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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 30  |  Issue : 2  |  Page : 98-102

The assessment of effects of yoga on pulmonary functions in asthmatic patients: A randomized controlled study


1 Department of Pulmonary Medicine, King George's Medical University, Lucknow, India
2 Department of Biochemistry, Lucknow University, Lucknow, Uttar Pradesh, India
3 Institute of Human Consciousness and Yogic Sciences, Lucknow University, Lucknow, Uttar Pradesh, India

Date of Web Publication24-May-2016

Correspondence Address:
Surya Kant
Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.182909

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  Abstract 

Background and Objective: Asthma is a serious health problem throughout the world, affecting people of all ages. It is a chronic inflammatory respiratory disorder. There are a few short-term studies with least number of the patients showing the impact of yoga on forced expiratory volume during the first second of the forced breath (FEV 1 ) and peak expiratory flow rate (PEFR). To assess the efficacy of yoga on pulmonary functions in asthma patients. Setting and Design: It was a randomized controlled trial, conducted at a tertiary-care teaching hospital in Lucknow, UP, India. Materials and Methods: The study was carried out in mild-to-moderate persistent asthma (FEV 1 > 60%) patients aged between 12 years and 60 years. The patients were recruited from the Department of Pulmonary Medicine and were randomly divided into two groups as follows: "the case group" and "the control group." Their spirometric assessments were done at the baseline, third month, and sixth month. Statistical Analysis Used: The statistical analysis was done by using GraphPad inStat version 3.05 software Inc., year 2000 (Version. 3.05 GraphPad software, Inc., California, USA). Results and Conclusion: No significant changes were found in spirometric variables in "the control group" during the course of the study. In contrast, "the yoga group" got significantly better improvement in spirometric variables. The result shows that yoga can be an adjuvant therapy along with standard medical treatment for the better management of asthma.

Keywords: Adjuvant, asthma, spirometric variables


How to cite this article:
Agnihotri S, Kant S, Kumar S, Mishra RK, Mishra SK. The assessment of effects of yoga on pulmonary functions in asthmatic patients: A randomized controlled study. J Med Soc 2016;30:98-102

How to cite this URL:
Agnihotri S, Kant S, Kumar S, Mishra RK, Mishra SK. The assessment of effects of yoga on pulmonary functions in asthmatic patients: A randomized controlled study. J Med Soc [serial online] 2016 [cited 2020 May 28];30:98-102. Available from: http://www.jmedsoc.org/text.asp?2016/30/2/98/182909


  Introduction Top


Asthma is a chronic respiratory disorder characterized by reversible airway obstruction, allergic inflammation and airway hyper-responsiveness. In susceptible individuals, this inflammation causes symptoms that are usually widespread and variable such as airflow obstruction that is often reversible, either spontaneously or with treatment, and causes an associated increase in airway responsiveness to a variety of stimuli. [1] Yoga has been considered the best complementary and alternative medicine by the National Institute of Health. [2] Regular practice of yoga provides strength, endurance, and flexibility; facilitates characteristics of friendliness and compassion; and helps develop greater self-control, while cultivating a sense of calmness and well-being. [3],[4] The process of exhalation by the Buteyko method is an important technique in managing asthma. It reduces the frequency and intensity of asthma attacks and involves both physical and psychological factors. [5] By regular practice of yogasanas and pranayama, the constriction of bronchial tubes gets very much reduced. Slowly the capacity of bronchial tubes increases to a great extent and subsequently asthma can be gradually cured from roots. The present study is a split form of study based on the findings of a larger study on bronchial asthma.


  Materials and methods Top


This study was a randomized controlled trial, conducted at a tertiary-care teaching hospital in Lucknow, UP, India. Diagnosed cases of asthma were recruited from the outpatient department (OPD) of the Department of Pulmonary Medicine and were screened by a consultant for the participation in the study on the basis of the inclusion and exclusion criteria. The "Patients having mild to moderate persistent bronchial asthma severity according to GINA (Global Initiative for Asthma)-2009, with age ranging from 12-60 years were included in the study." They were nonsmokers or exsmokers who have not smoked for at least 6 months with reversible airflow limitation of >12% and >200 mL [postbronchodilator forced expiratory volume during the first second (FEV 1 ) >12% and >200 mL]. Patients with severe airflow limitation or more (FEV 1 <60%), Pregnant or lactating women, any associated chronic respiratory diseases and having major psychiatric illnesses and current smokers were excluded. This study was approved by the Institutional Ethics Committee of the hospital.

Sample size for the present study was calculated keeping in view 95% level of significance, 90% power of the study and two-tailed test. Assuming 15% increase in FEV 1 in the study and applying 10% loss to follow-up during the study period, 276 patients were selected for this study.

Sample size = c × p1 (1 - p1 ) + p2 (1 - p2 )(p1 - p2 ) 2

For 90% power, c = 10.5

p1 = 9.9% (Increase in FEV 1 from baseline to 8 weeks) {Vempati et al., 2009}

A total of 276 subjects who satisfied the inclusion criteria were allocated into two groups on the basis of a computer-generated random number table. They were divided into the following two groups - Yoga group who received yogic intervention for 6 months along with standard medical treatment and control group who received only standard medical treatment. Out of 276 subjects (138 cases and 138 controls), 17 subjects from the yoga group and 18 subjects from the control group dropped out during the study period. One hundred and twenty-one subjects of the yoga group and 120 subjects of the control group completed the study successfully. The pulmonary function test was performed with a spirometer (P.K. Morgan's Spiro 232 Pulmonary System) after adjusting it for age and sex according to the requirements of the GINA. Based on the symptoms and frequency of the disease and the daily medication regimen that the patients followed, the patients were classified as mild or moderate severity according to the GINA criteria.

Subjects in the yoga group received yogic intervention (asanas, pranayama, and meditation) for 30 min per day, 5 days in a week for a period of 6 months at the department of Pulmonary Medicine of a tertiary-care teaching hospital, Lucknow [Table 1]. The statistical analysis was done by using GraphPad inStat version 3.05 software Inc., year 2000 (Version. 3.05 GraphPad Software, Inc., California, USA).
Table 1: Yoga module for the yoga group

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  Results Top


Spirometric variables at baseline in between-group comparison are given in [Table 2]. Both the groups are comparable in every respect, and there was no significant difference found in any variable. The values of outcome measures are given in [Table 3],[Table 4],[Table 5] and [Table 6].
Table 2: Baseline scores of cases and controls (between the two groups)

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Table 3: Spirometric variables at third month (between the two groups)

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Table 4: Spirometric variables at sixth month (between the two groups)

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Table 5: Comparison of pre- post spirometric changes occurred in the cases and the control group after 3 month

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Table 6: Comparison of pre- and postspirometric changes occurred in cases and the control group after 6 month

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Between-groups comparisons are given in [Table 3] and [Table 4] after the third and sixth months, respectively, of the intervention of yoga to the yoga group. There was significant difference found in all the spirometric variables [forced vital capacity (FVC), FEV 1 , FEV 1 /FVC, and peak expiratory flow rate (PEFR)] at third month and sixth month in between-group comparison [Table 3] and [Table 4]. At the postintervention period, between-group differences were found highly significant with better improvement in FVC, FEV 1 , and FEV 1 /FVC, and PEFR [Table 4].

Comparison of pre and post spirometric changes occurred in the yoga group and control group at the third month and sixth month respectively after the intervention of yoga to the yoga group are given in [Table 5] and [Table 6]. It has been observed in pre-post comparison at third month that FVC increased significantly by 2.71% from 80.90 ± 5.48 to 83.09 ± 4.70 (P = 0.0003). FEV 1 and PEFR also increased significantly by 9.57% and 11.58% from 68.23 ± 5.87 to 74.76 ± 4.93 (P < 0.0001) and from 64.59 ± 4.89 to 72.07 ± 5.61 (P < 0.0001), respectively. Significant decrease of 4.07% was noted in FEV 1 /FVC from 71.52 ± 5.29 to 68.61 ± 6.78 (P = 0.0002) in the yoga group in comparison to the control group. There was no significant difference found in FVC and FEV 1 /FVC.

As seen in [Table 6], both groups have significant improvement at sixth month. In the yoga group, FVC, FEV 1 , and PEFR increased significantly in the yoga group in comparison to the control group. FVC increased significantly by 6.09% from 80.90 ± 5.48 to 85.83 ± 8.07 (P < 0.0001). FEV 1 and PEFR also increased significantly by 14.89% from 68.23 ± 5.87 to 78.39 ± 4.55 (P < 0.0001) and by 17.08% from 64.59 ± 4.89 to 75.62 ± 4.71 (P < 0.0001), respectively. FEV 1 /FVC decreased significantly by 6.85% from 71.52 ± 5.29 to 66.62 ± 3.97 (P < 0.0001). In the control group, there was also significant improvement found in spirometric variables at sixth month but in comparison to third month, it was not progressive. It has been observed that except for FEV 1 /FVC all the spirometric variables increased firstly at third month, but FEV 1 and FEV 1 /FVC both decreased significantly from baseline upto 6 th month in control group (duration 6 month).


  Discussion Top


The results of this study suggest that both the groups got significant improvement in 6-month study period compared to baseline scores, but the improvement was achieved relatively earlier by the yoga group in comparison to the control group. Between-group differences at sixth month were found to be highly significant with better improvement in all the spirometric variables.

A randomized controlled study of 60 patients has shown that lung functions improved significantly in the patients of the yoga group after 2 months of the yoga practice from the baseline. Pranayama and yoga breathing can be used to increase respiratory stamina, relax the chest muscles, expand the lungs, raise energy levels, and calm the body. [6]

A study has shown the effect of yoga on asthmatic patients and concluded that there was significant improvement in peak expiratory flow rate (PEFR). [7] A short-term study has also significant changes in FEV 1 and PEFR in the yoga group after the regular practice of yoga for 8 weeks of study period from the baseline. This study supported the efficacy of yoga in the management of bronchial asthma. [8]

A study has shown the effect of yoga training on pulmonary functions and revealed that the yoga breathing exercises are beneficial for asthma patients who used it adjunctively with standard pharmacological treatment. Yoga significantly improves the pulmonary functions in patients with bronchial asthma. [9] A study conducted on standard 8 students reported that lung function statistically improved in the students of the yoga group. They suggested that yoga be introduced at school level in order to improve physiological functions, overall health, and performance of the students. [10]

In a study, the effect of the Buteyko technique and pranayama in the bronchial asthma patients for a 6-month period has been reported and concluded that there was no significant change found in lung functions of the patients. [11]

The effectiveness of relaxation therapy has been studied in a group of asthmatics. It found mental relaxation to be more effective than muscular relaxation in the improvement of pulmonary function and subjective measures. [12]

A study was being done on 17 bronchial asthma patients aged between 19 years and 52 years. The results of this study showed that the subjects in the yoga group reported a significant degree of relaxation, positive attitude, and better yoga exercise tolerance. There was also a tendency toward lesser usage of beta-adrenergic inhalers. The pulmonary functions did not vary significantly between the yoga group and control group. The yoga techniques seem beneficial as an adjunct to the medical management of asthma. [13]

A study of yoga was being done on nine asthmatic patients for 7 days. It was a short-term study on a least number of the asthma patients. The results of this study showed no significant change in FVC, FEV 1 , and PEFR. [14]


  Conclusion Top


The previous studies support our findings but most of them were short-term studies and a small number of patients were being studied. The current study is the only long-term study that attempted to show the efficacy of yoga on pulmonary functions in asthma patients.

Overall, this study shows that yoga is an effective tool to improve the pulmonary functions, and it can be practiced as an adjuvant therapy with standard medical treatment of asthma with better outcome.

Financial support and sponsorship

Indian Council of Medical Research, New Delhi.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
O′Byrne P. GINA Executive Committee. Global strategy for asthma management and prevention. National Institutes of Health. Publication No. 02-3659. 2004. p. 18.  Back to cited text no. 1
    
2.
Williams K, Steinberg L, Petronis J. Therapeutic application of Iyengar yoga for healing chronic low back pain. Int J Yoga Ther 2003;13:55-67.  Back to cited text no. 2
    
3.
Collins C. Yoga: Intuition, preventive medicine, and treatment. J Obstet Gynecol Neonatal Nurs 1998;27:563-8.   Back to cited text no. 3
    
4.
Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga 2011;4:49-54.   Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Vasiljeva A, Nias D. The Buteyko method and the importance of carbon dioxide. Positive Health 2003;26-30.  Back to cited text no. 5
    
6.
Singh S, Soni R, Singh KP, Tandon OP. Effect of yoga practices on pulmonary function tests including transfer factor of lung for carbon monoxide (TLCO) in asthma patients. Indian J Physiol Pharmacol 2012;56:63-8.  Back to cited text no. 6
    
7.
Mekonnen D, Mossie A. Clinical effects of yoga on asthmatic patients: A preliminary clinical trial. Ethiop J Health Sci 2010;20:107-12.   Back to cited text no. 7
    
8.
Vempati R, Bijlani RL, Deepak KK. The efficacy of a comprehensive life style modification programme based on yoga in the management of bronchial asthma: A randomized controlled trial. BMC Pulm Med 2009;9:37.  Back to cited text no. 8
    
9.
Sodhi C, Singh S, Dandona PK. A study of the effect of yoga training on pulmonary functions in patients with bronchial asthma. Indian J Physiol Pharmacol 2009;53:169-74.  Back to cited text no. 9
    
10.
Mandanmohan, Jatiya L, Udupa K, Bhavanani AB. Effect of yoga training on handgrip, respiratory pressures and pulmonary function. Indian J Physiol Pharmacol 2003;47:387-92.  Back to cited text no. 10
    
11.
Cooper S, Oborne J, Newton S, Harrison V, Thompson Coon J, Lewis S, et al. Effect of two breathing exercises (Buteyko and pranayama) in asthma: A randomized controlled trial. Thorax 2003;58:674-9.  Back to cited text no. 11
    
12.
Vamos M, Kolbe J. Psychological factors in severe chronic asthma. Aust N Z J Psychiatry 1999;33:538-44.  Back to cited text no. 12
    
13.
Vedanthan PK, Kesavalu LN, Murthy KC, Duvall K, Hall MJ, Baker S, et al. Clinical study of yoga techniques in university students with asthma: A controlled study. Allergy Asthma Proc 1998;19:3-9.  Back to cited text no. 13
    
14.
Khanam AA, Sachdeva U, Guleria R, Deepak KK. Study of pulmonary and autonomic functions of asthma patients after yoga training. Indian J Physiol Pharmacol 1996;40:318-24.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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