The Role of Yoga in Bronchial Asthma- Juniper Publishers
Juniper Publishers- Journal of Complementary
Introduction
Asthma is a heterogeneous disease comprising of
clinical manifestations of varying severity. Patients of asthma suffer
from progressive and persistent decline in lung function throughout
life, the degree of decline varying among individuals.
Asthma affects 334 million people worldwide and 17
million people in India [1]. Majority of asthma patients are effectively
treated with conventional therapy. Despite advances in conventional
therapy, inadequate control of asthma continues to presenta serious
problem for a subset of patients. Patients of uncontrolled asthma pose a
greater burden for healthcare and require a disproportionate amount of
healthcare costs to be spent on treating their condition. Optimum
therapy for uncontrolled asthma remains an unmet need.
Although majority of patients respond well to
low-dose controller medications such as inhaled corticosteroids and
long-acting β-agonists, a subset of patients remains uncontrolled
despite the use of high-dose multiple-drug daily controller therapy.
These patients experience substantial morbidity due to the disease and
to the adverse effects of high-dose corticosteroids and generate high
healthcare costs [2-5].
Yoga is a non-pharmacological adjunct to conventional
therapy for asthma. The word “yoga” comes from the Sanskrit root yuj,
which means union or yoke; to join and to direct and concentrate one’s
attention [6]. Yoga is an ancient art form based on a harmonised system
of development of the body, mind, and spirit [7]. Yoga has been
classified by National Institute of Health, USA as a form of
Complementary and Alternative Medicine.
It is estimated that up to 300 million people
practice yoga worldwide and more than half of them are Indians [8].
National Health Interview Survey last conducted in United States of
America in 2007 estimated that yoga is the sixth most common
complementary health practice among adultsand more than 32 million
people practice it in the country [9]. The participation and awareness
in Yoga continues to increase in society, hence it is important for
clinicians to know about the nature of Yoga and its therapeutic
benefits.
Four basic principles underlie the teachings and
practices of yoga. The first principle is the human body is a holistic
entity comprised of various interrelated dimensions inseparable from one
another and the health or illness of any one dimension affects the
other dimensions. The second principle is individuals and their needs
are unique and therefore must be approached in a way that acknowledges
this individuality and their practice must be tailored accordingly. The
third principle is, yoga is self-empowering; the healing comes from
within, instead of from an outside source and a greater sense of
autonomy is achieved. The fourth principle is that the quality and state
of an individual’s mind is crucial to healing [10].
Regular practice of yoga promotes strength,
endurance, flexibility and facilitates characteristics of friendliness,
compassion, and greater self-control, while cultivating a sense of
calmness and well-being [11,12]. The practice of yoga produces a
physiological state opposite to that of the flight-or-fight stress
response and with that interruption in the stress response, a sense of
balance between the mind and body is achieved [13]. Psychological
factors like stress can modulate asthma symptoms and influence the
management of asthma [14]. At the individual level, increased stress
leads to the dysregulation of the hypothalamic-pituitary-adrenal and
sympathetic-adrenal-medullary axes, disrupting immune and respiratory
processes, and producing an increased risk of inflammatory diseases,
such as asthma [15]. Yoga offers an effective method of managing and
reducing stress. Yoga integrates an individual’s physical, mental
and spiritual componentsand produces a physiological sequence
of events in the body reducing this stress response. Yogic practices
enhance muscular strength and body flexibility, promote and
improve respiratory and cardiovascular functionand enhance
overall well-being and quality of life.
Asthma has many contributing factors, including exercise,
allergy, air pollution, emotional factors and genetics. A
multifaceted approach should be considered for its preventionand
treatment. Yoga is a complementary therapy, helpful for asthma
[16]. With its focus on awareness of breath and the mechanics
of breathing, yoga serves as an adjunct to conventional asthma
therapy [17]. Yoga is fundamentally different from conventional
medical practice in its approach to asthma. Instead of trying to
reduce the cause of disease to a single factor and to correct it,
yoga aims to treat illness by improving health of the individual
and restore inner harmony.
A study conducted by the Natural Therapies Unit of Royal
Hospital for Women in Sydney, Australia showed a significant
beneficial effect of SahajaYoga on asthma patients who were
resistant to steroids [18].
Yoga practice should complement medicaltreatmentas
prescribed by the physician. Regular yoga practice that combines
pranayama, asana and meditation methods offer the most benefit
[19].
Specific Pranayama Exercises
A vital scientific and therapeutic aspect of yoga, Pranayama
is thebreathing process or the control of the motion of inhalation,
exhalation and the retention of vitalenergy.
Ujayyi (breathing):The name comes from the Sanskrit
word “ujayyi,” which means “to conquer” or “to be victorious.
The lungs are completely filled by inspiration and while slightly
contracting the throat, breathing out is done through nose. This
breathing technique is used throughout Ashtanga and Vinyasa
yoga practices.
AnulomaViloma (three-part breathing): This threepart
breath slows breathing by creating small pauses between
the breath cycles. Payingattention to the movements of the
belly, lower ribs and upper ribs can be helpful. During an
asthmaepisode, this method may be more beneficial ifdone with
very brief pauses during inhalation, toencourage maximal entry
of oxygen and long, slow uninterrupted exhalation.
Extended exhalations:Initially the duration of inhalation
and exhalation should be equal. Then aim for a 1:2 ratio
ofinhalation and exhalation.
Alternate nostril breathing:This technique slows down
person’s breathing, and it is believed to balance the sympathetic
and parasympathetic nervous system.
Yoga chair breathing: The patient sits on a chair facing the
back ofanother chair and places his arms on the back of the chair
he’s facing. He inhales while gradually lifting thehead and spine
and opening the chest, and then exhales while moving the spine,
chest, and neck into gentleflexion, which is done five times.
Kapalabhati:The word kapalbhati is made up of two words:
kapalmeaning “skull” and bhati meaning “shining”. The technique
involves short and strong forceful exhalations and inhalation
happens spontaneously.
Specific Asanas
The concept of using asanas is to alter one’s physical posture
to increase breathing potential and breathe better. Asanas
are isometric exercises that involve acoordinated action of
synergistic and antagonist musclesin bringing about steadiness
and flexibility. A gentle and progressive asana practice will allow
the patient to increase lung capacity and strengthen intercostal
muscles and muscles of back and diaphragm in preparation for
pranayama [20].
Headstand (Sirshasana):It is the most important among
inverted asanas. It is usually done at the end of the yoga asana
practices.
Shoulderstand (Sarvangasana):It is an inverted pose,
with the body resting on the shoulders.
Plough (Halasana):Hala Asanapromotes strength and
flexibility in all the regions of the back and neck.
Fish (Matsyasana): The pose opens the rib case, deepens
the breath and reverses kyphosis.
Sitting Forward Bend (Paschimothanasana): This pose
uses gravity to calm and soothe the nervous system.
Cobra (Bhujangasana): This pose promotes thoraco -
diaphtagmaticbreathing, stretches the chest, strengthens the
upper back and shoulders, and diminishes kyphosis.
Locust (Shalabhasana):Shalabhasana strengthens back
muscles and cures ailments like sciatica and back ache.
Bow (Dhanurasana): It tones back muscles and maintains
the elasticity of spine, improving posture and increasing vitality.
Spinal twist (ArdhaMatsyendrasana): ArdhaMatsyendrāsana tones the spinal nerves and ligaments,
improves digestion and also improves liver and pancreas health.
Crow (Kakasana): Kakasana is a balancing posture which
strengthens the shoulders, arms and wrists.
Standing forward bend (Padahastasana): It is an inverted
posture which provides many of the same benefits of the seated
forward bend, the main physical benefit is to stretch the entire
backside of the body from the head to the heels.
Triangle (Trikonasana): Trikonasana (triangle pose)
augments the movement of the Half Spinal Twist and gives an
excellent lateral stretch to the spine, toning the spinal nerves and
helping the proper functioning of the digestive system.
Meditation
United States National Center for Complementary and
Alternative Medicine (NCCAM) defines meditation as “a conscious
mental process that induces a set of integrated physiological
changes termed the relaxation response.
Asthma flares is associated with anxiety and pain. The body’s
sympathetic nervous system, responsible for its “fight or flight”
response, goes into overdrive at the onset of an asthma flare, and
releases stress hormones into the body. Meditation lowers stress
hormone levels and decreases activity in the body’s sympathetic
nervous system. Medictation relaxes the mind and increases
mental alertness [21]. The controlled breathing regime practiced
as part of the meditation process is extremely beneficial for the
lungs. Meditation opens air passages and improves airflow. With
practice, one can learn to relax the body and breathe deeply early
during the onset of an asthma attack; at the same time, focusing
on the breathing freely will calm the mind and prevent anxiety or
panic to take control.
Wilson et al did a crossover study to evaluate the benefits of
Transcendental meditation on asthma. The results indicated that
transcendental meditation is a useful adjunct in treating asthma
[22]. In the Indian scenario, study by Biju et al showed that
yoga resulted in significant improvement in pulmonary function
tests, decrease in frequency of asthma attacks and decrease
in frequency of use of inhalers whereas the disease status
in controls deteriorated [23]. Yoga improves the mechanical
efficiency of our breathing and increases the total lung capacity
[24].
Thus, we see, Yoga contains elements that address problems
associated with asthma at every level - pranayama that slows
breathing and regulates the flow of “prana”, asana that relax and
tone the muscles, relaxation and meditation that act to calm the
mind and emotions culturing to heal the spirit. Treatment of
asthma is continually evolving. Multidisciplinary collaboration
by bringing together researchers and clinicians should be the
way forward in endeavours to provide effective solutions to help
patients (Table 1).
Disclaimer: Please do not stop using asthma treatment
without the advice of the specialist. Yoga should only be used to
complement standard
medical treatment.
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