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EFFECT OF PRANAYAMA (RECHAKA, PURAKA AND

KUMBAKA) ON BRONCHIAL ASTHMA - AN OPEN STUDY

MURTHY, K.J.R., SAHAY, B.K., SITARAMARAJU, P., MADHAVI SUNITHA,

RAMANANDA YOGI, VENKATAREDDY, M, ANNAPURNA, N., RAMESH, M.,
VIJAYALAKSHMI PRASAD AND ESWARAREDDY, M.
(Received original August, 1983: Revised version for publication December 1983)

Department of Medicine, Yoga and Electronics, Vemana Yoga Research Institute, 8-

1-14, Market Street, Secunderabad-500 003
ABSTRACT
Effect of PRANAYAMA was studied in 20 Males and 10 Females suffering from perennial
asthma. The mean age of the males was 32 years and females 25 years. The mean duration of
asthma was 7 years in males and 5 years in females.
Initial data regarding the clinical symptom, dosages of drugs and spirometry (absolute values,
predicated percentages and response to bronchodilator aerosol) were recorded and were repeated
every 15 days for 75 days. All were taught PRANAYAMA (RECHAKA, PURAKA WITH KUMBAKA)
under supervision in the Institute for half an hour every day in the morning.
The assessment was made on the basis of the mean clinical symptom score, mean dosage of
drugs and mean FEV1, mean % Predicted FEV1, FVC, FEV1/ FVC% AND PEFR of the particular
fortnight as compared to the initial values.
The results indicate that though there was a statistically significant increase in the absolute
values of the different parameters of ventilatory function and reduction in the dosages of drugs and
decrease in symptom - score, airways obstruction as noted by FEV1/FVC% remained unchanged.

INTRODUCTION

Effect of yoga on different physiological parameters has been studied earlier. (Miles 1963, Shanker
Rao 1968 and Udupa et al 1975). Significant reduction in blood pressure in hypertensive patients
practising yoga was reported by Benson et al (1974) Patel (1975) and Blackwell et al (1976).
The present study was conducted to assess the effect of yoga on patients suffering from
perennial asthma.

MATERIAL AND METHODS

Thirty patients suffering from perennial asthma undergoing yoga training at Vemana Yoga
Research Institute, Secunderabad, for control of their disease were studied as outpatients.
Patients suffering from seasonal asthma have been eliminated from the study so as to overcome
the differences that might result due to spontaneous remissions. History and details of the dosages of
different drugs that were being used wee noted. Patients were instructed very clearly that they should
continue to take the medicines in the dosages on which they were already on and they would reduce
their doses only when they felt better.
A symptom-score was made on the degree of their symptoms-cough; sputum and breathlessness (O-
Nil, 1-Mild, 2-Moderate 3-Severe) The number of tablets and scoring of different drugs-
bronchodilators, steroids and others were noted. Spirometry on a dry spirometer (Vitalograph Limited,
Herts, London) was made on empty stomach in sitting position in the morning every time. Peak
expiratory flow rate was estimated on Wright's Peak flow meter (Airmed Limited, Harlow, London).
Spirometry, Scoring of symptoms and dosages of drugs were made fortnightly. (Response to
broncho-dilator aerosol of Salbutamol (400 micro grams) was noted and only persons with more than
15% response in FEV1 FVC% were included in the study.
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YOGIC PRACTICES:

The type of Pranayama was Rechaka (Exhalation) - Puraka (Inhalation) with Kumbhaka
(retention) for half an hour every morning for 75 days. Yogic practices were carried out under the
supervision of yoga teachers in the Institute only. It consisted of slow inspiration through the left nostril

closing the right nostril with middle and little fingers and at the same time pushing out the abdomen,
Kumbhaka (retention of breath) is performed by closing the left nostril with the thumb and doing
Jalandara Bandha i.e. chin lock. (Touching the Jugular notch with chin). The breath is held as long as
possible. Expiration is through the right nostril while the left nostril is closed with the thumb and the
abdomen is drawn inside. The process is repeated by using the right nostril to inspire and left to
expire with breath being held in between. Exercise is carried out by using left and right nostrils
alternately. The ratio of inspiration: expiration:
Kumbhaka is 1:2:4: The technique is called "ANULOMA-VILOMA" (Venkata Reddy 1982)

ASSESSMENT:
Initial mean values of FEV1% predicted FEV1 FVC, FEV1/FVC% and PEFR were noted and
compared with the value at the end of each 15 days period.

Table-1
(Males n=20)
Initial 15 DAYS 30 DAYS 45 DAYS 60 DAYS 75 DAYS
FEV1 L-Sec. Mean 1.54 1.92 1.94 2.01 2.0 2.08
1SD 0.67 0.60 0.60 0.60 0.66 0.66
p Value <0.05 <0.05 <0.05 <0..05 <0.05
Mean % Predicted FEV 45.47 59.21 58.57 60.61 60.60 62.03
1SD 16.45 18.10 18.31 19.74 20.61 19.79
FVC L Mean 2.39 2.87 2.92 3.01 3.03 3.09
1SD 0.93 0.83 0.84 0.84 0.80 0.64
p Value <0.05 <0.05 <0.05 <0.05 <0.05
PEFR L Mean 261.76 319.25 324.25 331.25 332.50 338.56
1SD 95.12 113.97 99.7 33.04 81.83 83.83
p Value <0.05 <0.05 <0.05 <0.05 <0.05
FEV/FVC% Mean 67.12 69.27 66.30 66.15 66.10 67.75
1SD 19.78 17.63 21.24 16.91 17.32 19.70
p Value >0.05 >0.05 .>0.05 >0.05 >0.05 >0.05

Mean symptom score and drug scores of the initial and 15 days intervals were compared.
Student's paired- `t' test was used to determine the degree of statistical significance.

RESULTS

There were 20 males and 10 females. The mean age of the males was 32 ± 4.6 years and
females’ 25 ± 5.8 years. The mean duration of asthma was 7± 2.2 years in males and 5 ± 3.4 years in
females.

Males:

The mean FEV1 value at the beginning of study was 1.54 ± 0.67 litres, which increased to 2.08
±0.66 litres gradually by the end of 75 days. The mean predicted % OF FEV1 was 45.57 ± 16.45
initially which increased gradually to 62.03 ±19.79 at the end of 75 days, thereby showing that to start
with all the patients had a considerable degree of airways obstruction. The mean FVC value at the
beginning was 2.39 ± 0.93 litres and this increased gradually to 3.09 ± 0.64 litres. Also there was an
increased in Murthy et al: Effect of Pranayama on bronchial asthma the PEFR values over the period
of study from initial values of 261.75 ± 95.12 litres/min to 338.56 ±83.83 litres/min. The increments on
FEV1, FVC, and PEFR, were statistically significant from the end of first 15 days. FEV1 /FVC ratio
which was 67.12 ± 19.78 at the beginning of the study remained more or less same throughout the 75
days (Table.1)
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Females:
The mean value of FEV1 was 1.24 ± 0.52 litres in the beginning and 1.59 ± 0.62 litres at the end
of 75 days. The mean predicted % of FEV1 was 43.24 ± 16.94 initially increased to 58.64 ± 21.19. The
increase was significant after 30 days and 60 days of training. The FVC value was 1.71 ± 0.81 litres in
the beginning and 2.19 ± 0.75 litres at the end of 75 days. FVC also registered a significant increase
from the 1st 15 days of training onwards. Similarly, the PEFR values also increased significantly from

an initial value of 226.40 ± 93.84 litres/min. to 293126.90 at the end of 75 days. FEV1/FVC% was
69.74 ± 14.42 in the beginning and changed to 77.95 ± 10.90 at the end of the study and the
difference was not significant (Table.2)
.
Table-2
(Females n=10)
Initial 15 days 30days 45 days 60 days 75 days
FEV1 L-Sec. Mean 1.24 1.58 1.46 1.56 1.66 1.59
1SD 0.52 0.49 0.68 0.71 0.48 0.62
p Value <0.05 <0.05 <0.05 0.05 <0.05 <0.05
Mean % Predicted FEV 43.24 56.19 51.44 55.84 56.44 58.24
1SD 16.94 12.42 22.65 23.17 23.49 21.19

FVC L Mean 1.71 2.16 2.23 2.25 2.12 2.19

1SD 0.81 0.62 0.70 0.61 0.62 0.75
p Value <0.05 <0.05 <0.05 <0.05 <0.05
PEFR L Mean 226.40 254.90 258.70 283.30 275.70 293.20
1SD 93.84 83.05 105.04 133.39 121.20 126.90
p Value >0.05 >0.05 >0.05 0.05 >0.05
FEV/FVC% Mean 69.74 72.09 67.32 67.99 70.19 77.95
1SD 14.42 10.44 14.95 13.88 16.83 10.90
p Value >0.05 >0.05 >0.05 >0.05 0>0.05

Table-3
SYMPTOM SCORE
(MALES n=20)
Initial 15 days 30days 45days 60 days 75 days
Mean 0.98 0.65 0.50 0.30 0.25 0.22
±1SD 1.07 0.95 0.91 0.67 0.63 0.61
p value <0.05* <0.05* <0.05* <0.05 <0.05
(FEMALES n=10)
Mean 0.80 0.47 0.63 0.53 0.20 0.17
±1SD 0.76 0.68 0.72 0.68 0.41 0.38
p value >0.05 >0.05 >0.05 >0.05* >0.05*

Symptom Score:

Symptom score which were 0.98 ± 1.07 in males 0.80 ± 0.76 in females with beginning,
decreased to 0.22±0.61 and 0.17 ± 0.38 respectively at the end of 75 days. The reduction was
significant after 15 days of training in males and 45 days of training in females (Table 3).

Drug Score:

MALES:

There were 14 patients who were on oral bronchodilators and 4 patients on steroids and 2 on
steroids and bronchodilators. The drug score of patients requiring oral bronchodilators reduced
significantly from their initial value of 2.71 ± 1.54 to 0.91 ± 1.32 but patients on steroids as well as
steroids and bronchodilators did not show any significant reduction in their dosage schedules (Table-
4)
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FEMALES:

The drug score did not decrease significantly in steroids and non-steroid dependent patients.

DISCUSSION:

Studies conducted on patients with hypertension practising yoga have demonstrated that there is
reduction of blood pressure at different time intervals (Benson et al 1974 and Patel 1975).

It was not conclusively proved in any of the studies what exactly was the mechanisms that
brought about a reduction in the blood pressure, though a lowered cortical and autonomic arousal was
postulated (Black well et al 1976).

Asthma is a clinical situation, which is brought about by an interaction of various trigger-mechanisms

on the mast cells, which liberate chemical mediators of anaphylaxis. Also, there is a balancing
influence of both sympathetic and Para-sympathetic systems, a derangement of which plays a no
mean role in the production of the clinical attack of asthma. It is known that the autonomic nervous
system could be regulated by volition through practice. It is also known that the level of cortisol, an
important hormone in aborting the attack of asthma could be increased under certain conditions.
Table-4
DRUG SCORE
(MALES n=20)
0 1 2 3 4 5
Bronchodilators (Br.) 2.71 2.68 1.96 1.46 1.20 0.91
(14)
±1SD 1.54 1.59 1.39 1.25 1.25 1.32
p value >0.05 >0.05 >0.05 >0.05 >0.05
Steroids (ST) (4) 2.75 2.75 2.25 2.0 2.0 2.0
±1SD 2.22 2.25 2.63 2.83 2.83 2.83
p value >0.05 >0.05 >0.05 >0.05 >0.05
BR±ST (2) 2.0 2.0 2.0 1.0 0.50 0.25
±1SD 1.21 1.21 0.55 0.63 0.55 0.84
P value >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
(FEMALES n=10)
Bronchodilators (6) 2.33 2.33 2.50 2.00 1.50 1.00
±1SD 1.21 1.21 0.55 0.63 0.55 0.84
P VALUE >0.05 >0.05 >0.05 >0.05 >0.05
Steroids (4) 1.25 1.50 1.75 1.25 1.00 0.63
±1SD .50 1.29 1.50 1.50 1.15 0.75
p value >0.05 >0.05 >0.05 >0.05 >0.05 s

It was seem from results that though there was a significant increase in absolute value of FEV1
AND FVC there was no significant decrease in the airways obstruction as measured by FEV1/FVC%.
But it was gratifying to note that there was significant reduction of drugs used. Some questions arise.
How was that the obstruction persisted though there was an improvement in the clinical profile and
decrease in the requirements of drugs? Also, how was that though the absolute values of FEV1, and
FVC improved their ratio remained constant?
The change in the improvement of the clinical situation reinforced by the decrease in the drugs
cannot be easily ignored simply because the spirometry did not show any change in the degree of
airways obstruction. Miles (1963) had demonstrated that there was an increase of 15 to 25% of
oxygen consumption during yogic state. Shanker Rao (1968) also found that there was a significant
increase in the oxygen consumption in normal volunteer subjects between the pre-yogic and yogic
status at different altitudes. Significant increase in plasma cortisol levels was noted in healthy
volunteers after Pranayama (Udupa et al 1975).
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The patients themselves acted as their controls over the period of study. The variables introduced
are (1) the environment of the Institute (2) the considerate, interested research worker, (3) the air of
expectancy about the whole procedure and the regular practice of the controlled breathing methods
under expert guidance. The main argument against these experiments would be the absence of
controls, sex and age matched. However, the effects of these yoga exercises to assess their impact
on asthmatics have been tried in this open study. It is clear that the patients enjoyed both subjective
and objective improvement over the period. Any effort to improve the patient’s control over such a
disturbing syndrome is worthwhile.

This open study of Pranayama on bronchial asthma has demonstrated the usefulness of this
practice on patients with moderate and mild symptoms. It supplements drug therapy in an effective
manner. For more severe forms of bronchial asthma the practice cannot be recommended as those
on steroids either alone or in combination with bronchodilators did not show significant reduction in
their steroid requirement.

REFERENCES:
1. Miles, W.R (1963): Oxygen consumption during the three type of breathing patterns J. Appl.
Physiol 19 (1) 75-82.
2. Shanker Rao P(1968): Oxygen consumption during yoga type of breathing at altitudes of 520
meters and 3800 mtrs. Ind. J.Med. Res.56,701-705.
3. Udupa.K.N Singh, R.H and Settiwar, R.M (1975): A comparative study on the effect of some
individual yoga practices in normal persons - Ind J.Med. Rs. 63 1066--1071
4. Herbert Benson, A Rosner, Barbara, R Marzetta Helen M. Klochuk, (1974): Decreased blood
pressure in Pharmacologically treated hypertensive patients who regularly elicited the relaxation
response. The Lancet 23, 289-291.
5. Chandrapatel, (1975): Croydon. Survey: 12 months follow up of Yoga and Bio-feed back in the
management of Hypertension, The Lancet 11, 62-64.
6. Barry Blackwell, Saul Bloomfield, Peter Gartside, Ann Robinson, Irwin Hanenson, Herbert
Magnedeium, Sanford Nedich, Ranald, Zibler (1976): Transcendental Meditation in Hypertension.
The Lancet 31, 223-226.
7. Venkata reddy, M., Editor- Hatharathnavali (1982): P 89 Sloka No: 95.
8. Udupa, K.N.Singh, R.H. and Settiwar R.M (1975); Studies on the effect of some yogic breathing
exercises (PRANAYAMA) in normal persons Ind.J.Med.Res.63 1062-1064.