PATIENTS AND METHODS
Table 1 shows details of 106 patients with established bronchial asthma satisfying the clinical criteria of Crofton and Douglas and Shivpuri that were included in this study. The age range was 9 - 47 years with a mean of 26.4 years. There were 15 women in each group. Fifty three pairs of patients matched for age, sex and type, severity, and duration of asthma were selected from a bigger group who came to our out patient clinic for yoga therapy. One from each pair was randomly selected for training in yoga, and the other served as control.
Although all 106 patients were equally motivated to take up yoga, the 53 randomly allocated patients willingly served as controls. They continued taking their usual drugs during the study.
All techniques of measurement, the length of each interview, and the people recording the data were the same for both groups. The yoga group attended a training programme of two and a half hours daily from 18.00 to 20.30 hours after work for two weeks. They were introduced to an integrated programme of the following selected yoga exercises.
Table 1 Details of Patients
Breathing exercises (5 minutes)- five types of rhythmic, comfortable breathing techniques associated with simple hand and body movements, Sithilikarana vyayama (Yoga exercises to loosen the joints) and suryanamaskar (five minutes).
Yogasanas- (a) General yogasanas (20 minutes). Simple physical postures (in the standing, sitting, prone, and supine positions), performed with smooth, comfortable bending movements and slow breathing procedures. The asana practices end with the subject maintaining the final posture with the body relaxed (b) Savasana (10 minutes). Deep relaxation to relax the muscles regionally followed by conscious slowing of breathing and calming of mind.
Pranayama (10 minutes)- Four types of special breathing techniques performed with comfortable, slow, deep breathing.
Meditation and devotional session (15 minutes)- slow mental chanting of the syllable "OM" leading to slowing of mental activity. The devotional session was meant to harness the emotions, resulting in a feeling of freedom.
Kriyas (weekly)- Traditional voluntary nose and stomach wash techniques (neti and vamana dhouti) followed by Savasana.
Lectures and discussions - These were based on yoga philosophy and therapy.
We instructed 53 patients to continue the 65 minutes of yoga daily during the follow up period. For the purpose of analysis those patients who stopped the practices or did not practise for more than 16 days each month were eliminated from the study. Although we continued to record their progress. Twenty five patients dropped out of the study: seven after six months of follow up, seven after 12 months, two after 18 months, four after 24 months, and five after 30 months. All patients reported for check ups at intervals of six months. The frequency of visits and the relationship between doctor and patients were the same for both groups.
At the initial interview patients were instructed to keep a diary. They were told to record each attack of airway obstruction, it's severity, and the dosage of the drugs they consumed. They continued to take prescribed bronchodilator drugs throughout the study. When they noticed an improvement or deteriotatation in their asthma they were permitted to change their dosage as required, and they recorded this in their diaries. Any change in the brand of drug, however, was decided by the doctor. At each of the follow up visits information from patients diaries and from clinical examinations was recorded. The mean weekly number of attacks for each period of follow-up was calculated severity of attacks was graded: 1=mild, but did not disturb sleep or daily routine; 2=moderate, disturbed sleep and daily routine and was relieved by oral drugs; 3=severe, required injection or admission to hospital. We obtained a score for drug treatment by calculating the mean number of bronchodilator tablets and injections taken each week for each period of follow up. None of the patients used inhalers. Peak expiratory flow rate was obtained by recording the best of three attempts on a mini Wright Peak flow meter.