| Abstract|| |
Background: Asthma is a chronic inflammatory disorder of the airways. The chronic inflammation causes an associated increase in airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing at night or in the early morning. Most of the studies have reported, as the effects of yoga on bronchial asthma, significant improvements in pulmonary functions, quality of life, and decrease in medication use, but none of the studies has attempted to show the effect of yoga on biochemical changes.
Objective: To evaluate the effect of yoga on biochemical profile of asthmatics.
Materials and Methods: In the present study, 276 patients of mild to moderate asthma (FEV 1 > 60%) aged between 12 to 60 years were recruited from the Department of Pulmonary Medicine, King George's Medical University, U.P., Lucknow, India. They were randomly divided into two groups: Yoga group (with standard medical treatment and yogic intervention) and control group as standard medical treatment (without yogic intervention). At completion of 6 months of the study period, 35 subjects were dropped out, so out of 276 subjects, only 241 subjects completed the whole study (121 subjects from yoga group and 120 subjects from control group). Biochemical assessment was carried out at baseline and after 6 months of the study period.
Results: In yoga group, there was significant improvement found in the proportion of hemoglobin and antioxidant superoxide dismutase in comparison to control group and significant decrease was found in total leukocyte count (TLC) and differential leukocytes count in comparison to control group. There was no significant change found in TLC, polymorphs, and monocytes in between group comparison.
Conclusions: Yoga group got significantly better improvement in biochemical variables than control group. Result shows that yoga can be practiced as adjuvant therapy with standard inhalation therapy for better outcome of asthma.
Keywords: Asthma; adjuvant; hyper- responsiveness; intervention; wheezing.
|How to cite this article:|
Agnihotri S, Kant S, Kumar S, Mishra RK, Mishra SK. Impact of yoga on biochemical profile of asthmatics: A randomized controlled study. Int J Yoga 2014;7:17-21
|How to cite this URL:|
Agnihotri S, Kant S, Kumar S, Mishra RK, Mishra SK. Impact of yoga on biochemical profile of asthmatics: A randomized controlled study. Int J Yoga [serial online] 2014 [cited 2020 Mar 31];7:17-21. Available from: http://www.ijoy.org.in/text.asp?2014/7/1/17/123473
| Introduction|| |
Asthma is a chronic inflammatory disorder of the airways in which various cells and cellular elements play a role. The chronic inflammation causes an associated increase in airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing at night or in the early morning. About 300 million people are suffering from asthma globally ,, and about 10% of it belongs to India. Asthma is defined simply as reversible airway obstruction. Reversibility occurs either spontaneously or with treatment. The basic measurement is peak flow rates and the diagnostic criteria used by the British Thoracic Society.  Yoga is known for its beneficial effects on physiologic and psychologic functions and improves the quality of life of the patients. ,,,,,,, During the last 3 decades, extensive physiologic research has been done on yogic practices. It has been reported that yoga can increase muscular efficiency, endurance time,  and aerobic capacity and can reduce perceived exertion after exercise. ,, Chronic inflammation plays a major role in the pathogenesis of asthma, and it has long been recognized that many of the inflammatory cells that are involved in mediating these processes reach the lung via the blood. In asthma, the dominant peripheral blood leukocyte found in the airway is the eosinophils , and the degree of eosinophils involvement is correlated with various markers of severity including symptoms,  loss of lung function,[ 20], and with airway hyperresponsiveness. In asthma, the presence of neutrophils and eosinophils in the airway is broadly reflected by increased numbers of these cells in peripheral blood. ,, Reactive oxygen species, released from eosinophils, alveolar macrophages, and neutrophils, seem to play a key role in asthma. They may directly contract airway smooth muscles; stimulate histamine release from mast cells and mucus secretion.  Asthma is, therefore, also associated with oxidative-antioxidative imbalance in the body and might have a psychosomatic origin. Attack of asthma involves both physical and psychological factors. By regular practice of yogasanas and pranayama, the constriction of bronchial tubes gets very much reduced. Slowly, the capacity of bronchial tubes increases to a great extent and subsequently gradually asthma can be cured from roots.
| Materials and Methods|| |
Study design and setting
This study is a randomized controlled trial. Diagnosed cases of asthma (FEV 1 >60%) who attended the outpatient department (OPD) of the Department of Pulmonary Medicine, King George's Medical University, U.P., Lucknow, India were screened by a consultant for participation on the basis of inclusion and exclusion criteria. Eligible subjects were invited for the yoga and fulfilled the criteria to enroll in this study after getting their written consent. The study was approved by the institutional ethics committee.
- Mild to moderate persistent bronchial asthma severity according to GINA- 2009
- Reversible airflow limitation measured by ≥12% increase and ≥200 mL absolute increase in FEV 1 after post bronchodilator
- Nonsmokers or exsmokers with <10 pack/year who have not smoked for at least 6 months
- Patient's age ranging from 12 to 60 years.
- Those who had a clinical diagnosis of asthma but did not satisfy the diagnostic criteria
- Patients with severe airflow limitation or more (FEV 1 <60%)
- Pregnant/lactating women
- Associated chronic respiratory diseases such as pulmonary tuberculosis and autoimmune lung diseases.
- Major psychiatric illnesses.
A total of 276 subjects were included in the study after randomization which was done by computer-generated random number table. Subjects were divided into two groups, yoga group who received yogic intervention for 6 months along with standard medical treatment and control group who received only standard medical treatment. Out of 276 subjects, 17 subjects from yoga group and 18 from control group dropped out during the study. A total of 121 subjects (67 males and 54 females) from the yoga group and 120 subjects (71 males and 49 females) from the control group completed the study.
Peripheral venous blood (5 mL) was taken for the study of biochemical changes occurred at baseline and after 6 months. A total of 3 mL blood was taken without using an anticoagulant and allowed the blood to clot for 30 min at 25°C, and then centrifuge the blood at 2,000 × g for 15 min at 4°C. Pipette off the top yellow serum layer without disturbing the white buffy layer. Serum was diluted 1:5 with sample buffer provided by Superoxide Dismutase Assay Kit (Item No. 706002) Cayman Chemical Company, USA before assaying for SOD activity, while left 2 mL blood was used for the determination of hemoglobin which was performed by hemoglobinometer; assessment of total leukocyte count (TLC) and DLC was done by Neubauer Chamber Cell Counting Method.
Subjects in the yoga group received yogic intervention for 30 min per day in the morning, 5 days in a week for a period of 6 months at the Department of Pulmonary Medicine, King George's Medical University, U.P., Lucknow, India [Table 1]. A qualified yoga trainer was selected by expert panel for this study to give the proper training of yoga to the yoga group.
Paired (dependent) t-test was used to test the mean difference score of the subjects at baseline and after 6 months in both groups, i.e., yoga/intervention and control group. The differences in pre and posttreatment scores were used for the analysis. Student's independent sample t-test was used to compare the differences in scores between two groups (yoga vs. nonyoga group). The statistical analysis was done by using GraphPad InStat (Version. 3.05 GraphPad software, Inc., California)
| Results|| |
The socioeconomic or demographic, clinical and outcome variables of the subjects are given in [Table 2] and [Table 3]. As seen in [Table 2], all the variables are similar and no significant difference was found in both groups but in [Table 3], both groups are comparable at baseline in every respect except lymphocytes and superoxide dismutase (SOD). The values of outcome measures are given in [Table 4] and [Table 5]. Since, there was significant difference found in lymphocytes count and SOD level; therefore, baseline was considered as a constant covariate for between group comparisons.
It has been observed in the pre-post comparison that hemoglobin increased significantly by 7.52% from 11.7 ± 1.43 to 12.58 ± 1.46 (g/dL) (P = 0.001), proportion of polymorphs decreased significantly by 2.57% from 70.70 ± 8.93 to 68.88 ± 7.68 (P = 0.016), eosinophils decreased significantly by 47.96% from 9.05 ± 1.62 to 4.71 ± 1.19% (P < 0.0001). Monocytes also decreased significantly by 63.0% from 5.24 ± 1.54 to 1.98 ± 1.09% (P < 0.0001). There was a significant increase of 4.85% found in SOD level from 10.32 ± 5.55 to 10.82 ± 5.84 U/mL (P < 0.0001) in yoga group in comparison to control group [Table 4]. TLC and proportion of lymphocytes also decreased significantly in both group but there was not much difference found in their percentage change. At postintervention, between group differences were found highly significant with better improvement in hemoglobin, lymphocytes, eosinophils, and SOD [Table 5].
|Table 4: Comparison of pre and post biochemical changes occurred in yoga group and control group |
Click here to view
| Discussion|| |
The results of this study suggest that the levels of hemoglobin and antioxidant SOD were significantly increased in yoga group in comparison to control group and significant decrease was found in TLC and differential leukocytes count in comparison to control group. There was no significant change found in TLC, polymorphs, and monocytes in between group comparison.
Eosinophils has a crucial role in the pathogenesis and course of asthma, as most allergic and nonallergic asthmatic patients, including those with mild asthma, has a bronchial eosinophilia and there is significant association between eosinophils activation and asthma severity as well as bronchial hyperresponsiveness. Tissue eosinophilia was found to be significantly greater in fatal asthma than in patients with chronic asthma.  Although eosinophils protect us against parasites and other infectious agents, its high level is also responsible for the allergic reaction and worsen asthma state.  Lymphocytes play a crucial role in the inflammatory processes of allergic asthma.  Monocytes are inflammatory cells that accumulate in the airway in asthma. In a study, it has shown that low-density monocytes from subjects with asthma retain the ability to be activated in vivo and in vitro and may orchestrate immune reactions in mild asthma.  In a study, it was found that the number of monocytes was similar to that of healthy controls in nonattack stage of asthma. The number of monocytes in the peripheral blood may change in close relation to asthma attacks elicited by allergic reactions. 
A previous study has shown that there was a significant increase in the proportion of eosinophils, basophils, lymphocytes, and in the ECP level in induced sputum of occupational allergics after the specific provocation.  Other previous studies also support our findings. In a study after 6 weeks of yoga training, there was significant increase in hemogloblin %, decrease in leukocytes count and differential count showed decrease in lymphocyte, eosinophil, monocytes, and basophils, but it was statistically insignificant. 
The free radicals increase asthma because they increase the consumption of oxygen, while antioxidants prevented the consumption of oxygen in the cells and helps in decreasing the symptoms of asthma. SOD is a scavenging enzyme, has the capacity to scavenge the oxygen radical. Hence, it helps in prevention of consumption of oxygen and cellular damage. A few studies also suggested that free radicals may be involved in the development of pulmonary disorders such as asthma.  However, probably none of the study has shown the impact of yoga on biochemical profile of asthmatics in India as done in the current study.
| Conclusion|| |
The current study shows that the yogic intervention significantly increased the level of hemoglobin, SOD, and significantly decreased the levels of eosinophils and monocytes in differential leukocytes count in the patients of bronchial asthma . Overall, this study shows that yoga is an effective tool for the improvement and can be practiced as an adjuvant therapy to standard inhalation therapy for better outcome of asthma.
| Acknowledgement|| |
We are grateful to those patients who kept patience for 6 months up to the completion of study period and performed regular yoga practice. We are also thankful to yoga instructor and entire faculty of the Department of Pulmonary Medicine, King George's Medical University, Lucknow, U.P., India.
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Department of Pulmonary Medicine, King George's Medical University, Uttar Pradesh, Lucknow
Source of Support: Indian Council of Medical Research, New Delhi,
India, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]