Various breathing difficulties are explained in Ayurveda under the term shwasa. The term shwasa is used to denote respiration and exchange of air in the body. Shwasa is used for both normal (physiological) and abnormal (pathological) states. Shwasa diseases may be explained as a disease in which the respiratory function is disturbed.
In Ayurveda, Shwasa is classified in the following types.
- Maha Shwasa
- Urdhwa Shwasa
- Chinna Shwasa
- Kshudra Shwasa
- Tamaka Shwasa
Tamaka Shwasa is correlated with the disease of bronchial asthma based on its signs and symptoms and etiopathogenesis. The term tamaka shwasa consists of two words tamaka and shwasa. Here tamaka means sadness, and shwasa is used to express both physiological and pathological respiration. This disease is called tamaka, as the intensity of the disease precipitates during the night. During the state of attack, dyspnea becomes so severe that the patient feels entering into darkness. Tama also means darkness.
Asthma is one of the globally spread diseases. It is a non-communicable disease which means the disease can’t be transmitted from one person to the other. However, it is a hereditary inflammatory disease of lungs. There are several pulmonary diseases that are in the stretch. Of them, asthma specifically affects the bronchi of the lungs. It’s a long term disease. Asthma obstructs the airways of the lungs.
The world health organization categorised asthma amongst one of those major diseases. An estimation of More than 339 million people suffers from asthma in 2016.
The numbers might have spiked in these four years. It’s in both high income and low-income countries, yet a higher count of deaths of asthma are seen in low-income countries. Which is explained in the hygiene hypothesis later on.? asthma is capable of deaths in adults and altering the activities in patients for a lifetime.
Though it has no direct cure, asthma has got medications to control the severity. A life-style well planned and apt management of asthma can give a good life to people alongside. An approximation of 417,918 deaths by asthma all over the globe is estimated by the world health organization. And around 24.8million have been living with disabilities and without activities during 2016.
Centres for Disease Control and Prevention put forth light on certain facts around asthma. The numbers stated that one in every 12 children in the United States suffers from asthma. The age group stands in between newborn to seventeen years. One in every 10 asthma patients over the world comes from our country.
India being a developing country, and its economy backed by most low and middle-class people is several steps lagging in the field of medicine. Most of the citizens cannot afford health insurance and medical cover-ups. This makes the patients unreachable to the major diseases. Despite barriers in treatment, education programmes are conducted for awareness. In 2016 1.31 billion people with two per cent of adults and six per cent of children had fallen to asthma.
The mortality rate of asthma has been falling in the country for years. Rajasthan and Uttar Pradesh record higher deaths. As an endeavour, the government of India has announced health insurance covers for low-income families from 2018.
Mortality rates because of asthma have decreased over the last decades by a better understanding of the disease. However, 170 men per million and ninety women per million died in 2010 of asthma. This varies for every country across the globe. Some of the children diagnosed with asthma are not being followed up with good health checkups further. The diagnosis of asthma in children also affects the life of their parents
Causes for asthma
The lungs are the respiratory organs in the body. The respiratory tract goes through the nasal passages to the lungs. They are a pair of lobed spongy organs filled with air. Has alveoli in it. The windpipe that brings in the air from nostrils branches and extends into the lungs as bronchi. Further divided into bronchioles, that ends up as alveoli. The greatest fact about the lungs is they can accommodate the space of a tennis court. So there is always a vast space for the oxygen. There are more than 30 thousand bronchioles in each lung. They are hairline in thickness. These bronchi and bronchioles constitute the bronchial tree. All these airways help in conditioning the body. Before we understand we shall see the flow of our breath into the lungs. The breath we intake Passes from nostrils, the throat, down the windpipe making a way into the lungs through the bronchial tree filling up the alveoli.
In asthma they get narrow limiting the airflow into the lungs. The walls of the airways swell, this becoming narrow. The muscles within the bronchioles become tight. Thus inhibiting the airflow to the lungs. Bronchospasms and airflow obstruction are the primary changes in developing asthma. The lungs develop inflammation and become swollen. Mucous gets deposited in the narrowed airways.
The causes of asthma are complex.
- Both genetic and environmental factors. That means it gets affected by the genetics passed on from lineage and by the changes in the living environment.
- At the least, not just both of them but also the epigenetics, the heritable factors other than DNA in the cells adds to its cause.
- Asthma which starts in newborn and in children who are below adolescence is purely genetic. And more than twelve years and above its likely to be caused by environmental, medications, and exacerbation.
Let’s see the environmental effect on asthma and it’s aggression.
- The air we breathe in brings in a lot of oxygen to our lungs. It also collects everything that’s around as we inhale.
- All the dust, smoke and metals, chaff, pollution etc, comes along with the air we take in.
- Smoking as we know not only kills the smoker but also pollutes the air around him. The smoke is contagious to the lungs. It causes chronic bronchitis and emphysema alongside asthma too.
- In particular talking about women, pregnant women who smoke are more likely to pass asthma to the newborns. Also, carrying women who undergo constant psychological stress, and those who take many painkillers in the form of paracetamol or acetAminophen, antibiotics of any sort leads to asthma in babies. Pregnant women using any types of H2 blockers to suppress the acids may develop asthma in babies.
- Now getting back to the environmental factors, will start from the dirt, smoke that emits in industrial areas. In our country, the low-income families, above and below the poverty line functions as labour in the industries and factories. Eventually, they reside in the packed slums nearer to that industrial area. Low-quality air is occupied in the industrial as well as crowded and minority community resident areas.
- Organic compounds that are volatile and rotates in the air, the residues of pesticides, plastics, formaldehyde and PVCs promote asthma in children.
- The allergens that reside in and around the home such as cockroaches, dust mites, animal fur and feathers, webs, viruses, bacteria and unhygienic surroundings bring in respiratory infections. These are more likely to develop into asthma in children who are below the adolescence.
- For those who are prone to that allergy, and less immune, they get easily caught by asthma onset. Dusting, brooming, cleaning, organising old stocked up things, taking cold foods, and beverages, ice creams etc, worsen the disease and inflammation in the lungs.
- Maintaining clean and hygienic corners and floors, changing the clothes and sheets regularly, vacuum cleaning the dust, frequent sanitizing the things, staying away from low-quality air keeps away from the environmental risks of asthma.
- The hygiene hypothesis is put forth to explain the cause of asthma in the newborns. It states that those babies that aren’t born through a natural birth passing by the birth canal exposed to healthy bacterial colonies are more immune to those who are born by Caesarian section. The science behind is, the exposure to the bacterial endotoxin at an early age makes the body immune to the development of asthma. The exposure at any growing age in a reverse can result up in bronchoconstriction and respiratory tract infections. Less affluent and highly conscious living children are in more risks of allergens when compared to those that are carefree and full of life.
- If your parents or siblings suffer from asthma, you are more prone to it. Asthma game full-on genetics. There are 25 genes in our body that are recognized to be associated with asthma. These are related to the immune system and inflammation. Genetics of a person when comes in contact with bacterial endotoxin may cause variants in the genes that develop asthma. The more the exposure to the endotoxin and environmental irritants, the more is the risk of asthma.
- Those that are more likely to catch infections, more with allergies and less immune from being a baby are asthma prone. Rhinitis and eczema are two respiratory diseases that cause inflammation in the nose and itchy inflammation of skin respectively. Eosinophilia which increases the white blood cells and mucus in a way is also a risk factor for asthma. Obesity and asthma have a linear correlation. Using medications such as aspirin, NSAIDs and certain enzyme inhibitors, beta-blockers making the person more susceptible to asthma.
- Exacerbation: To explain clearly, some patients show stability in asthma but suffer a sudden acute asthma attack. The progressively worsening of asthma in a line. This is evidently caused by triggers around. A poor immune system, a viral or bacterial infection, psychological stress, dander and dust around, cockroaches and mites around, being exposed to allergens etc can trigger the attacks. In children during winters, or going to schools in rainy and autumn seasons, can cause these acute attacks. Due to the sudden exposure to the allergens, and also the coolest climate prevailing around, and viruses with infections spreading alongside. A seasonal omalizumab treatment four to six weeks before school begins helps to reduce the autumn attacks. It’s one of those costly medicines. Any infections by bacteria or virus worsen asthma and also any kind of respiratory diseases. Those that are undergoing psychological stress, are prone reactive to allergens. They develop immune reactions to the irritants easily, consequently ending up with the disease. Talking about the aid and need of exacerbation, it shall subdue after a while. But as long as the duration of the exacerbation is so is the difficulty caused in the respiratory system.
- Hence it is considered an emergency health condition and requires care of a doctor. The symptoms of an exacerbation are rise in the heartbeat, difficulty in breathing, wheezing, cough and rage.
An asthma attack signifies a group of symptoms. A patient experiencing an acute asthma attack becomes breathless, wheezing and chest tighten. Some patients cough continuously, and wheezing can not be heard too. The respiratory muscles are put to use much in this attack, the exhalation becomes stronger than inhalation, and the chest becomes over-inflated. The nails and skin may turn bluish. In severe attacks, even the bronchodilators and corticosteroids can not help.
Asthma is classified and adopted names by the severity and the symptoms shown.
The scale goes through io intermittent severity to severe persistent severity. These are grouped on the basis of several parameters such as duration and frequency of symptoms, the symptoms in nights, forced expiratory volume in one second noted as FEV and peak expiratory flow rate. For intermittent severity, it goes up to 2weeks and in severe persistent patients, it is on a daily basis. Still, research is going on in categorising the subgroups of asthma.
non-atopic asthma is when it is not caused by any allergens. This corresponds to about 10-30 per cent of the disease with women most affected by it. Usual treatments do not work for this type of asthma.
Alcohol-induced asthma is when asthma is worsened by alcohol consumption. Though drinking alcohol does not start asthma, certainly worsens it in the patients already living with it. Japanese are the living examples from the ethnic groups.
Aspirin-induced asthma also called aspirin-exacerbated respiratory disease (AERD) serves for 9 per cent of asthmatics. The medications used for other respiratory problems and NSAIDs, cause the direct worsening of asthma.
Occupational asthma is caused by the occupations of the patients. Those that work as labour in the industries, chemical factories, plastics and polymers, latex and timber depots are more susceptible to the disease. The people working with solderings, food processors, hairdressers, welders, Shepherds, house staff, sanitary workers, animal fur, nurses, dust and grains etc attracts many allergens risky for the disease worsening.
Exercise-induced asthma is seen in those who exercise vigorously. In people living with asthma, bronchoconstriction happens when exercising. It may also happen in people about 20 per cent who do not have asthma too. Sprinters, athletes, swimmers, cross country skiers, professional players etc commonly get this. Those exercising in dry and cold weather are dangerously prone to this illness.
Allergic asthma is when it is severed by the irritants and allergens around. From pollen of the flowers to the dust in the house corners, food, perfumes and sprays etc. Some smell like wood burning, cold air, polluted air, smoke from cigars and factories, some products used in the house that develop asthma comes under non-allergic asthma or intrinsic asthma. Nocturnal asthma as the name suggests worsens in the night. The heartburn, dust mites in the bed and around, the pet fluff and dander fell all around triggers this. The natural sleep cycle of a person also triggers nocturnal asthma.
CVA furthermore called a cough variant asthma which shows only continuous dry cough. If left untreated it may end up in some serious asthma flares.
Signs and symptoms of asthma
Shortness of breath, a patient with asthma faces difficulty in breathing. The breath falls low. The chest tightens and pain intensifies in the chest. It brings the struggle to cope with breathing. All the accessory respiratory muscles get strained. Continuous coughing and wheezing occur. Sometimes only wheezing is seen. In cold or winters, even in rains, or by wheather change the symptoms worsen.
If the asthma is recurrent and signs are becoming more frequent, that’s the sign of asthma worsening. Anxiety, panic attacks, talking with difficulty, exhaustion, fatigue are seen in asthmatics. Some experience deterioration in early mornings.
Not everyone will have all of these signs and symptoms. Each patient may show a different symptom based on the severity. Any of these symptoms prevailing for a longer time or any among these experienced for more than 2weeks should see a doctor.
Your first asthma symptom will not be an acute asthma attack. An exacerbated attack is seen after a long duration of severity or after a long time of showing symptoms and signs. It doesn’t come as a sudden blow as in a cardiac attack.
Many countries consider differential diagnosis while diagnosing asthma. In children, other airway diseases such as rhinitis, sinusitis, stenosis of the trachea, vascular rings, laryngotracheomalacia, bronchitis etc and in adults for COPD, congestive heart failure too.
Signs and Symptoms of Tamaka Shwasa
- Catching pain in the head, neck, chest, and flanks
- Cough accompanied by cracking sound
- Loss of taste
- Running nose
- Excessive thirst
- Respiration becomes painful feeling life-threatening
- Patients feel as if entering into darkness
- Finds temporary relief after expectoration
- Unable to breathe lying down
- Feels better in sitting posture
- Eyes are gazing up
- Sweating in forehead
- experiences great distress
- The feeling of dryness in the mouth
- Difficulty in breathing increases
- Desires hot comforts
- Worsens when the sky is filled with the cloud, drinking cold water. the cold breeze, intake of kapha predominant food articles
Diagnosis of asthma:
There is no specific and precise test for asthma or a single test to check for asthma in a baby. There will be a series of assessments over the symptoms, the medical history of the family, physical examination and various criteria before concluding any result.
Spirometry is carried on the children of only above five years of age. Spirometry is a breathing test which calculates the airflow, it is not done for children of young age cause it is difficult to calculate their breath typically. The most precise and best test for asthma can be said as spirometry. It measures the forced expiratory volume in one second. Before carrying out this test, a bronchodilator is administered, to make it substantiating the diagnosis. Those that are with mild asthma do not need this test. This is carried out for every year or for a couple of years to follow up on the patient’s health progress.
Some pulmonologists use the single-breath diffusing capacity to check asthma from the COPD existing.
A peak expiratory flow of more than 20 per cent for more than or for two weeks, being treated with bronchodilators or corticosteroids inhalation is tested. Though it is not often tested it is used for people with severe persistent asthma.
Treatment and Medications for Asthma
Medications for asthma are two general classes, quick-acting and long term asthma medications. Besides, there are breathing exercises.
Long term medications include corticosteroids as the most effective drugs. As everyone knows asthmatics are prescribed inhalation, beclomethasone is given. These reduce the inflammation and mucus obstruction. Agonist drugs such as formoterol and salmeterol are given in combination with the anti-inflammatory drugs. In acute exacerbations, antagonists are given in addition to the corticosteroids. Mostly prescribed for those with acute attacks and persistent asthma. Injections of aminophylline which are bronchodilators in function are given, but beta-agonist drugs are more efficiently chosen over these. Anticholinergic’s drugs relieve muscle contractions and chest tightening. But not chosen as a routine drug. For treating children, not a specific but a combination of a beta-agonist, and installed corticosteroid are planned.
Mast cell stabilizers are another option to look for in treating chronic cases.
Fast-acting treatment of asthma includes salbutamol, a quick-acting adrenoceptor agonist. In those suffering from exercise-induced asthma and have to exercise as a compulsion, these are given before exercise. In a chest tightness during an exacerbation, anticholinergic is given to ease the struggle and avoid emergency hospitalisations immediately. The patients who use the combinations of short-acting beta-adrenoceptor and short-acting anticholinergics may experience vibration or agitation. The adrenergic agonists have concerns in cardiac simulation, however not recommended because of it. The use of short-acting drugs only comes to aid and must be used for recovering from an acute attack. They shouldn’t be relayed upon on a routine.
Breathing exercise increases the capacity of the lungs. The flowing of the air in and out of the lungs helps sustain the symptoms of asthma.
Ayurvedic Treatment for Asthma
Ayurvedic treatment for asthma can be divided into three basic steps. They are as follows
- Avoiding the causative factors
- Palliative treatments
- Purificatory treatments
The first line of treatment is avoiding indulgence in causative factors. If the precipitating factors are not avoided, then they further aggravate the disease leading to complications. In Tamaka Shwasa or Asthma, avoiding the triggering factors or causative factors is very important, and it has to be done as soon as possible.
Causative factors for Tamaka Shwasa are
- Prolonged cough.
- Intake of dry, cold, heavy, incompatible food and irregular intake of food.
- Excessive Intake of black gram, beans, sesame, meat of aquatic animals.
- Frequent intake of cold water and exposure to cold climate.
- Exposure to dust, smoke, and wind or living environment
Trauma to throat, chest, and vital organs, etc.
Shamana or Palliative treatments are the first stages of treatment, where the asthmatic patient is advised to take some internal medication. Sometimes, minimal external therapies like steaming are advised. This works when the disease is in the initial stage or when showing mild symptoms. The treatment is followed by the right diet and lifestyle changes and avoidance of triggering factors.
Purificatory procedures (panchakarma treatments) are advised when there is an accumulation of excessive doshas in the body. The purificatory treatments depend on the predominance of the doshas. If there is more kapha, then Vamana or therapeutic vomiting is advised, and if there is pitta predominance, Virechana or therapeutic purgation is advised. Once the body gets purified by these purificatory procedures, the internal medications work much efficiently.
Ayurvedic treatments for asthma depend on the state and stage of the disease. For the best result, one needs to follow the right food habits and lifestyle along with the medications. Repeated purification may be required to eliminate the accumulated causative factors from the body, and finally, preventive medications are advised to prevent the reoccurrence and strengthen the body.
Ayurvedic Medications for Asthma
Various ayurvedic medicinal preparations are used in the treatment of Asthma in the form of decoctions, tablets, powders, herbomineral preparations, etc…. Here are the few ayurvedic medicines used in treating asthma
- Dashamoolakatutraya Kashayam
- Balajeerakadi kashayam
- Dashamoola kashayam
- Nayopayam Kashayam
- Dhanwantharam Gulika
- Swasanandam Gulika
- Karpooradi Thailam
- Agastya Rasayana
(These medications are to be taken only under strict medical supervision. Do not do self-medication, and it can be dangerous. Ayurvedic medications are prescribed depending on the state and stage of the disease)
Preventive care for Asthma
No matter what your health condition is, breathing exercises are always promising. Increase your lung capacity by focusing the inhalation and exhalations for at least 5mins a day. This avoids respiratory issues.
Recognise the allergens and irritants for you. Stay away from them.
Find out those that worsen your asthma and also your severity.
Pneumonia and influenza vaccines are a must. The only way to avoid flare-ups is being vaccinated.
Do not neglect the asthma action plan given by the doctors. Do not skip the medications. Do not overlook your prescription. The way to curb asthma is to organize it. Do not rely upon the quick-acting inhalers and see a doctor instead.
Lead a healthy lifestyle and do not disregard the signs and symptoms shown up if any. Being treated at the earliest is the best. Asthma has no cure, it is chronic and mild too. There is no shortcut other than living with it by managing it. Do not undergo psychological stress.
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