Efficacy of Yoga in Respiratory Disorders: Summary of research
The holistic science of Yoga is the best lifestyle ever designed and is effective in managing non-communicable lifestyle disorders (Bhavanani, 2013). Modern research has focused on psycho-physiological beneficial effects of Yoga which is more than a mere physical exercise (Jeter et al, 2015).
Scientific basis of using Yoga as an adjunct therapy in chronic obstructive pulmonary disease (COPD) is well established with significant improvements in lung function, quality of life indices and bronchial provocation responses coupled with decreased need for regular and rescue medicinal usage (Nagarathna & Nagendra, 1985; Vempati et al, 2009).
Behera reported perceptible improvement in dyspnoea and lung function in patients of bronchitis after 4 weeks of Yoga therapy that used a variety of postures and breathing techniques (Behera, 1998).
Yogic cleaning techniques such as dhauti kriya (upper gastrointestinal cleaning with warm saline or muslin cloth) and neti kriya (warm saline nasal wash) remove excessive mucous secretions, decrease inflammation and reduce bronchial hypersensitivity thereby increasing provocation threshold while kapalabhati through forceful exhalations improves the capacity to exhale against resistance (Satyaprabha et al, 2001).
A nonspecific bronchoprotective or bronchorelaxing effect has been also postulated (Singh, 19875) while improved exercise tolerance has been reported following Yoga therapy in patients of chronic severe airways obstruction (Tandon, 1978).
It has been reported that well-performed slow yogic breathing maintains better blood oxygenation without increasing minute ventilation, reduces sympathetic activation during altitude-induced hypoxia (Bernardi et al, 2001) and decreased chemoreflex sensitivity to hypoxia and hypercapnia (Spicuzza et al, 2000).
Asthmatic patients showed a statistically significant improvement in Transfer factor of the lung for carbon monoxide (TLCO), forced vital capacity (FVC), forced expiratory volume in 1st sec (FEV1), peak expiratory flow rate (PEFR), maximum voluntary ventilation (MVV) and slow vital capacity (SVC) after 2 months of Yoga practice. Quality of life also increased significantly. It was concluded that pranayama and Yoga postures may be used to increase respiratory stamina, relax the chest muscles, expand the lungs, raise energy levels, and calm the body (Singh et al, 2012).
A study to assess beneficial effects of Yoga in exercise-induced broncho-constriction in children aged 7–16y reported that all exercise-response-positive asthmatics became exercise response-negative asthmatics after 3 months of bi-weekly Yoga training (Tahan et al, 2014). It was recommended that Yoga training can supplement drug therapy to achieve better control of asthma in children.
In a recent study of 120 non-smoking male and female patients of asthma in the age group of 17–50 years, 8 weeks of Yoga breathing exercises used adjunctively with standard pharmacological treatment significantly improved quality of life (Sodhi et al, 2014).
A meta-analysis was published by Cramer and colleagues on Yoga and COPD (Cramer et al, 2019) to determine the effectiveness and safety of yoga interventions on disease symptoms, quality of life and function in patients diagnosed with chronic obstructive pulmonary disease (COPD). They reported that there were robust effects of yoga on exercise capacity and pulmonary function in patients with COPD. Yoga, specifically yoga breathing techniques, can be an effective adjunct intervention for patients with COPD. They also stated that Yoga’s safety needs to be assessed in more depth in future studies.
All of these mechanisms can help bring about both objective and subjective improvements in the condition of patients with bronchitis. Yoga as a therapy is also cost effective, relatively simple and carries minimal risk and hence should be advocated as an adjunct, complementary therapy in our search for an integrated system of medicine capable of producing health and well being for all.
However all this optimism needs to be tempered with the negative findings from a recent systematic review and meta-analysis that reviewed 14 RCTs with 824 patients (Cramer et al, 2014). They concluded that there was no evidence for effects of Yoga compared with sham Yoga or breathing exercises and that no effect was robust against all potential sources of bias. They ended by saying, “Yoga cannot be considered a routine intervention for asthmatic patients at this point. It can be considered an ancillary intervention or an alternative to breathing exercises for asthma patients interested in complementary interventions.”
A novel RCT tried to develop a better understanding of which patients with chronic illness tend to respond to integrative medicine interventions, by identifying a set of characteristics or qualities that are associated with a positive outcome (Kligler et al, 2012). This was undertaken as an integrative medicine approach to asthma and incorporated journaling, Yoga breathing instruction, and nutritional manipulation and supplementation. Responders demonstrated an attitude of “change as challenge;” a view of themselves as “independent” and “leaders;” an ability to accept one’s illness while still maintaining a feeling of control over one’s choices; a connection to the deeper context or meaning of complementary and alternative medicine (CAM) interventions, as opposed to just “previous experience” of CAM; and a sense of determination, commitment, and “willingness to fight” for what one needs from the health care system. Non-responders were more often uncertain and anxious in their relationship to their asthma, tending to fall back on denial, and lacking a connection to the deeper context or philosophy of CAM interventions.
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