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PATIENTS AND METHODS
Patients
Seventeen students with documented asthma, based upon spirometry data of improvement of forced expiratory volume in first second (HEV1) values by at least 20% after bronchodilator inhalation, volunteered for this study. The group consisted of 9 females and 8 males. Ages of the patients ranged from 19-52 years with a mean of 26.5 years (Table1) who attended the allergy and asthma clinic at the Harshorn Health Center of Colorado State University, Fort Collins, Colorado. The study was carefully explained to the students. Each patient signed consent to serve as a subject in the project: each patient then completed a detailed clinical questionnaire regarding his/her asthma. The Expert Panel on the Management of Asthma (National Asthma Education Program) defined asthma as a lung disease with the following characteristics: 1) airway obstruction that is reversible (but not completely so in some patients) either spontaneously or with treatment; 2) airway inflammation; and 3) increased airway responsiveness to the variety of stimuli.27 The severity and diagnosis of asthma was based upon guidelines established by the expert panel of the National Asthma Education Program.28 There were no smokers in either the control or yoga groups. All 17 patients completed the study and there were no dropouts.
Study Design
Students with asthma were randomly assigned (complete random design) to either the yoga group (9 subjects) or the nonyoga control group (8 subjects). During the study period, the records, of both groups were coded. Decoded data were unavailable to the principal investigations. The investigating physicians did not know which patients were undergoing the yoga intervention. The yoga group attended yoga classes offered at the health center by trained yoga teachers. The
Table 1 Vital Data
 classes were 45 minutes in duration, three times of week, for the study period of 16 weeks. The participants were given audio cassettes and written information to continue the practices at their residences. All patients, including those in the control group, were seen at the health center by one of the principal investigators at regular intervals. All of the students were given a peak flow meter (ASSESS peak flow meter, Healthscan Products, Cedar Grove, NJ) and instructed to record daily AM and PM peak flow readings throughout the study period.
Self-Report Measurement
A weekly symptom questionnaire from the asthma symptom check list devised by Kinsman et al. 29 was adapted with modification to assess changes in the symptoms and signs of the patients’ asthma. A four point severity scale and five point frequency scale was included in the weekly questionnaire (Table II)
Physiological Measurements
Pulmonary function was assessed 30 objectively by measurement of FEV1, FVC, and FMEF using a spirometer (Spirometrics, Inc., Flowmate). Weekly measurements were made and the mean of these recordings was used in the results.
Yoga Methods
1. The integrated set of yogic practices included
| A. The initial warm up activity with relaxed breathing techniques with stretching exercises. Breathing exercises (5 minutes). Five types of simple, rhythmic, slow and comfortable breathing practices associated with simple hand and body movements including hands stretch breathing, moon posture breathing, tiger breathing (Fig.1).
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B. Loosening exercises (5minutes) (Sithilikarana Vyayama) yoga practices to loosen the various joints.
| 2. Yogic postures:
| A. General yogasanas-physical postures (20 minutes): Simple, easy physical postures in standing, sitting, prone, and supine positions performed with smooth, comfortable bending movements along with specific slow-breathing procedures. These postures include lateral stretch, half wheel posture, forward bend, crocodile posture, cobra posture, half lotus posture, and shoulder stand (Fig. 2).
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B. Corpse posture (Savasana) (10 minutes): Deep relaxation practice to consciously relax the muscles regionally, followed by conscious slowing of breath and calming of the mind (Fig.3).
| 3. Breath slowing techniques (Pranayama) (10 minutes): three types of special breathing techniques (Nadisuddhi, Sitkari, and Bhramari) (Fig. 4) performed with easy, comfortable, and slow deep breathing without voluntary breath-holding.
4. Meditation and discussion session (15 minutes): slow mental chanting of the syllable "aum" leading to slower mental activity. The discussion session was designed to understand the emotional well being and positive out- look in general and to result in a feeling of freedom and relaxation.
5. Lectures and discussions were based on yoga philosophy and yoga therapy. Embedded in these practices are the key features of yoga operating from four different levels: deep relaxation of different groups of muscles, slowing of breath and no voluntary holding of breath, calming of the mind, and emotional equipoise. Table II
 Statistical Analysis
The weekly Symptom Questionnaire from control and yoga groups were analyzed using Mann-Whitney's test by the staff of the Department of Statistics, Colorado State University, Fort Collins, Colorado.
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