Bronchial Asthma And Its Diurnal and Seasonal Variability from Ayurveda Perspective

In this blog will look into the seasonal change and variability of the diurnal changes and  its  symptoms and exacerbation of the bronchial asthma. It is a  reversible  airway obstructive disease . Will discuss integrative pulmonary medical perspective with use of Ayurveda to understand the disease at new angle.

Bronchial asthma is the bronchoconstrive disease lung disorder  with generally  good a bronchodilator response. It is one the common disorder with about 5% of population been affected at varying degree. An improvement of 12% and more than 200ml in Force vital capacity and or First Expiratory volume in first second on Pulmonary function test suggest underlying bronchial asthma. Also if the mechacholine challenge test is done and is positive at a lower concentration in a clinically adequate picture suggest underlying bronchial asthma. This are the general diagnostic criteria for diagnosis or asthma or exclusion of the bronchial asthma.

Bronchial asthma patient have a varying degree of the symptoms based on the degree of the severity of the disorder one has, specially if they have  more than 3-5 years of the symptoms. Bronchial asthma could be related to the intrinsic asthma factors or the extrinsic  cause or combination of both with allergic symptoms affecting the  nasal and sinus passages. The common asthma symptoms are cough, wheezing, post nasal drip and the reflux symptoms.

Patient with moderate to severe persistent bronchial  asthma symptoms may see a diurnal variation in their daily symptoms and also see the variability of   the symptoms as the weather changes. With the change in the  fall to winter, winter to spring or spring to summer they have different variability of the symptoms and it s exacerbation.

Now lets look into the asthma at different angle. Looking at the angle of Ayurveda and its relation with the daily symptoms. It helps to understand the reason for the change as diurnal variable or seasonal variability.

Ayurveda or traditional  Indian medicine has documented the day divided into 3 sets of 4 hours and similarly for the night also. This change happens with the movement of the sun and so is the change in the barometric pressure in the daytime and the  night time . This will has some effect on the airway in patients with bronchial asthma and change in the wheezing, cough, shortness of breath symptoms.

Ayurveda has describe the day in the Kapha, Pitta, and Vata periods. Kapha is earth and water. Pitta is fire and water. Vata is air and space combinations.  Ayurveda describes five basic elements of the universe from which the body and mind is formed. They are the five great elements namely Space, earth, water, fire, and earth. Body is formed with this permutation and combination of this elements based on one’s on genetics. So this five elements when combined in 3 different combination sets will give rise to 3 basic change or called the Dosha in Ayurveda. So there are Kapha dosha, Pitta dosha and the Vatta dosha. This individual  dosha  again will  give rise to the 3 phases of time during the day and similarly during the night. Day time divided equally with the night time so 12 hours of day and night. As there are 3 dosha will  again divide the day and night in 3 sets again

The Kapha period ( earth + water component which increased at that time in the body  ) is 6am-10am or 6am-10pm where there is increase in flame formation and the mucus secretion. Patients generally have some respiratory symptoms at that time. The Pitta period  ( Fire+ water component increased at this time in the body) is 10am-2pm or 10pm -2am and generally  have the  increase in the acid secretion, GERD symptoms. Genrally there is  decrease in the bronchospasm at that time. Respiratory symptoms do get better generally around lunch time or around midnight  but may get worse latter.  The Vata  period ( air+ space increased at this time in the body) is 2pm-6pm or 2am-6am when the gas is more formed and passed, bronchospasm or cough may come back, person with heart problem may get chest tightness symptoms. Also the night time symptoms of use of inhalers in the middle of the night comes back.

As there is weather pattern in the nature  and it give rise to the   climate.  As discussed  above period  of Kapha, Pitta and Vatta  will give rise to the Kapha period of weather in winter time, Vata period in the spring and the fall time and Pitta period in the summer time. So the patient depending on the genetics  or the Prakruti of the person will have some phase more worse then the other. Some may have worse time in the spring but summer may not be as bad or symptoms may almost goes away. In some it comes in the fall  but winter may be ok. And in some the winter and fall is bad but spring and summer may not be as bad.

By understanding  one owns asthma symptoms if one keeps a log of the symptoms and keep a small diary and the peakflow  one can understand the pattern of the asthma. This may help as a useful guide to prevent future attacks or at least understand the sequence of events happening and more preventive measure may be taken accordingly. If one shows its pattern to their doctor may further guide accordingly.

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10 Helpful Tips For Bronchial Asthma Patients This Winter Season

In this blog we will see bronchial asthma and its management aspect of the disease with asthma prevention tips. Winter months for many bronchial asthma patients is the rough time of the year, as well as for some asthma patients the spring and or fall is a tough time.  A few helpful tips may help understand the asthma disease process, understanding your asthma symptoms; plan the asthma care to prevent exacerbation of asthma symptoms.

1. Update Doctor Visit: Have a Doctor visit if not done recently this fall, especially if you have moderate to severe bronchial asthma. Get checked by your physician if not done recently to adjust your inhalers, nebulizers and medications, flu vaccination and follow the recommendations of your physician. Make sure you have enough refills on your medication.

2. Emergency Prescription: Have a prescription of antibiotic and steroid handy if you have severe persistent bronchial asthma.  Based on the severity of underlying asthma, it may be good to have a prescription of an antibiotic and prednisone handy especially if you have an exacerbation of symptoms on the holiday or weekend and doctor may not be available right away.  In mild cases discuss such plan with your doctor for medication to be called in to the pharmacy.

3. Know Your Medication: Understand your medications, read about the inhalers you are taking.  Know the normal dose, frequency and maximum dose allowed in 24 hours.  Know the precautions which need to be taken, like with inhaled steroids, the need to rinse the mouth after use.  Understand the side effects of the medication. This is a key of asthma management.  Report side effects if you get to your health care provider. Know your treatments of asthma that you are getting from your health care provider. Similarly the treatments for asthma that you have received before. With this understanding will help you understand your disease process. Example once you needed the tapering steroids when you were sick was given for your asthma exacerbation. If you are taking long acting bronchodilator with the inhaled steroids and it is the ongoing treatment for your asthma to control asthma symptoms.

4. Peak Flow Meter: Get a pick flow meter if you don’t have and do peak flow meter reading and keep a log of your peek flow.  If there is a change in your peek flows inform your health care provider. Many peak flow meters will have green, yellow and red zone and keep track of it. With the change in the zone or change in peak flow by more than 100 inform your physician.

5. Simple Precautions To Take: Wash your hands frequently; this will prevent germs from passing from one person to another person. Stay away from sick people.  If you know someone is sick avoid contact with them as much as possible, as this will prevent exposure and exacerbation of the symptoms.  Cover your face when coughing.  This prevents germs being spread through the air and other people being exposed if you are sick.

6. Urgent Treatment for Bronchial Asthma: Get urgently treated with the onset of cold symptom, bronchitis, early pneumonia symptoms. Know your asthma symptoms and especially if someone in the family feels that it has changed don’t ignore it. It needs to be controlled.    If you get cold or respiratory symptoms contact your doctor to see if an antibiotic is needed or whether a change of inhalers may be needed would be adequate or if there is a need for steroids. See plan #2 and discuss with your doctor before you get sick.

7. Bronchial Asthma Education: Learn about the disease, exacerbation factors, and prevention and how to control.  Get familiar with asthma symptoms. Night time cough is a very common symptom of asthma not under control or its onset is a good of worsening asthma clue which most people don’t think. They think of wheezing which comes later and cough is a common symptom of asthma. Need for night time use of the inhaler means that the asthma symptoms are not under control. Post nasal drip and the GERD are two other exacerbation factors of asthma that one needs to look into if it starts suddenly. Smoking cessation if one is smoking is a key for asthma control. There are no specific cures for asthma but good education and understanding the disease and how to adjust medication, drugs, exercise, few foods to avoid, good life style, good sleep and relaxation, Yoga and Pranayama may work for many to control the asthma and allergy symptoms under control.

8. Bronchial Asthma and Food: Learn about the food that causes the bronchospasm, increase mucus production, increase post nasal drip or sinus congestion or sinus headaches etc. Few foods to avoid is  cold water or ice water or  cold drinks or ice drinks or anything that is cold and not at room temperature as it produces slow bronchospasm and increase mucus formation and slows the digestion. Unfortunately chocolate which tastes so good is not good for asthma it increases bronchospasm. Foods like banana, milk products, tomatoes, potatoes, eggplant etc. increase mucus formation. Avoid them if possible.

9. Plan The Emergency Care: Think what you or your family will do if your asthma flares up? Make a plan now. What if the flare up is mild will you call your doctor and be seen? If it is moderate then will you go to the Emergency room to get treated right away? What if you cannot breath will you call 911? Who will call 911? Who will inform EMS or emergency medical service personal about the medical condition and the medication that you are taking. Plan the care and take care of asthma. By this there is no last minute panic in the family.

10. Learn Ayurveda and or Other Alternative Medical Prevention Options:  Prevention is better than the cure is the old say in English. Many asthma patients are looking for a prevention aspect and cannot find that works. Ayurveda is the science of healthy living and is the traditional Indian medical science. Ayurveda is oldest medical science which has documented the asthma and its causes and prevention and treatment.  Bronchial asthma is a long term disease for many people.  If one is interested by slowly learning natural ways to control it may decrease long term use of medication and side effects of the drugs and improve quality of life. Use the medicines and inhalers under guidance of the doctor but as asthma improves the dose could be decreased or minimized or discontinued gradually. Or only need for the rescue inhaler is needed. One should know that if more than 2 albuterol inhaler canisters use in one calendar year means that asthma is not under control.  Make a short term and long term plan for asthma improvement.  By understanding your own body your mind and emotion is a key to improve health and Ayurveda helps to provide this insight.  Learn your body type, imbalance of the energy in the body, toxin built up, body type food, all this are referenced in Ayurveda. What we eat is what we are is the old say and it is true. As food has effect on our health and so is the effect on asthma symptoms. Ayurveda has a great insight for prevention of asthma. If one is interested in learning more than one may learn  appropriate Ayurveda diet based on the one’s Prakruti ( genetics) and Vikruti ( imbalance or toxins in the body). Good book to start is Ayurvedic Cooking for Self-Healing by Usha Lad, Vasant Lad.

Coordinate care with your physician and do regular follow up. No asthma care improves without multimodalities management like medication, inhalers, diet, exercise, sleep, relaxation, social support, and off course good guidance and monitoring of health care professional. Good luck and best wishes…

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Integrative Medical Treatment & Management Benefits in patients with Bronchial Asthma and Chronic Obstructive Pulmonary Disease

Bronchial Asthma and COPD Treatment

This is the first blog for the web site asthma-copd-care.com discussing the need for the integrative medical management and treatment approach for patients with bronchial asthma and chronic obstructive pulmonary disease (COPD). In this blog, we will discuss the standard approach for bronchial asthma and chronic obstructive pulmonary disease, and the benefits of adding other modalities to further optimize medical treatment.

Bronchial asthma is a very common respiratory disorder. Almost everyone knows someone in his or her family, friend or co-worker who suffers from bronchial asthma. It has multiple facets and gets worse with time if remains untreated. If untreated, it leads to deterioration of health and increase in medical expenses.  Similarly, the outcome is the same for those with COPD, but it is generally seen in smokers mostly, for which they themselves are responsible. There are a few patients who have COPD as a result of second hand smoke exposure.

Inhalers are key in the treatment of disease control. There are different groups of inhalers used to treat asthma and COPD.  Many are common in its treatment as it is a similar disease but not completely the same either. Bronchial asthma is an airway reversible disease and has good response with bronchodilators but the same is not true in the case of COPD as the bronchodilator has less airway reversibility than asthma.

There are short-acting inhalers, long-acting inhalers, steroid inhalers and other medications, which are taken orally for control of the symptoms. These help to control the symptoms of asthma or COPD, but do not eliminate or decrease the need in the long run.  If the disease is not under control then this increases the cost of health care and dependence on medication.

Standard medial therapy is excellent in helping to control the symptoms of asthma or COPD, but when other alternative modalities are added to the current standard medical management then the chance of slowly improving the asthma and COPD is there. This may help to overall improve the symptoms and cut down the need for inhalers. This may happen in many patients but not all, and still may show some clinical improvement. This may decrease the need for Emergency visits, urgent care visits or hospitalization.

The integrative medial treatment approach is an addition to other alternative modalities of treatment like Ayurveda, Yoga, Pranayama, exercise, special diet, etc., to the standard medical treatment that one is getting.  The goal is to use the multidisciplinary approach to control the disease of asthma and/or COPD, as it is simple, yet a complex disease that has multiple mechanisms of manifestation and exacerbation. A multi-modality treatment approach helps rather than just using the standard treatment of just inhalers or nebulizers alone. This is our observation in our practice in the group of patients who prefer the approach of integrative modalities of treatment verses the standard medication treatment alone protocol.

One may think, can such kind of integrative treatment approach help? Why does adding a regimen like exercise, special diet, Ayurvedic herbs, improvement of sleep through good sleep hygiene and lifestyle, etc., help?

There are no standard medical trials or any head-to-head medical trials involving the findings found in medical literature to prove or disprove it, but it is our experience that it helps patients with asthma and/or COPD from our observation of hundreds of patients having been followed over many years in our Pulmonary and Sleep Medicine Clinic. We have taken many of the observations from the literature of Ayurveda and incorporated in current medical treatment. We have tried to incorporate two different medical systems for overall improvement of asthma or COPD. It is like using the parallel software of an Apple computer to connect two different operating systems of Microsoft and MAC to get the benefits of both software and operating systems.

We have seen that Ayurveda gets incorporated better with standard medical treatment and it helps the patient. Ayurveda is the oldest documented medical literature. Asthma is not a new disease it has existed for thousands of years so why not use that data and old observation of Ayurveda to help patients currently suffering from the disease and incorporate it with current medical science to further optimize the patient’s health?

By adding the basic principles of Ayurveda, the world’s oldest medical science, we have seen that gradually, over many months and in 2-3 years the body starts changing. One may say that toxins come out of the body or the airway reactivity decreases. Or it may be part of rejuvenation of the body. Thereby slowly the exacerbation of the asthma or COPD symptoms mayl decrease. One needs to improve the digestion, postnasal drip, heartburn symptoms, irritable bowel symptoms, excess gas or bloating sensation, irritability or lack of sleep or inadequate sleep one has with asthma and/or COPD.

Nature has pairs of opposites forces. As there is a disease in the body so exists a healing system in the body, also. We would like to tap into the second one. The body has inherent properties of healing on its own, it just needs adequate condition and time, and if it happens then there is a high chance that the body can get better. Although there are so many variable factors, there are few known and most of are unknown to us but the body has a tendency to heal and get better.

A disciplinary approach is needed with clinical monitoring of asthma and COPD treatment and management by addressing every issue of the symptoms one has one by one and giving time for the body to change. This will subsequently bring improvement in breathing, decrease respiratory infection, decrease in need of rescue inhaler or nebulizer, sleep improvement, etc.

Because of this kind of need for medical management of asthma and COPD, we have designed the bronchial asthma and COPD integrative medical treatment protocol to help patients who are interested in this kind of medical approach. The program is clinically monitored for underlying asthma and COPD disease progress.

The asthma and COPD program uses the best of eastern and the western medical science to optimize underlying bronchial asthma and chronic obstructive pulmonary disease. We have used this approach on hundreds of patient with excellent results.

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