Tamaka Swasa (Bronchial Asthma): Aetioology & Management

Tamaka Swasa (Bronchial Asthma): Aetioology & Management

1. Tamaka Swasa (Bronchial Asthma) Aetioology & Management Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U) Professor Deptt . of Rasashastra & Bhaisajya Kalpana (BAMC) (Pt . Deendayal Upadhyay Memorial Health Sciences and Ayush University), Chhattisgarh

2. Swasa “ Swasana swakarmani ” Obstruction related to Jeevan or Vayu is called Swasa Roga Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

3. Components of the Upper Respiratory Tract Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

4. Human Respiratory System Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

5. Upper Respiratory Tract Functions Passageway for respiration Receptors for smell Filters incoming air to filter larger foreign material Moistens and warms incoming air Resonating chambers for voice Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

6. Components of the Lower Respiratory Tract Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

7. Functions Larynx: maintains an open airway, routes food and air appropriately, assists in sound production Trachea : transports air to and from lungs Bronchi : branch into lungs Lungs : transport air to alveoli for gas exchange Lower Respiratory Tract Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

8. Gas Exchange Between the Blood and Alveoli Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

9. Classification of Swasa Swasa is mainly caused by the Vata and Kapha doshas . Swasa is broadly classified into five types 1. Maha swasa 2. Urdha swasa 3. Chhinna swasa 4. Tamak swasa 5. Kshudra swasa Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

10. Pathology Due to excessive intake of kapha aggravating food and regimen, the kapha along with vata gets into pittasthana and causes swasa . Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

11. Classification of Tamak Swasa Tamaka swasa is of two types namely Pratamaka swasa associated with fever, fainting, distention of abdomen and indigestion. Santamaka swasa is pacified by taking of cold regimen. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

12. Factors that vitiate the Pranvaha Sarotus : run ‘ Vyadi ’ (disease) Kshaya : Physical wasting. Veg-Dharan : Retention of natural physical urges. Rookshata : Loss of unctuousness in body. Vyajama : Unaccustomed physical exercises. Kshudha : Prolonged Starvation Darunawastha : Chronic ailments. These factors are not only applicable in weakening the strength of Lungs and Heart but make them prone to ailments of Lungs and Heart. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

13. Factors Responsible for Bronchial Asthma ( TamakSwasa ) Raja and Dhooli n Vayu Gaseous and Suspended particulate polluting air. Sheersthana Dwelling in cool and damp place. Apa tarpana Indulgence in activities causing wasting of body. Amma pradoshaja Metabolic and immune calerrors in body. Marmabhighat Damagetovitalorgans . Vishamashanat Intake of unwholesome food. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

14. Difficulty in breathing or shortness of breath may be simply termed as Swasa (Asthma). Tamak Swasa (Bronchial Asthma) is a chronic disease causing inflammation and occasional obstruction of the airways. Tamak Swasa (Bronchial Asthma) exacerbations are acute episodes of progressively worsening shortness of breath, coughing, wheezing and chest discomfort. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

15. Causes TS is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swells. This reduces the amount of air that can pass by. In sensitive people, TS symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers) Types : 1. Episodic. 2. Chronic Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

16. Triggering factors: Can aggravate symptoms in a patient who is having Bronchial Asthma 1. Inhalation of Allergens : House dust, pollen, mold , animal dander 2. Environment : Cold and dry climate, cooking gas fumes, passive cigarette smoking, paints, sprays 3. Infections : Upper Respiratory Tract infections, Viral infections 4. Drugs : Aspirin, Pain killers (NSAIDs) 5. Food : Colouring agents of food, food preservatives, ice creams 6. Exercise : Vigorous exercise particularly on cold and dry day 7. Psychological factor : Stress 8. Occupation : Wood and cotton dust, chemicals Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

17. Causes of Tamaka Swasa a s per Ayurveda 1. Intake of dry, cold , heavy, incompatible food and irregular intake of food 2. Excessive Intake of black gram, beans, sesame, meat of aquatic animals. 3. Intake of cold water and exposure to cold climate 4. Exposure to dust, smoke and wind 5. Excessive exercise, over indulge in the sexual activity 6. Trauma to throat, chest and vital organs. 7. Suppression of natural urges. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

18. Signs and symptoms 1. Breathlessness along with forcible expiration 2. Cough 3. Wheezing 4. Tightness of chest 5. Thick mucus sputum 6. Aggravation of above symptoms during night and early morning 7. Fainting during the bought of cough. 8. Sleeplessness, discomfort increases when lied down on bed 9. Gets comfort in sitting posture. 10. Sweating on the forehead. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

19. Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom. Asthma attacks can last for minutes to days, and can become dangerous if the airflow is severely restricted. Symptoms include: Cough with or without sputum (phlegm) production Pulling in of the skin between the ribs when breathing (inter costal retractions) Shortness of breath that gets worse with exercise or activity Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

20. Emergency symptoms Bluish colour to the lips and face Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack Extreme difficulty breathing Rapid pulse Severe anxiety due to shortness of breath Sweating Other symptoms that may occur with this disease Abnormal breathing pattern --breathing out takes more than twice as long as breathing in Breathing temporarily stops Chest pain Tightness in the chest Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

21. Who gets asthma? If someone in the family already has asthma that persons are more likely to develop asthma. Children with eczema or food allergy are more likely to develop asthma than other children. Allergy to pollen, house dust, mites or pets also increases your chance of developing asthma. Exposure to tobacco smoke, air pollution or other inhaled irritants can also cause asthma symptoms in those with an underlying tendency to asthma. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

22. Is there any relation with age for starting asthma? Asthma can start at any age, although about half of all people with asthma have had their first symptoms by the age of 10, and many children with asthma have had their first asthma attack before the age of 6 . Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

23. What causes asthma? The causes of asthma are not fully understood. Asthma is probably usually caused by a mixture of hereditary factors (those you are born with) and environmental factors, but how these factors work together is still largely unknown. Allergens from house dust, mites and pets are the most common causes, but many other allergens such as pollen and moulds can cause asthma. Some patients with asthma have no obvious allergies. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

24. What are the main aggravating factors of asthma ? Inhalation of Allergens like House dust, Pollen, Mold , Animal dander, Cold and dry climate, cooking gas fumes, passive cigarette smoking, paints, sprays. Upper Respiratory Tract infections, viral infections. Drugs like Aspirin, Pain killers (NSAIDs), Colouring agents of food, food preservatives, ice creams , Vigorous exercise particularly on cold and dry day, Stress, Wood and cotton dust, chemicals etc. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

25. Can weather changes trigger asthma? Yes, sudden weather changes (e.g. cold winds, humidity and storms) can trigger asthma in some people. Some of these sudden changes can cause the release of allergens such as pollen that can make asthma worse in people whose asthma is allergy-related. Cold air can also have a direct irritant effect on inflamed airways. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

26. Is asthma a psychological (psychosomatic) disease? No, asthma is not a psychological condition; it is a long-term (chronic) inflammatory disease that leads to extra-sensitive and easily irritated airways, especially when it is not properly treated. Although asthma is not a psychological condition, emotional stress can trigger the symptoms. For example, financial problems, not enjoying your work or worrying about your family can all help to trigger symptoms if you already have asthma. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

27. What is acute asthma and what is chronic asthma? Acute asthma is a severe form of asthma which is of recent origin (a few minutes to a few hours) while a chronic asthma is a condition where one experiences either a prolonged breathless or more commonly recurring attacks of acute asthma. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

28. When to Contact a Medical Professional 1. An asthma attack requires more medication than recommended 2. Symptoms get worse or do not improve with treatment. You have shortness of breath while talking 3. Your peak flow measurement is 50% -80% of your personal best 4. Drowsiness or confusion 5. Severe shortness of breath at rest 6. A peak flow measurement is less than 50% of your personal best 5. Severe chest pain 6. Bluish colour to the lips and face 7. Extreme difficulty breathing Rapid pulse Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

29. Outlook (Prognosis) There is no cure for asthma, although symptoms some times improve over time. With proper self management and medical treatment, most people with asthma can lead normal lives. Possible Complications The complications of asthma can be severe. Some includes: Death D ecreased ability to exercise and take part in other activities Lack of sleep due to night time symptoms Permanent changes in the function of the lungs Persistent cough Trouble breathing that requires breathing assistance (ventilator) Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

30. Exam. and Tests 1. Allergy testing : may be helpful to identify allergens in people with persistent asthma. 2. Wheezing or other asthma-related sounds may be heard. However, lung sounds are usually normal between asthma episodes. Tests may include 3. Arterial blood gas 4.Eosinophil count (a type of white blood cell) and IgE (a type of immune system protein called an immunoglobulin) 5. Chest x-ray is useful in differentiating the asthma from other lung diseases 6. Pulmonary function tests include Spirometry and peak flow which estimate the narrowing of the bronchial tubes and how fast an individual can breathe 7. Peak flow measurements 8. Methacoline challenge test and Nitric oxide tests are confirmatory tests in Bronchial asthma. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

31. Management of Swasa Roga Nidan parivarjan - Avoid disease triggers and etiogenic factors Shodhan Chikitsa - Purification of morbid factors from body Shaman Chikitsa - Symptomatic and palliative management AaharVihar - Dietetics and lifestyle in disease Vegkala Chikitsa - Management of acute episode Rasayana Chikitisa - Rejuvenation Pranayama - Deep breathing exercises Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

32. Nidana Parivarjan -Avoid disease triggers and aetiogenic factors Smoking Cold air Gaseous and dust pollution including deodorants, fresheners Heavy unctuous diet/indigestion Fasting Unwanted drugs Un accustomed exertion Pratishaya -Rhinitis Humidity Kshaya -physical wasting Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

33. Tobacco Elimination: Eliminate tobacco smoke from the home. This is the single most important thing a family can do to help a child with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair --this can trigger asthma symptoms. Persons with asthma should also avoid air pollution, industrial dusts, and other irritating fumes as much as possible. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

34. Shodhan Chikitsa Purification of morbid factors from body Nitya Virechan - Regular purgation. Snehana & Swedan - Uro Snehana followed by Nadi Swedana and vamana . Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

35. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

36. Shaman Chikitsa Symptomatic and Palliative management Expectorants/ Mucolytics ( Kapha nissarak )-e.g. Sitopladi ch 3 gm, Suddha tankan 500 mg, Swaskuthar ras 120 mg two to three times a day with honey, Madhuyashti Quath 100 ml twice day. Bronchodilators ( Swasnalika vispharak )-e.g.- Kantkari avleha 10 gm twice a day, Kanakasva 10 ml with water twice a day. Somlata ch 2 gm BD if acute episode Anti allergics -e.g.- Haridra khanda 3 gm, Rasmanikaya 60 mg, Praval panchamrit 100 mg mix with honey two to three times a day. Sirishavleha 10 gm BD, Sirishadi kwatha 100 ml twice a day. Somlata ch . 2 gm three times a day with hot water. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

37. Aahar Vihar -Dietetics and lifestyle Avoid-High fat milk, Excessive oils in food, Curd, Tubors , Fish, Cold water and drinks, etc. In life style routine avoid Cold air, getting wet in rains, humid places, excessive physical and mental exertion, physical and mental stress, factors and medications leading to physical and immunological debility, etc. Take-Cereals like wheat floor, seasoned rice, low fat milk, lean meat, vegetable. And meat soups, light drink s and beverages, honey, Luke warm water, lemon, green leafy vegetables, etc. In life style engage in accustomed physical exercises, day time rest, engage in activities that assure physical and mental relaxation Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

38. Vegkala Chikitsa - Management of acute episode Complete rest Plenty of fluids Oxygen Som Churna - 2 to 3 gm with Vasadi qwath 3 to 4 times a day. Kanakasva -10 ml (with equal quantity water) thrice a day. If possible and patient is relatively fit and have entrapped secretions in chest try to induce emesis by giving Madhuyashti quath or Takan leha especially in children. If the condition does not improve patient be referred to intensive care. Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

39. Rasayana Chikitisa - Rejuvenation Chyavanprash Rasayana Ashwagandha Rasayana Amritprash Rasayan etc Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

40. Useful medicinal plants for Bronchial Asthma Kantakari ( Solanum xanthocarpum ) Vasa ( Adhatoda vasica ) Sunthi ( Zingiber officinalis ) Bharangi ( Clerodendrum serratum ) Pushkara moola ( Innula racemosa ) Karkata Shringi ( Pistacia inergerrima ) Haridra (Curcuma longa ) Sirisa ( Albezia lebeck ) Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

41. Kantakari Vasa Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

42. Sirisa Karkata Shringi Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

43. Haridra Sunthi Vd . Sujit Dalai M.D.(NIA), Ph.D.(S.U ) [email protected]

44. Thank You