Brigham & Women’s Hospital Harvard Medical School Yoga and Asthma Yoga Alliance Webinar May 12, 2020 Sat Bir S. Khalsa, Ph.D. Assistant Professor of Medicine, Harvard Medical School Director of Yoga Research, Yoga Alliance Director of Research, Kundalini Research Institute Editor in Chief, International Journal of Yoga Therapy Research Associate, Benson Henry Institute for Mind Body Medicine Research Affiliate, Osher Center for Integrative Medicine
Overview Asthma: • is a chronic disease of the lungs • affects adults and children of all ages • is characterized by repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing Asthma Prevalence in the U.S.: Slide set ppt, Downloadable set of 18 slides graphically summarizing asthma prevalence in the United States https://www.cdc.gov/asthma/Asthma_Prevalence_in_US.pptx
Causes, Risk Factors, Burden – In most cases, we don’t know the exact causes of asthma and we don’t know how to cure it. – Most people with asthma can control their symptoms by: • avoiding things that trigger an asthma attack and • receiving appropriate medical care – Without proper management, asthma can result in frequent emergency department (ED) visits, hospitalizations, and premature deaths. Asthma Prevalence in the U.S.: Slide set ppt, Downloadable set of 18 slides graphically summarizing asthma prevalence in the United States https://www.cdc.gov/asthma/Asthma_Prevalence_in_US.pptx
Prevalence and Burden Asthma: • affects 25 million people, including 6.0 million children under 18; • is a significant health and economic burden to patients, their families, and society: – In 2016, 1.8 million people visited an ED for asthma-related care and in 2016, 189,000 people were hospitalized because of asthma Asthma Prevalence in the U.S.: Slide set ppt, Downloadable set of 18 slides graphically summarizing asthma prevalence in the United States https://www.cdc.gov/asthma/Asthma_Prevalence_in_US.pptx
https://www.cdc.gov/asthma/asthmadata.htm
Asthma Factors Triggers ⚫ allergen exposure, infection, exercise, cold weather, dietary ⚫ emotional stress Pathophysiology ⚫ bronchoconstriction ⚫ bronchial hyperresponsiveness ⚫ airway inflammation
Pathophysiology https://www.nhlbi.nih.gov/health-topics/asthma
Stress and Asthma “The fact that psychological factors can influence asthma symptoms underscores the critical role of the brain…Yet, research directed toward understanding the pathophysiology of asthma has mostly overlooked the role of the brain.” “Asthmatics under chronic stress had a larger HPA-axis response to an acute stressor, which failed to show the suppressive effects on inflammatory markers observed in those with low chronic stress.” From: Mind-body interactions in the regulation of airway inflammation in asthma: A PET study of acute and chronic stress. Rosenkranz MA, Esnault S, Christian BT, Crisafi G, Gresham LK, Higgins AT, Moore MN, Moore SM, Weng HY, Salk RH, Busse WW, Davidson RJ, Brain Behavior and Immunity, 58:18-30, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045317/pdf/nihms782546.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654539/pdf/nihms872246.pdf
Yoga Practices Postures, Breathing, Relaxation, Meditation Self-Regulation Awareness Spirituality Fitness ↑Flexibility ↑Attention ↑Unitive State ↑Stress Regulation ↑Strength ↑Emotion Regulation ↑Mindfulness ↑Transcendence ↑Coordination/Balance ↑Resilience ↑Concentration ↑Flow ↑Respiratory Function ↑Equanimity ↑Cognition ↑Transformation ↑Self -Efficacy ↑Self -Efficacy ↑Meta -cognition ↑Life Meaning/Purpose Global Human Functionality ↑Physical & Mental Health, ↑Physical Performance ↑Stress & Emotion Regulation, ↑Awareness/Mindfulness, ↑Meta -cognition ↑ Positive Behavior, ↑Wellbeing, ↑Values, ↑Life Purpose & Meaning, ↑Spirituality
Rationale of Yoga for Asthma “Pranayama may have psychophysiological benefits by increasing the patient’s sense of control over stress and thus aids in reducing their autonomic arousal factors. Yoga stabilizes autonomic equilibrium with a tendency towards parasympathetic dominance rather than stress-induced sympathetic dominance. Yoga therapy readjusts the autonomic imbalance, controls the rate of breathing and relaxes the voluntary inspiratory and expiratory muscles, which results in decreased sympathetic reactivity. Yoga increases respiratory efficiency, balances activity of opposing muscle groups and slows dynamic and static movements.” From: A study of the effect of yoga training on pulmonary functions in patients with bronchial asthma, Sodhi C, Singh S, Dandona PK, Indian Journal of Physiology and Pharmacology, 53:169-74, 2009.
Yoga for Asthma Research
Yoga for Asthma Meta- analysis From: Yoga for asthma, Yang ZY, Zhong HB, Mao C, Yuan JQ, Huang YF, Wu XY, Gao YM, Tang JL, Cochrane Database Systematic Reviews, Apr 27;4:CD010346, 2016.
“…there is preliminary evidence to support the use of yoga and mindfulness for enhancing physical and psychological health of children and adolescents with asthma. …there is a need for self - management interventions such as yoga and mindfulness, for symptom management and self-regulation of triggers. Yoga and mindfulness-based interventions offer inexpensive, non-invasive approaches which may decrease stress and anxiety and improve lung function in children and adolescents.”
Yoga for Asthma From: Yoga for bronchial asthma: a controlled study, Nagarathna R, Nagendra HR, British Medical Journal, 291:1077-9, 1985.
Yoga for Asthma From: Study of pulmonary and autonomic functions of asthma patients after yoga training, Khanam AA, Sachdeva U, Guleria R, Deepak KK, Indian Journal of Physiology and Pharmacology 40:318-324, 1996.
Yoga Lifestyle for Asthma From: The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial. Vempati R, Bijlani RL, Deepak KK, BMC Pulmonary Medicine, 30;9:37, 2009. https://bmcpulmmed.biomedcentral.com/track/pdf/10.1186/1471-2466-9-37
Yoga Lifestyle for Asthma From: The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial. Vempati R, Bijlani RL, Deepak KK, BMC Pulmonary Medicine, 30;9:37, 2009. https://bmcpulmmed.biomedcentral.com/track/pdf/10.1186/1471-2466-9-37
Yoga Lifestyle for Asthma From: The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial. Vempati R, Bijlani RL, Deepak KK, BMC Pulmonary Medicine, 30;9:37, 2009. https://bmcpulmmed.biomedcentral.com/track/pdf/10.1186/1471-2466-9-37
Yoga for Asthma From: Yoga training improves quality of life in women with asthma. Bidwell AJ, Yazel B, Davin D, Fairchild TJ, Kanaley JA. Journal of Alternative and Complementary Medicine, 18:749-55, 2012.
Yoga Lifestyle for Asthma From: Effect of yoga practices on pulmonary function tests including transfer factor of lung for carbon monoxide (TLCO) in asthma patients. Singh S, Soni R, Singh KP, Tandon OP, Indian Journal of Physiology and Pharmacology, 56:63-8, 2012. https://ijpp.com/IJPP%20archives/2012_56_1_Jan%20-%20Mar/63-68.pdf
Yoga for Asthma From: The effect of yoga on respiratory functions, symptom control and life quality of asthma patients: A randomized controlled study. Bahçecioğlu Turan G, Tan M, Complementary Therapies in Clinical Practice, 38:101070, 2020.
Yoga & Exercise-Induced Asthma - Children Figure 2. Maximum FEV 1 % Fall Before and After Yoga Training Maximum FEV1 % Fall Exercise Response Positive Asthmatics Exercise Response Exercise Response Positive Asthmatics Negative Asthmatics From: Is yoga training beneficial for exercise-induced bronchoconstriction? Tahan F, Eke Gungor H, Bicici E, Alternative Therapies in Health and Medicine, 20:18-23, 2014.
Yoga Effect on Inflammatory Markers in Asthma From: Impact of yoga on biochemical profile of asthmatics: A randomized controlled study, Agnihotri S, Kant S, Kumar S, Mishra RK, Mishra SK, International Journal of Yoga, 7:17-21, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4097911/?report=printable
Pranayama for Asthma Research
“We found that the breathing exercises or yoga and/or pranayama are generally multi-component packaged interventions, and are described as follows: Papworth technique, Buteyko technique, Yoga and/or Pranayam. These techniques primarily modify the pattern of breathing to reduce hyperventilation resulting in normalisation of CO2 level, reduction of bronchospasm and resulting breathlessness. In addition they also change the behaviour, decrease anxiety, improve immunological parameters, and improve endurance of the respiratory muscles that may ultimately help asthmatic children. We found 10 clinical trials conducted in children with asthma of varying severity, and found to benefit children with chronic (mild and moderate) and uncontrolled asthma, but not acute severe asthma.”
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