ASTHMA PREVENTION THROUGH LIFESTYLE MODIFICATIONS
In 2022, it was reported that around 300 million people worldwide have asthma and among which 37.9 million are in India. Apart from the mortality and morbidity associated with bronchial asthma, the economic burden it levies on the nation is highly challenging. This includes not only direct cost spent on medical health care but also absenteeism from work and school which markedly affects the economic status of the country. The co-morbidities associated with this clinical condition is broadly categorised into two: Immediate and Remote. While the immediate co-morbidities range from rhinitis, rhinoconjunctivitis and sinusitis, the latter can be as grave as heart disease, stroke, osteoporosis, and cancer. The disease can lead to serious respiratory complications including pneumonia, the collapse of part or all the lungs, respiratory failure and status asthmaticus.
Classical symptoms of Bronchial Asthma are cough, wheezing, chest tightness and shortness of breath. The etiological factors of Bronchial Asthma are of two types viz. Inducing factors which basically initiate the disease pathology and Provoking factors which precipitate an episode in an already known patient. While the former includes genetic factors, allergy and viral infections, the latter known factors include exposure to allergens (including food), environment, occupation, recurrent infections especially involving the upper respiratory tract, exercise, and various psychological factors.
Conventionally, the condition is treated using anti-inflammatory drugs and bronchodilators. Anti-inflammatory drugs are chiefly corticosteroids administered either in the form of metered close inhalers or as pills or liquid medications. Bronchodilators may be short-acting or long-acting. However, this approach involves high costs and is generally associated with high drug reliance and other harmful side effects. For example, inhaled corticosteroids can induce local effects like oral candidiasis, dysphonia, reflex cough or bronchospasm and serious systemic effects like poor growth, decreased bone density, disseminated infection, easy bruising, cataracts and glaucoma, adrenal gland suppression etc. Bronchodilators are known to produce unfavourable effects ranging from nausea, vomiting, and headache to serious issues like nervousness, restlessness, insomnia, and tremor. Besides, these are merely curative approaches and do not offer preventive care. In this scenario, Ayurveda can potentially contribute in both curative as well as preventive foci in a quite safer way. Disease prevention has three faces: Primary, secondary, and tertiary and Ayurveda can be effectively applied in all three.
Primary prevention aims at preventing the inducing factors both before and after birth. Factors before birth are primarily genetic predispositions. High-risk parents should be guided appropriately with genetic counselling wherever applicable. Also, planning of the regimes of a pregnant lady can contribute a lot in preventing asthma in the offspring. Ayurveda classics have mentioned that if a garbhini consumes slaishmika aahaara the baby runs a high risk of developing slaishmika vikaara like swaasa roga. Further, mental stress and infections during pregnancy hold strong relation to asthma in the baby.
After birth, recurrent respiratory infections show a high incidence in children. If not properly addressed to it can lead to bronchial asthma. The childhood age group is vulnerable to this condition owing to :
- Developing anatomical structures (Aparipakwa dhaatu)
- Delicacy (Sukumaara)
- Psychologically weak (Aklesasaha)
- Immature immune system (Asampoorna bala)
- Kapha pradhaana
So, this age needs special care, particularly in the following areas:
- Ensure adequate neonatal care to avoid infections.
- Promote breastfeeding.
- Nutritious diet
- Parental care
- Physical strength improvement (bala / immunity)
Breastfeeding strengthens the immune system of the baby by maternal antibodies thereby lowers the incidence of respiratory illness and protecting it from allergies. A well-balanced nutritious diet will support the development of immunity. Nutritional requirements must be identified and adequately met. Keeping the babies off junk foods will ensure a satisfactory nutritional status. The dietetic principles of Ayurveda should be followed to enhance appetite and digestion. Physical and psychological support from parents plays a pivotal role in the child’s growth and development. Physical strength can be developed by adequate physical exercise in various forms of recreation like games, swimming etc. and using Rasaayana drugs and formulations like Chyavanapraasam, Kooshmaanda rasaayanam etc. Also, maintaining a healthy physical environment is an essential requisite. Care must be taken to avoid indoor pollutants like kitchen exhaust, parental smoking etc. Regular cleaning and disinfection of the house must be ensured. Dhoopanam with drugs mentioned for air purification like guggulu, musta, usira, madhuka, haridra etc is beneficial. But a child allergic to smoke should not be exposed directly to the fumigation.
Secondary prevention considers both physical and mental factors which provoke an episode of asthma. Mental stress is closely associated with bronchial asthma. Promoting psycho-analysis and extending relaxation techniques, meditation and counselling is seen to control the diseases effectively.
While considering the physical factors, 90% of cases of asthma are attributed to
atopic factors or allergens and only 10% are caused secondary to environmental and other factors. So, an effective approach will be to avoid the allergen but since it is practically impossible, the focus should be on strengthening the body to combat the allergens. This can be achieved either medically, i.e., immunotherapy or by lifestyle modification in terms of daily and seasonal regimes.
Planning a lifestyle needs a clear understanding of the disease pathogenesis. Asthma or swaasam involves the vitiation of vaata due to factors including environmental allergens, dietary reasons, trauma, or iatrogenic causes which is precipitated in the praanavaha srotas. Simultaneously, Kapha prakopaka(vitiating) aahaara initiates a metabolic disturbance in the mahaasrotas, i.e, aamasaya and disturbs the praanavaha, udakavaha and annavaha srotas. In praanavaha srotas it produces swaasam. Thus, the key points to remember are the doshas primarily involved are kapha and vaata and accordingly, the lifestyle modifications should aim at preventing further praanavaha sroto vaigunya by vaata and kaphasanchaya in aamaasaya.
Based on this understanding, the following Dinacharyas are advisable:
Breathing exercises: Hands in and out breathing, Hands stretch breathing, Head up and down breathing, Ankle stretch breathing, Sasaankaasana breathing, Dog breathing and Tiger breathing and Chair breathing.
Yogaasanas: Ardhakatichakraaasana, Paadahastasana, Ardhachakraaasana, Trikonaasana, Parivritta trikonaasana, Vajraasana, Sasaankaasana, Suptavajraasana, Paschimottanasana, Ushtrasana, Gomukhasaana, Makarasaaana, Bhujangasana, Salabhaasana, Dhanuraasana and Soorya namaskaram.
Praanayaamam: Kapaalabhaati, Sectional breathing, Nadisudhhi Praanaayaama, Sooryaanuloma Praanaayaamam, Ujjayi Praanaayaama and Bhraamari Praanaayaama
Conditioning: This is a technique which helps in desensitizing the mucous membrane of the respiratory tract to minimize hypersensitivity on exposure to allergens. This includes Neti (jala and sutra) and dhauthi. These procedures also help in cleansing the respiratory tract.
The relation between aahaara and asthma is well elaborated in Ayurveda classics and is quite evident clinically also.
Due importance must be given to the observance of aahaara vidhi as advocated in Ayurveda i.e, the food should be ushna, snigdha, consumed only when previously eaten meal is fully digested and inappropriate maatra.
The practice of drinking only hot water processed with Lajjalu (mimosa pudica), Khadir (Acacia catechu), Jeeraka (Cuminum ciminum), etc. must be advocated. Patients must be educated to avoid food articles which are guru, seeta, vishtambhi, vidaahi example matsya, kanda, sarshapa, maasha, aanupamaamsa, dadhi. The practice of adhyasana and virudhhaahaara must be avoided.
Some common home recipes beneficial in Asthma:
- Tea with maricha and ardraka
- Takra(Buttermilk) processed with turmeric and curry leaves
- Chutney- with curry leaves, ginger, pepper, onion
- Steam cake –yava
- Milk with haridra churna and honey
Seasonal regimes:
Atopic asthma shows a high incidence in spring and summer while non-atopic in winter (82.3%) and monsoons (75.8%). Symptoms worsen early morning and night. According to Ayurveda classics also swaasa roga exaggerates during Hemanta and Varsha.
Hemanta charya including Abhyanga with vaatahara taila followed by Ushnodaka snaana, practices like Swedana, Dhoomapaana and keeping the body covered with warm clothing must be advised. During Varsha ritu, agnideepana must be ensured with panchakola churnam and the practice of dhoomapaana and dhoopanam be advised. Rtu-shodhanam must be administered especially in Vasanta Rtu and sarat ritu. In Vasanta Rtu either the classical way or with Sadya sneha using Ghrta bharjita peya (3 days), Swedana with Sarshapa taila + ushnodaka snana (1 day) and Vamana with madanaphala yashtimadhu Kashaya. In sarat Sneha sweda followed by virechanam with Trivrit choorna + Draaksha swarasa.
Practices of Sadvruttam chiefly avoid vegadhaarana especially Kaasa, sakrt, mutra, udgaara, chardi, and trishna. Ensure early to bed, early to rise. Avoid sunlight and exposure to mist, wind and dust. Maintain personal hygiene and environmental hygiene. Avoid tight dressing, visiting crowded places, negative emotions and maintain mental harmony.
Tertiary prevention aims at minimizing the co-morbidities and complications. Higher risk of Oro-dental pathologies is reportedly associated with asthma due to decreased salivary protection against extrinsic and intrinsic acids. This can be prevented by Dantadhaavana with Khadira, Karanja, Nyagrodha etc, hot water gandoosham, dhoomapaanam with guggulu, haridra , madhukam, yavam with ghee. Naimittika rasaayanam namely Pippali and Agastya rasaayana can effectively prevent comorbidities.
Conclusion
Preventive care can reduce economic burden and improve the Quality of Living. This can be achieved by modulating lifestyles and routines. The ayurvedic lifestyle suggests less expenditure and can be practised with easily available low-cost drugs without any side effects and requires no hospitalization.
