Saturday, January 22, 2011

Asthma or Shwasa

Asthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing.

Asthma 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.
Muscles within the breathing passages contract (bronchospasm), causing even further narrowing of the airways.
This narrowing makes it difficult for air to be breathed out (exhaled) from the lungs.
This resistance to exhaling leads to the typical symptoms of an asthma attack.
This reduces the amount of air that can pass by.

When the inflammation is "triggered" by any number of external and internal factors, the passages swell and fill with mucus.

Causes :
The exact cause of asthma is not known.

In sensitive people, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers).
An asthma attack is a reaction to a trigger. 
It is similar in many ways to an allergic reaction. 

Each person with asthma has his or her own unique set of triggers. 
Most triggers cause attacks in some people with asthma and not in others. 

Common triggers of asthma attacks are the following :
01. Exposure to tobacco or wood smoke.
02. Breathing polluted air.
03. Inhaling other respiratory irritants such as perfumes or cleaning products.
04. Exposure to airway irritants at the workplace.
05. breathing in allergy-causing substances (allergens) such as molds, dust or animal dander.
06. An upper respiratory infection, such as a cold, flu, sinusitis, or bronchitis.
07. Exposure to cold, dry weather,
emotional excitement or stress.
08. Physical exertion or exercise.
09. Reflux of stomach acid known as gastroesophageal reflux disease or GERD.
10. Sulfites - an additive to some foods and wine.
11. Menstruation - In some, not all, women, asthma symptoms are closely tied to the menstrual cycle.

Risk factors for developing Asthma :
01. Hay fever (allergic rhinitis) and other allergies - this is the single biggest risk factor.
02. Eczema - another type of allergy affecting the skin.
03. Genetic predisposition - a parent, brother or sister also has asthma.

Symptoms :
Asthma attacks can last for minutes to days, and can become dangerous if the airflow is severely restricted.

01. Cough with or without sputum (phlegm) production
Pulling in of the skin between the ribs when breathing (intercostal retractions).
02. Shortness of breath that gets worse with exercise or activity.
03. Wheezing, which... 
       a) Comes in episodes with symptom-free periods in between 
       b) May be worse at night or in early morning 
       c) May go away on its own 
       d) Gets better when using drugs that open the airways (bronchodilators) 
       e) Gets worse when breathing in cold air 
       f) Gets worse with exercise 
       g) Gets worse with heartburn (reflux) 
       h) Usually begins suddenly

Emergency symptoms :
01. Bluish color to the lips and face
02. Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack
03. Extreme difficulty breathing
04. Rapid pulse
05. Severe anxiety due to shortness of breath
06. Sweating

Other symptoms that may occur with this disease:
01. Abnormal breathing pattern - breathing out takes more than twice as long as breathing in
02. Breathing temporarily stops
03. Chest pain
04. Nasal flaring
05. Tightness in the chest

Current guidelines for the care of people with asthma include classifying the severity of asthma symptoms, as follows:
01. Mild intermittent : 
This includes attacks no more than twice a week and nighttime attacks no more than twice a month. Attacks last no more than a few hours to days. Severity of attacks varies, but there are no symptoms between attacks.

02. Mild persistent : 
This includes attacks more than twice a week, but not every day, and nighttime symptoms more than twice a month. Attacks are sometimes severe enough to interrupt regular activities.

03. Moderate persistent : 
This includes daily attacks and nighttime symptoms more than once a week. More severe attacks occur at least twice a week and may last for days. Attacks require daily use of quick-relief (rescue) medication and changes in daily activities.

04. Severe persistent : 
This includes frequent severe attacks, continual daytime symptoms, and frequent nighttime symptoms. Symptoms require limits on daily activitie

Exams and Tests :
01. Spirometer :
This device measures how much air you can exhale and how forcefully you can breathe out. The test may be done before and after you take inhaled medication. Spirometry is a good way to see how much your breathing is impaired during an attack.
02. Peak Flow Meter :
This is another way of measuring how forcefully you can breathe out during an attack.
03. Oximetry :
A painless probe, called a pulse oximeter, will be placed on your fingertip to measure the amount of oxygen in your bloodstream.
04. Blood Test : 
There is no blood test than can pinpoint the cause of asthma.
Your blood may be checked for signs of an infection that might be contributing to this attack.
In severe attacks, it may be necessary to sample blood from an artery to determine exactly how much oxygen and carbon dioxide are present in your body.
05. Chest x-ray :
A chest x-ray may also be taken. This is mostly to rule out other conditions that can cause similar symptoms.

Treatment :
Like any other chronic disease, asthma is a condition you live with every day of your life. 
You can have an attack any time you are exposed to one of your triggers.

Asthma cannot be cured, but it can be controlled.

You have a better chance of controlling your asthma if it is diagnosed early and treatment is begun right away.

With proper treatment, people with asthma can have fewer and less severe attacks.

Without treatment, they will have more frequent and more severe asthma attacks and can even die.
The goal of treatment is to avoid the substances that trigger your symptoms and control airway inflammation. 

There are two basic kinds of medication for treating asthma:
01. Control drugs to prevent attacks
02. Quick-relief drugs for use during attacks

The most common control drugs are: 
01. Inhaled corticosteroids (such as Azmacort, Vanceril, AeroBid, Flovent) prevent symptoms by helping to keep your airways from swelling up.  
02. Long-acting beta-agonist inhalers also help prevent asthma symptoms. Do not take long-acting beta-agonist inhaler drugs alone. These drugs are generally used together with an inhaled steroid drug. It may be easier to use an inhaler that contains both drugs.  
03. Leukotriene inhibitors (such as Singulair and Accolate)Omalizumab (Xolair), which blocks a pathway that the immune system uses to trigger asthma symptoms. 

Quick-relief drugs include : 
Short-acting bronchodilators (inhalers), such as Proventil, Ventolin, and Xopenex.
A severe asthma attack requires a check-up by a doctor.

You may also need a hospital stay, oxygen, and medications given through a vein (IV). 

Prevention :
01. You can reduce asthma symptoms by avoiding known triggers and substances that irritate the airways.
02. Cover bedding with "allergy-proof" casings to reduce exposure to dust mites.
03. Remove carpets from bedrooms and vacuum regularly.
04. Use only unscented detergents and cleaning materials in the home.
05. Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold.
06. Keep the house clean and keep food in containers and out of bedrooms - this helps reduce the possibility of cockroaches, which can trigger asthma attacks in some people.
07. If a person is allergic to an animal that cannot be removed from the home, the animal should be kept out of the bedroom.
08. 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.

Ayurvedic View : 
Shwasa :
In Ayurveda, Asthma is known as 'Shwasa Roga'.
Samprapti (Pathogenesis) :
The vitiated 'Pranvayu' combines with deranged 'Kapha dosha' in the lungs causing obstruction in the 'Pranavaha srotas'(Respiratory passage). This results in gasping and laboured breathing. This condition is known as 'Swas Roga'.

Causes :
Factors related to Diet :
Excessive indulgence in lablab beans ,black grams, raw milk, soar curd, excess salt, flesh of aquatic and wet land animals.
Excessive use of 'Ruksha'(dry) and 'Guru'(heavy) diet.
Excessive use of cold water and cold drinks.
Excessive use of 'Abhishandi'(Kapha producing) diet. Excessive use of not easily digestible and irritant food.

Factors related to Work :
Excessive exposure to dust and smoke.
Excessive wind, cold, cold bath or excessive heat, sun bath.
Exhaustive exercise, walking, excessive sexual activities.
Supression of natural urges.
Psychological factors.
Other Factors :
Trauma to vital organs - chest, throat.
Asthma may be as a sequaelae in other diseases like Fever, Long standing common cold, Tuberculosis , Anaemia, Heart disease, Poisoning etc.

Types :  
Five types of 'Swas Roga' are described in Ayurvedic texts.

1. Maha shwasa
2. Urdhva shwasa
3. Chinna shwasa
4. Thamak shwasa
5. Kshudra shwasa 

Symptoms :
01. Maha Shwasa :
Heavy breathing.
Helplessness (unable to withstand the trouble).
Respiration is accompanied with sounds resembling those of high pitch sounds from the nose, resembling that of a bull in heat.
Common sense and intelligence are lost.
Eyes and face are unsteady.
Obstruction of urine and faeces.
Broken voice.
Dryness of throat.
Frequent delusions.
Severe pain in ears, temples and head.

02. Urdhva Shwasa :
Prolonged upward breathings (expiration) but difficult respiration.
Obstructed movement of vata.
An upward gaze.
Rolling eye balls.
Terrified look.
Severe pain as though his vital organs are being cut.
Speech choke.
03. Chinna Shwasa :
Patient breathes with interruptions.
Cutting pain in the vital organs.
Burning sensation.
Obstruction in the urinary bladder.
Eyes are unsteady - full of tears.
Delusion or coma.
One eye is angry - red in color. 
Dryness of mouth.
Irrelevant talks.
Feeling of helplessness - inability to do anything.
Loss of chhaya - complexion.
Loss of conciousness.

04. Thamaka Shwasa :
Pain in head, neck, chest, flanks, cough accompanied with cracking sound.
Loss of taste, appetite.
Running nose.
Thirst, Forceful bouts of respiration.
Feeling of going into darkness - losing conciouseness of the surrounding. 
Momentary comfort after expectoration.
Inability to breathe on lying.
Comfortable on sitting.
Eyes wide open.
Perspiration on forehead.
Dry mouth.
Desire for hot comforts.

05. Kshudra Shwasa :
Maruta (Vata) on being aggravated by exertion and overeating, produces Kshudra Shwasa which subsides by itself (without any medication). 

It is heavy breathing on exertion, passes of soon by rest and it is not very troublesome.
Prognosis :
According to Ayurveda out of five types first three are not curable.
Thamaka shwasa is yapya (Controllable) and is difficult to cure.

The last one (Kshudra shwaasa) is curable. 
More than 75% of the cases of swasa roga belong to last two catagories.

Preventive Tips for Asthma : 
01. Avoid over exercise and over indulgence in sex.
02. Go for morning or evening walk, do yoga mainly 'Pranayama'.
03. Drink boiled water in plenty.
04. Avoid perfumes , Agarbatti, Mosquito repellents.
05. Keep rooms well ventilated.
06. Avoid air conditioners, coolers and direct air of fan.
07. Avoid Tobacco, wine and smoking 
08. Avoid over eating . 
09. Take light dinner one hour before going to bed.
10. Avoid cold and damp places.

Foods to be avoided :
Even though the diet differs between different age groups of the patient there are some common foods which trigger asthma attack in most people. 
They are...
01. Milk and other dairy products 
02. Egg 
03. Gluten containing foods  
04. Alcoholic beverages 
05. Strong tea 
06. Fried foods 
07. Sulphites which are used as preservative in beer, wine, bottled lime juice etc. 
08. Shell fish 
09. Nuts 
10. Soy 
11. High salt diet 
12. Cold foods 
13. Saturated fatty acids 
14. Acid forming foods 
15. Food which contains yeast like bread and blue cheese 
16. Food colours (E102, E104 etc.)

The food stuffs especially those which induce the production and secretion of mucous such as dairy products, chocolates, cakes etc. should be avoided since the mucous gets accumulated in the constricted airway making the condition more worse. 

Similarly the food item which contains high level of saturated fatty acids such as red meat (beef, pork, mutton etc.) and butter should also be avoided. Diet rich in gluten was found to induce asthma attack. Gluten is basically a complex protein which is very difficult to digest. 

Foods to be included in the diet :
Certain food items when consumed help in relieving the symptoms by reducing the inflammation. 
When such foods are consumed the nutrients present in it goes straight to the lungs and thus helps in the fast relief of inflammation in some people. 

01. Fruits and vegetables should be eaten in plenty since it is rich in antioxidants and also contains nutrients that enhance the immune system.

02. Food items rich in vitamin C and Vitamin E contain large amount of antioxidants in it. These antioxidants play a great role in relieving asthma symptoms. Antioxidants act by neutralising the free radicals. Food items like orange, lemon, broccoli, brussels sprouts, kiwi, grapes, pine apple etc. are example for food rich in vitamin c. Example for food items with vitamin E are soy meal, sun flower seed, almond, turnip, mustard, kale, whole grain etc. Even though the cooking oil is rich in vitamin E it should not be consumed too much as it has got many other unhealthy effects too. 

03. Vegetables especially the green leafy vegetables like spinach, lettuce etc. contain plenty of bioflavonoid which helps in neutralising the action of antioxidants. 

04. Fish which is rich in omega three fatty acids should be consumed in large amount as it can reduce the airway inflammation. Example for such fishes is mackerel and salmon. 

05. Food which contains sulphur compounds in it like raw onion and scallions are also found to reduce the airway inflammation. 

06. Coffee due to the caffeine present in it helps in reducing the severity of asthma attack.

Food items used for Asthma treatment :   
01. Honey : Honey plays an important role in relieving asthma symptoms.When an asthma patient is made to inhale above a jar containing honey, the asthma symptoms especially the breathlessness gets relieved to a greater extend.
02. Figs : Figs helps in relieving the asthma symptoms by draining of the phlegm thus giving comfort to the patient. Figs should be consumed after soaking in water overnight. Three to four figs a day gives good result.
03. Lemon : Lemon was also found to show great result in asthma treatment.  
04. Ginger : Ginger when consumed along with fenugreek and honey acts as good expectorant. This should be consumed both morning and evening.
05. Garlic : Garlic gives good result when taken after boiling in milk. This is effective especially in the early stages of asthma.
06. Drum stick leaves : The soup prepared with drumstick leaves gives good result in asthma treatment.

Thus the asthma patient should be very much bothered about his diet. 
In addition to this the food which promotes mucous production should also be avoided. 
Also the patient should try to avoid heavy meals which will take more time for digestion and instead should go for lightener meals taken frequently.

Classical Preparations :
01. Dashamoola Kaduthrayam kashaayam
02. Elakannaadhi kashaayam
03. Dashamoolam kashaayam
04. Bala Jeerakaadhi kashaayam
05. Kaasamardhakaadhi kashaayam
06. Bhaarngee Kannaadhi kashaayam
07. Vidhaaryaadhi kashaayam
08. Balaa Koovallaadhi kashaayam
09. Vasarishtam
10. Kanakasavam
11. Dashamoolaarishtam
12. Jeerakaarishtam
13. Agasthya rasayan
14. Dashamoola rasayan
15. Taamboola lehya

Useful Plants :
01. Amalaki : Emblica officinalis - നെല്ലിക്ക 
02. Haritaki : Terminalia chebula - കടുക്ക
03. Bibhitaki : Terminalia bellirica - താന്നിക്ക
04. Haridra : Curcuma longa - മഞ്ഞള്‍ 
05. Daruharidra : Berberis aristata - മരമഞ്ഞള്‍ 
06. Guggul : Commiphora mukul - ഗുല്‍ഗുലു 
07. Gokshura : Tribulus terrestris - ഞെരിഞ്ഞില്‍
08. Ginger (Zingiber officinale) - ഇഞ്ചി
09. Garlic : Allium sativum Linn. - വെളുത്ത ഉള്ളി

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  1. great advise and handsome done ---be aware the society ----congrats

  2. Nice Job.I have shared it on my face book page.Keep up the good work of public service.May God reward you.


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