require treatment with corticosteroids by mouth. Stopping LABA probably makes little or no important difference to asthma control or asthma-related quality of life. Whether or not stopping LABA increases the risk of serious adverse events or exacerbations requiring an emergency department visit or hospitalisation is uncertain.
Delivery methods
Medications are typically provided as metered dose inhalers (MDIs) in combination with an asthma spacer or as a dry powder inhaler. The spacer is a plastic cylinder that mixes the medication with air, making it easier to receive a full dose of the drug. A nebulizer may also be used. Nebulizers and spacers are equally effective in those with mild to moderate symptoms. However, insufficient evidence is available to determine whether a difference exists in those with severe disease. For delivering short-acting beta-agonists in acute asthma in children, spacers may have advantages compared to nebulisers, but children with life-threatening asthma have not been studied. There is no strong evidence for the use of intravenous LABA for adults or children who have acute asthma. There is insufficient evidence to directly compare the effectiveness of a metered-dose inhaler attached to a homemade spacer compared to commercially available spacer for treating children with asthma.
Adverse effects
Others
Inflammation in the lungs can be estimated by the level of exhaled nitric acid. The use of exhaled nitric oxide levels (FeNO) to guide asthma medication dosing may have small benefits for preventing asthma attacks but the potential benefits are not strong enough for this approach to be universally recommended as a method to guide asthma therapy in adults or children.
When asthma is unresponsive to usual medications, other options are available for both emergency management and prevention of flareups. Additional options include:
- Humidified Oxygen alleviate hypoxia if saturations fall below 92%.
- Corticosteroid by mouth are recommended with five days of prednisone being the same 2 days of dexamethasone. One review recommended a seven-day course of steroids.
- Magnesium sulphate intravenous treatment increases bronchodilation when used in addition to other treatment in moderate severe acute asthma attacks. In adults intravenous treatment results in a reduction of hospital admissions. Low levels of evidence suggest that inhaled (nebulised) magnesium sulfate may have a small benefit for treating acute asthma in adults. Overall, high quality evidence do not indicate a large benefit for combining magnesium sulfate with standard inhaled treatments for adults with asthma.
- Heliox, a mixture of helium and oxygen, may also be considered in severe unresponsive cases.Intravenous salbutamol is not supported by available evidence and is thus used only in extreme cases.
- Methylxanthines (such as theophylline) were once widely used, but do not add significantly to the effects of inhaled beta-agonists. Their use in acute exacerbations is controversial.
- The dissociative anesthetic ketamine is theoretically useful if intubation and mechanical ventilation is needed in people who are approaching respiratory arrest; however, there is no evidence from clinical trials to support this.
- For those with severe persistent asthma not controlled by inhaled corticosteroids and LABAs, bronchial thermoplasty may be an option. It involves the delivery of controlled thermal energy to the airway wall during a series of bronchoscopies. While it may increase exacerbation frequency in the first few months it appears to decrease the subsequent rate. Effects beyond one year are unknown.
- Monoclonal antibody injections such as mepolizumab , dupilumab, omalizumab may be useful in those with poorly controlled atopic asthma. However, as of 2019 these medications are expensive and their use is therefore reserved for those with severe symptoms to achieve cost-effectiveness. Monoclonal antibodies targeting interleukin-5 (IL-5) or its receptor (IL-5R), including mepolizumab, reslizumab, benralizumab, in addition to standard care in severe asthma is effective in reducing the rate of asthma exacerbations. There is limited evidence for improved health-related quality of life and lung function.
- Evidence suggests that sub-lingual immunotherapy in those with both allergic rhinitis and asthma improve outcomes.
- It is unclear if non-invasive positive pressure ventilation in children is of use as it has not been sufficiently studied.
Adherence to asthma treatments
Staying with a treatment approach for preventing asthma exacerbations can be challenging, especially if the person is required to take medicine or treatments daily. Reasons for low adherence range from a conscious decision to not follow the suggested medical treatment regime for various reasons including avoiding potential side effects, misinformation, or other beliefs about the medication. Problems accessing the treatment and problems administering the treatment effectively can also result in lower adherence. Various approaches have been undertaken to try and improve adherence to treatments to help people prevent serious asthma exacerbations including digital interventions.
Alternative Medicine
Evidence is insufficient to support the usage of vitamin C or Vitamin E for controlling asthma. There is tentative support for use of vitamin C in exercise induced bronchospasm. Fish oil dietary supplements (marine n-3 fatty acids) and reducing dietary sodium do not appear to help improve asthma control. In people with mild to moderate asthma, treatment with vitamin D supplementation or its hydroxylated metabolites does not reduce acute exacerbations or improve control. There is no strong evidence to suggest that vitamin D supplements improve day-to-day asthma symptoms or a person's lung function. There is no strong evidence to suggest that adults with asthma should avoid foods that contain monosodium glutamate (MSG). There have not been enough high-quality studies performed to determine if children with asthma should avoid eating food that contains MSG.
Tab Pantocid 40 mg once For 1 week (before food) 1 0 0 (reduces the amount of acid production)
Tab Augmentin Duo 625 mg 1 0 1 for 1 week (Augmentin Clavulanic acid) Antibiotic for Pneumonia
ASCORIL-D (For Dry cough)
Tab LEVOFLOX 500mg once for 1 week 1 0 0 (Bacterial infection)
Tab Mucinac 600 mg 1 0 1 For 1 Week (mix with water) (Excess mucus production) Mucolytic agent.
Syp Reswas 10 ml 1 0 1 For 1 Week (Dry Cough)
Tab Pulmoclear 100/600 mg once for 2 weeks 1 0 0 Acebrophylline 100 mg + Acetylcysteine 600 mg Fourrts India. (Treatment of COPD)
Piriton CS Syrup 100ml (Treatment of dry cough)
Tab Cepodem 200 mg (Treatment of Bacterial Infections)
Tab CEPODEM 325 MG Once for five days
Tab TELEKAST-L Once for 3 month. Montelukast 10 mg+ Levocetrizine Hydrochloride 5 mg
BUDAMATE 200 MCG TRANSINHALOR 2 PUFF Twice for 1 Month
1 puff twice for 2 month (Gargle after procedure)
Tab ACEBROPHYLLINE SR 200 MG For two weeks AB PHYLLINE-SR mucolytic and bronchodilator. It works by relaxing the muscles of the airways and also thins and loosens mucus, ...
Tab PREDMET 16 MG Twice for 5 Days.
Tab Mondeslor once for 2 week 0 0 1 (Sneezing and runny nose due to allergies.)
Syp Corex DX 10 ML Twice for two week 1 0 1 (Dry Cough)
Taxim powder for oral suspension 50mg (to treat bacterial infections)
Emeset syrup (To control vomiting)
Montair LC Kid Syrup 60 ml (Anti Asthmatic for treatment of Allergy symptoms. Symptom of sneezing , running nose)
Nasoclear nasal spray 20 ml
Tab Levoday 250 mg
Tab SOMPRAZ 40 MG Once for five days (before food) used in the treatment of Gastroesophageal reflux disease (Acid reflux),Peptic ulcer disease,Zollinger-Ellison syndrome.
Tab Omeprazole 40 mg (Same as above)
Panchkarma
Chyawanprash one tsf trice a day.
- Mix a cup of fenugreek decoction, a little honey and a spoonful of ginger juice. Consuming this mixture is beneficial in asthma attack treatment.
- To reduce the attack of asthma, mix two teaspoons of honey and one spoon turmeric and consume it.
- Garlic intake is very useful in asthma treatment. Boil four to five garlic buds in 30 liters of milk and eat it daily. Apart from this, grind two buds of garlic and mix it in ginger tea. Drinking this tea in the morning also benefits.
- Drinking hot coffee also provides relief in asthma. The breathing tube gets cleaned by coffee, which does not make breathing difficult.
- Put a little bit of camphor in mustard oil and heat it and after cooling it massage the waist and chest. Asthma symptoms start decreasing when massage with this oil every day.
- To treat asthma with natural remedies, take few dry leaves of peepal tree and burn them in a vessel. Now after the burn, filter these burnt leaves by a cloth. Now mix honey with this and consume. Asthma patient gets relief when this treatment is done two to three times a day for two months.
- Put the basil leaves in the water and grind it, then mix two teaspoons of honey and eat it. This home remedy provides relief in asthma.
- Cardamom is also beneficial in the treatment of asthma attack. Eating large cardamom gives comfort from both asthma and hiccup. Take large cardamom, dates and grapefruit in equal amounts and grind them. Mix it with honey and consume. It removes asthma and cough.
- Turmeric late : or Haldi dudh : Mix one spoonful of turmeric powder in a glass of milk and consume it. This Ayurvedic remedy keeps bronchial asthma and allergy under control.
- Drink ten to twelve glasses of water daily and do not drink water while eating.
- Put two spoonful amla powder in one cup, then add one teaspoon of honey to it and mix it well. Consume this mixture daily in the morning.
- Put four to five cloves in half glasses of water and boil for five minutes, then filter it and add some honey and drink it. This ayurvedic treatment of asthma can be done twice a day to three times a day.
- Mix one third of the spinach juice and two thirds of carrot juice and drink a glass every day. Use of Bathua (Chenopodium Album), garlic, barley and ginger is beneficial for asthmatics.
The prognosis for asthma is generally good, especially for children with mild disease. Mortality has decreased over the last few decades due to better recognition and improvement in care. In 2010 the death rate was 170 per million for males and 90 per million for females. Rates vary between countries by 100 fold.Globally it causes moderate or severe disability in 19.4 million people as of 2004 (16 million of which are in low and middle income countries). Of asthma diagnosed during childhood, half of cases will no longer carry the diagnosis after a decade. Airway remodeling is observed, but it is unknown whether these represent harmful or beneficial changes. Early treatment with corticosteroids seems to prevent or ameliorates a decline in lung function. Asthma in children also has negative effects on quality of life of their parents.
While asthma is twice as common in boys as girls, severe asthma occurs at equal rates.In contrast adult women have a higher rate of asthma than men and it is more common in the young than the old.
Global rates of asthma have increased significantly between the 1960s and 2008 with it being recognized as a major public health problem since the 1970s. Rates of asthma have plateaued in the developed world since the mid-1990s with recent increases primarily in the developing world. Asthma affects approximately 7% of the population of the United States and 5% of people in the United Kingdom Canada, Australia and New Zealand have rates of about 14–15%.
The average death rate from 2011 to 2015 from asthma in the UK was about 50% higher than the average for the European Union and had increased by about 5% in that time. Children are more likely see a physician due to asthma symptoms.
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