Efficacy of Yoga on requirement of rescue inhaled medication in asthma patients

Transcription

1 Indian Journal of Traditional Knowledge Vol. 15 (4), October 2016, pp Efficacy of Yoga on requirement of rescue inhaled medication in asthma patients *Shruti Agnihotri 1, Surya Kant 1, SK Mishra 2 & RK Mishra 3 1 Department of ulmonary Medicine, King George's Medical University, Lucknow , U, India; 2 Institute of Naturopathic and Yogic Sciences, Lucknow University, Lucknow ; 3 Department of Biochemistry, Lucknow University, Lucknow s: saishruti.agnihotri@gmail.com, dr.kantskt@rediffmail.com, satyendramishra.yoga@gmail.com, rkm399@rediffmail.com Received 05 October 2015, revised 29 February 2016, updated 08 June 2016 Asthma is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. The chronic inflammation causes an associated increase in airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing at night or in the early morning. The objective of this study is to evaluate the effect of yoga on rescue medication uses in asthma patients. A total of 300 subjects of mild to moderate persistent asthma (FEV 1 > 60) aged between 12 to 60 yrs were recruited from the Department of ulmonary Medicine, King George s Medical University, U, Lucknow, India. Their rescue medication use was assessed at baseline, then after 3-month and 6-month from baseline. 45 subjects were dropped out during the study period while 255 subjects completed the study successfully. Decrease in the rescue medication use was much less in the yoga group at 3 rd month while at the end of 6 th month the use of rescue medication decreased by in the yoga group as compared to control group. About 55 decrease was found in the yoga group in rescue medication use which shows that yoga can be used as an adjuvant therapy with standard inhalation therapy and rescue medication use can be reduced. Keywords: Adjuvant, Asthma,, Wheezing, Yoga IC Int. Cl. 8 : A01D 20/00, A01D 11/00, A01D 23/16, A01D 11/18, A62B, A01D 23/03, A61B 5/00, A61B 17/42 Asthma is a chronic inflammatory respiratory disease characterized by periodic attacks of wheezing, shortness of breath, and a tight feeling in the chest. A cough producing sticky mucous is a characteristic symptom. Asthma is an ancient Greek word that means panting, gasping or inflamed tight feeling in the chest 1. It is very common in children, teens and adults. It is a condition where the air passages in the lungs become inflamed. Asthma is categorized into four categories: intermittent, mild persistent, moderate persistent and severe persistent 2. Yoga has been considered as a form of Complementary and Alternative Medicines 3. The word "yoga" comes from a Sanskrit root "yuj" which means union, or yoke, to join, and to direct and concentrate one's attention 4,5. Regular practice of yoga provides strength, endurance, flexibility and facilitates characteristics of friendliness, compassion, and greater self-control, while cultivating a sense of calmness and wellbeing 6,7. The practice of yoga produces a physiological state opposite to that of the flighor-fight stress response and with that interruption in the stress *Corresponding author response. It provides a sense of balance and union between the mind and body 8. Yoga is known for its beneficial effects on physiologic and psychological functions and improves the quality of life of the patients Use of rescue inhaled medication is totally concerned with asthma patients, so that the present study is based on mild to moderate persistent asthma patients to know the effect of yoga on requirement of rescue inhaled medication. However, the effect of yoga on rescue inhaled medication use in asthma patients has been studied but all of the studies were short term. The present study is based on the findings of one of the aims of the larger study on bronchial asthma. Objective To evaluate the effect of yoga on requirement of rescue inhaled medication in asthma patients. Materials and methods Study design and setting This randomized controlled trial was conducted to know the requirement of rescue inhaled medication in asthma patients with yoga intervention and standard

2 676 INDIAN J TRADIT KNOWLE, VOL. 15, No. 4, OCTOBER 2016 medical treatment both in yoga group as well as in non- yoga group (without yoga intervention). Diagnosed cases of asthma were recruited for the study who attended the Out atient Department (OD) of the Department of ulmonary Medicine, King George s Medical University, U, Lucknow, India on the basis of inclusion and exclusion criteria. Inclusion criteria 1 Mild to moderate persistent bronchial asthma severity according to GINA Reversible airflow limitation measured by >12 increase & >200 ml absolute increase in FEV 1 after ost Bronchodilator. 3 atients aged between yrs. Exclusion criteria 1 Those who had a clinical diagnosis of asthma but did not satisfy the diagnostic criteria. 2 atients with severe airflow limitation or more (FEV 1 < 60). 3 regnant/lactating women. 4 Chronic respiratory diseases and major psychiatric illnesses. Ethical consideration This study was approved by the Institutional Ethics Committee of the King George s Medical University, U, Lucknow. A signed informed consent was obtained from all the subjects before being enrolled for the study. They were free to withdraw from the study at any stage of the study period without assigning any reason. Study participants In this randomized controlled trial, 300 subjects who satisfied the inclusion criteria were allocated into two groups: the yoga group and the control group. Out of 300 subjects (150 cases and 150 controls), 25 subjects from the yoga group and 20 subjects from the control group dropped out during the study period. One hundred twenty five subjects from the yoga group and 130 subjects from the control group were completed the study. Yogic intervention Subjects in the yoga group received yogic intervention (asanas, pranayama & meditation) for 30 min per day, 5 days in a week for a period of 6 months at Department of ulmonary Medicine, King George s Medical University, U, Lucknow Yogic techniques Table 1 Yoga module for yoga group Duration (min) Asanas Gomukhasana (sitting posture) 2 Ardhamatsyendrasana (sitting posture) 2 aschimottanasana (forward bending) 0.5 Bhujangasana (backward bending) 0.5 Dhanurasana (backward bending) 0.5 Naukasana (boat pose asana) 1 arvatasana (standing posture) 1 Tadasana (standing posture) 0.5 Shavasana (relaxing/resting asana) 5 ranayama Nadishodhana 3 Bhastrika 2 Bhramari 2 Meditation 10 Total Duration 30 min (Table 1). A qualified yoga trainer was selected by the expert panel to give the proper training of the yoga to the patients. During the follow up of the study patients of the yoga group and the non-yoga group had taken the standard medication according to GINA guidelines (inhaled corticosteroid with LABA combination and inhaled β-2 agonist). Analysis of Data aired test was used to test the mean difference score of the subjects at baseline, after 3 months and 6 months in both groups, i.e., yoga and control groups. Student's independent sample test was used to compare the differences in scores between yoga and non-yoga group. Differences were considered significant if p<0.05. The Statistical analysis was done by using Graph adin Stat version 3.05 software Inc, year 2000 (Version Graph adsoftware, Inc., California). Results Use of rescue medication at baseline in between group comparison is given in Table 2. Both groups are comparable in every respect and there was no significant association found in both groups. The values of outcome measures are given in Tables 3-6. Between groups comparisons are given in Tables 3&4 after 3rd month and 6 th month respectively the intervention of yoga to the yoga group. There was no significant difference found in two groups at 3 rd month in between group comparison (Table 3) but the between group comparison at 6 th month showed a highly significant difference in the medication use (Table 4). Comparison of pre- and post symptom

3 AGNIHOTRI et al.: YOGA AND RESCUE INHALED MEDICATION IN ASTHMA 677 Table 2 Baseline scores of cases and control Cases Controls medication use (puffs/day) * value significant (5 level of significance) value not significant (>0.05) for any of the parameter Table 3 Scores of cases and controls at 3 rd month Cases Controls medication use (puffs/day) * value significant (5 level of significance) value not significant (>0.05) for any of the parameter Table 4 Scores of cases and controls at 6th month Cases Controls medication use (puffs/day) < * value significant (5 level of significance) value not significant (>0.05) for any of the parameter Table 5 Comparison of pre and post rescue medication changes occurred in yoga group and control group after 3 month Medication Medication Use (puffs/day) Baseline Yoga group After 3 month t Baseline After 3 month Control group < < * value significant (5 level of significance) value not significant (>0.05) for any of the parameter Table 6 Comparison of pre- and post rescue medication changes occurred in yoga group and control group after 6 month Yoga group Control group Medication Baseline After 6 month t Baseline After 6 month Medication Use (puffs/day) < < value significant (5 level of significance) value not significant (>0.05) for any of the parameter score changes occurred in yoga group and control group at 3 rd month and 6 th month respectively after the intervention of yoga to the yoga group are given in Tables 5&6. It has been observed in pre- post comparison at 3 rd month in the yoga group that medication use decreased significantly by from to in the yoga group (<0.0001) and decrease was found in control group from to (<0.0001). As seen in the Table 6, a significant difference of found in the rescue medication use from to (<0.0001) in the yoga group and it was found from to (<0.0001) in the control group. Discussion The results of this study suggest that at posintervention, between groups differences were found highly significant with better improvement in the rescue medication use. It was observed in within group comparison that the decrease was much less in the yoga group at 3 rd month while at the end of 6 th month the use of rescue medication decreased by in the yoga group in comparison to control group. About 55 decrease was found in the yoga group which showed that yoga may be used as an adjuvant therapy along with standard medical treatment and the requirement of rescue medication can be reduced. A randomized controlled trial has

4 678 INDIAN J TRADIT KNOWLE, VOL. 15, No. 4, OCTOBER 2016 shown the effect of yoga on asthmatic patients and concluded that the yoga group showed 66.7 reduction in the use of salbutamol puff and 58.3 salbutamol tablets while control group showed only a reduction of 16.6 in the use of puff 17. In a randomized controlled study the frequency of rescue medication use significantly decreased over the study period in both groups (yoga as well as control group). But the decrease was achieved relatively earlier and was more marked in the yoga group than in the control group 18. A study reported that the buteyko breathing technique (The ink City Lung Exerciser) and pranayama can improve symptoms and reduce bronchodilator use 19. Results of some controlled trials with small number of patients support our findings but some of the randomized trials were not supported by sound evidence 20. A review article showed the result of 195 papers regarding yoga in 24 journals indexed in Integrative and Complementary Medicine. All the presented results indicate the scientific effects of yoga. A large number of diseases were treated with yoga therapy in which several studies reported psychological and physiological outcomes of yoga therapy 21. Conclusion The current study shows that the yogic intervention decreased the use of rescue medication. About 55 decrease was found in the yoga group in rescue medication use which shows that yoga can be used as an adjuvant therapy with standard inhalation therapy and rescue medication use can be reduced. Overall, the study shows that yoga can be practiced as an adjuvant for better outcome of asthma. Suggestions for future work Due to the small number of controlled trials and due to the small number of patients studied, it is not possible to make firm judgments regarding the long-term efficacy of using yoga to control asthma attacks. It is recommended to more carefully construct randomized controlled trials using strict methodology and more rigorous trials are needed to conduct. Asthma is a serious health problem of the community but in severe condition yoga is not helpful in achieving any benefit. So, it is also recommended to conduct the randomized controlled trials on mild to moderate persistent asthmatic patients. Acknowledgment Authors are grateful to all the patients who kept patience for 6 months up to the completion of study period and performed regular yoga practice. We are also thankful to yoga instructor and entire faculty of the Department of ulmonary Medicine and the Institutional Ethics Committee, King George s Medical University, Lucknow, U, India and Indian Council of Medical Research (ICMR), New Delhi for financial support. References 1 Agnihotri S, Kant S, Mishra SK & Tripathi M, Role of Yoga in Asthma Management, Dynamics of Human Health (DHH), 2(1) (2015): 2 Cockcroft DW & Swystun VA, Asthma control versus asthma severity, J Aller Clin Immunol, 98 (1996) Williams K, Steinberg L & etronis J, Therapeutic application of iyengar yoga for healing chronic low back pain, Int J Yoga Ther,13(2003) Lasater J, The heart of antajali, Yoga J, 137 (1997) Raub JA, sychophysiologic effects of hatha yoga on musculoskeletal and cardiopulmonary function: A literature review, J Altern Comple Med, 8 (2002) Collins C, Yoga: Intuition, preventive medicine, and treatment, J Obstet Gynecol Neonatal Nurs, 27(1998) Catherine Woodyard, Exploring the therapeutic effects of yoga and its ability to increase quality of life, Int J Yoga, 4 (2011) Arora S & Bhattacharjee J, Modulation of immune response in stress by yoga, Int J Yoga, 1 (2008) Ray US, Sinha B, Tomer OS, athak A, Dasgupta T & Selvamurthy W, Aerobic capacity and perceived exertion after practice of Hatha yogic exercises, Indian J Med Res, 114 (2001) Nagendra HR, Integrated yoga therapy for mental illness, Indian J sychiatry, 55(2013) Telles S, Raghuraj, Maharana S & Nagendra HR, Immediate effect of three breathing techniques on performance in a letter cancellation task, erceptual and Motor Skills, 104(2007) Agnihotri S, Kant S, Mishra SK & Singh R, Efficacy of yoga in mild to moderate persistent chronic bronchial asthma, Indian J Tradit Knowle, 15(2) (2016) Bentley AM, Menz G, Storz C, Robinson DS, Bradley B, Jeffery K, et al., Identification of T lymphocytes, macrophages, and activated eosinophils in the bronchial mucosa in intrinsic asthma, Relationship to symptoms and bronchial responsiveness, Am Rev Respir Dis, 146(1992) Joshi M & Telles S, A nonrandomized non-naïve, comparative study of the effects of kapalabhati and breath awareness on even related potentials in trained yoga practitioners, J Alter Complem Med,15(2009) Khemka SS, Negendra HR & Hankey A, of integral yoga on psychological and health variables and their correlations, Int J Yoga, 4(2011) Schwartz J & Weiss ST, rediction of respiratory symptoms by peripheral blood neutrophils and eosinophils in the First National Nutrition Examination Survey (NHANES I), Chest, 104(1993)

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