PATIENTS AND METHODS

Among the patients followed up in our continuing research program, we present here the results of 570 cases selected at random. These patients satisfied the clinical criteria of Crofton and Douglas (14) and Shivpuri (15) for diagnosis of bronchial asthma.

After the initial diagnosis and recording of data on these patients, they underwent a yoga training program for either 2 weeks (2 ½ hr. daily) or 4 weeks (1 ¼ hr. daily). The training program consisted of the following:

1. Breathing exercises (5 min): Five types of simple, rhythmic, slow, and comfortable breathing practices associated with simple hand and body movements.

2. Sithilikarana Vyayama and Suryanamaskar (5 min): Yoga practices to loosen the joints.

3. Yogasanas:

	(1) General Yogasanas (20 min): Simple easy physical postures in standing, sitting, prone, and supine positions performed with smooth, comfortable bending movements along with specific slow-breathing procedures. Maintenance with ease and relaxation in the final posture characterized the asana practices.
	(2) Savasana (10 min): Deep relaxation practice to consciously relax the muscles regionally, followed by conscious slowing of breath and calming of the mind.

4. Pranayama (10 min): Three types of special breathing techniques. (Nadisuddhi, Sitkari, and Bhramari) performed with easy, comfortable, and slow deep breathing without voluntary breath holding.

5. Meditation and devotional session (15 min): Slow mental chanting of the syllable “OM” leading to slower and slower mental activity. The devotional session was meant to harness the emotions, resulting in a feeling of freedom.

6. Kriyas (once a week): Traditional voluntary nose and stomach-wash techniques (Neti and Vaman-dhouti) followed by Savasana.

7. Lectures and discussions: These were based on yoga philosophy and yoga therapy. Embedded in these practices are the key features of yoga operating from different levels:

	1. Deep relaxation of different groups of muscles.
	2. Slowing of breath.
	3. Calming of the mind.
	4. Emotional equipoise.
	5. A life-style of internal awareness and bliss in action.

These points were emphasized in the theory classes. The patients were given a feel for these aspects in the practical sessions. For example, we asked them to maintain smiling, tension-free face throughout the sessions. Such instructions help them out of their usual habit of getting tense and feeling stress.

After completing the course, the patients were asked to continue the sessions regularly. Some of them opted to continue at home by themselves and some attended the yoga classes at our centers. Many of them attended 1 or 2-month courses subsequent to their initial training program. But the bulk of the patients chose to continue for an hour daily at home after their first course. Some did the exercises for a half hour in the morning and a half hour in the evening if they could not set aside a full hour at one time. Kriyas were practiced on weekends. The patients learned to use breathing exercises while seated to overcome mild to moderate attacks of bronchospasm, which gave them enormous confidence about the reversibility of their condition. In case of children below 10 years old, the regularity and accuracy of practice was ensured by giving the same yoga training to one of the parents, who supervised practice at home. Elderly persons were asked to omit from the asanas prescribed three difficult practices, Sarvangasana, Halasana, and Cakrasana. Persons who had a previous history of chronic-ear discharge or surgery of the ear were asked to omit Jalaneti Kriya. Persons who had marked nasal blockage practiced Jalaneti Kriya daily at the time when their symptoms were worst.

Patients were given the freedom to decrease or increase the dose of bronchodilator, depending on their requirement. Those dependent on cortisone were encouraged to shift slowly to a nonsteroidal bronchodilator and then taper off. They made a note of the changes in medication in their diary which they presented during their follow-up visits. (Necessary changes in the brand of the drug required by the patient were always decided by the attending doctor.) At the end of the initial program, the participants were instructed to send us each month a completed questionnaire; their responses provided information about the state of their health (see Appendix). They were also asked to visit one of our outpatient clinics for periodic checkups and advice. In addition, monthly meetings of these patients were organized in different areas of the city.

The patients were also brought together at yearly follow-up camps of 1-3 weeks. The pattern of courses in these camps resembled that of the initial training program. The exercises learned during the initial training program were reviewed, with any necessary advice and correction in technique given. Except for the first refresher course in 1980, all other follow-up courses were nonresidential. All necessary information and test results were recorded during the camp sessions, and participants were informed about the developments of the research work and results in a monthly newsletter. The newsletter also served the purpose of announcing meetings, camps, etc., and allaying any doubts patients may have expressed.

Apart from the above, data collection was undertaken once a year. The patients were asked to report to our outpatient clinics during hours specifically assigned to them by the doctor in charge. Usually the patients were sent three reminder letters over 2 months during the monsoon period, which has been found to be the worst period for asthmatics in Bangalore.

The annual follow-up drive also consisted of house visits to those patients who did not respond to the letters. Members of our trained paramedical staff recorded the necessary information and asked the patients to visit our clinics and provide more detailed information about their health.