Yoga therapy of bronchial asthma
In medicine, there is such a thing as “psychosomatic illness”. This refers to a pathological condition, based on the development of which is a clear link body and mind. Moreover, very often the development of psychosomatic diseases psyche plays determines the starting value. World Health Organization has approved a list of psychosomatic diseases, which include such common ailments as hypertension, peptic ulcer disease, atopic dermatitis, coronary heart disease. This category is related and asthma.
Indeed, all of these diseases have a definitive link to the psycho-emotional background and stress overload. Debut and development of the disease tend to have a psychogenic cause. Bronchial asthma – a bright representative of psychosomatic pathology. Close relationship of breathing and mind in humans caused, on the one hand, the mechanisms of the disease, on the other – in this regard, and based yogaterapii great opportunities. In the formation of neuro-psychological variant asthma is a tendency to use the disease as a means of inadequate adaptation to micro social environment and the temporary abstraction from solving emotional problems (G.B.Fedoseev, VI Trofimov, 2006).
Bronchial asthma (BA) can be defined as a chronic inflammatory disease of the bronchial tree, accompanied by breach of reactivity and sensitivity of the bronchi and manifested attacks of breathlessness. Shortness of breath is associated with impaired patency of the bronchi, their swelling and spasms and is expiratory in nature (ie, shortness of breath associated with obstruction of exhalation). The disease develops on the background of hereditary predisposition to allergic diseases.
In addition to psychogenic causes, based on the development of asthma is an allergic component, which in childhood can manifest initially in the form of skin food allergies. Then symptoms begin to capture the upper respiratory tract (allergic rhinitis, pollinosis, laryngeal edema) – in this case are already allergen substances that enter the body through the respiratory tract: house dust, insects, wool, pollen, etc. Further allergic process starts capturing the bronchial tree, and bronchial tubes in contact with an allergen raise the tone spazmiruyutsya, which leads to deterioration of their conductivity. Furthermore, the holding air on the airway mucosal edema worsens occurring and mucus hypersecretion. All this leads to the fact that the expiratory small bronchi are fallen down, there is a difficulty in exhaling and expiratory occurrence (i.e., associated with an exhalation) dyspnea.
In the pathogenesis of AD is also essential autonomic imbalance at the level of the bronchial tree. Recall that the parasympathetic nervous system increases the tone of smooth muscle of the bronchi (ie constricts the bronchial tubes, it is called bronchoconstriction), and stimulates secretion of mucus. The sympathetic system, by contrast, expands bronchi (bronchodilation) bronchial and improves conductivity. In patients with asthma found various violations of the autonomic control of the bronchial tone, characterized by increased parasympathetic activity; however, most likely, these violations are of a secondary nature and are associated with chronic inflammation. It has been shown that inflammatory mediators (messenger molecules) can stimulate sensory nerve endings, which leads to reflex parasympathetic bronchoconstriction (G.B.Fedoseev, VI Trofimov, 2006).
Some importance are also endocrine mechanisms. Insufficient activity and adrenal glucocorticoid (GC) hormones play a significant role in the development of inflammation and bronchial hyperreactivity. Most often glucocorticoid insufficiency occurs because glucocorticoid hormone via the mouth (very common embodiment the treatment of severe asthma). In addition, a role playing malfunction of the hypothalamic-pituitary-adrenal axis. When failure occurs HA reduction effect of these hormones on inflammation, the immune system and on the selection of anti-inflammatory mediators in allergic reactions.
Estrogens have little bronchoconstrictor (narrowing) and progesterone – weak bronhodilyatiruyuschim (spreading) effect. Imbalance of estrogen / progesterone predisposes to the development of allergic reactions and bronchospasm in women (G.B.Fedoseev, VI Trofimov, 2006).
For the treatment of asthma Western medicine offers pharmacological drugs to suppress the immune-allergic inflammation, as well as inhalation drugs affecting the autonomic system of the bronchial tubes. Often initially appointed inhalants, excitatory receptors of the sympathetic system and thus causes temporary bronchodilation (salbutamol). Also used are substances that block receptors parasimpatiki to inhibit vasospasm. Often this category of drugs to patients addictive formed and subsequently has to add inhalable synthetic hormones (glucocorticoids) that strongly inhibit local immunity, thereby blocking the allergic inflammation. In case of failure of the above means the last step is the appointment of hormones glucocorticoids orally. This type of therapy has broad spectrum of severe side effects (steroid stomach ulcers, osteoporosis, hypertension, steroid diabetes, suppression of the synthesis own hormones, disorders of lipid metabolism).
Meanwhile, non-drug treatments often have a clear and demonstrative effect, allowing lower doses of pharmacological agents or abandon them altogether. In the words of GB Fedoseyev, “serious non-drug benefit is saving that remission occurs due to the recovery of their own compensatory capacity of the organism of the patient.” Such methods of treatment, reducing its own resources, applies yogaterapiya.
Bronchial asthma – a disease that is very responsive to yogaterapevta efforts and, as a rule, as a result of studies manages to achieve a significant improvement. The main directions of practices that should be practiced from the beginning.
1) An important element of practice are elements sukshma vyayamy actively engage the shoulder girdle. In AD, there are marked changes in the form of hyper muscle with a common segmental innervation with light: belt, ladder, trapezius, serratus anterior, spine rectifier. When the voltage of these muscles are broken ribs and movement across the chest, changing the position of the head and shoulder area. As a result, broken drainage bronchi and develops the so-called early expiratory closure of the bronchial tubes, resulting in a rapidly deteriorating ventilation in the lower parts of the lungs (V.A.Epifanov, 2008). It is therefore important at the earliest stages of training to use to enter joint workouts are actively involved muscular and ligamentous and articular apparatus of the shoulder girdle. This allows you to remove the local muscle tension and evenly distribute the muscle tone, optimize the performance of the respiratory muscles and eventually improve the pulmonary ventilation. In addition, dynamic practice, engages the shoulder girdle and proprioceptive sensitivity of this area, allow to break the chain of pathological motor-visceral reflexes, to normalize relations between the musculoskeletal system, central nervous system and the bronchial tree.
2) Forced types of breathing – Kapalabhati and bhastrika – can achieve the implementation of several mechanisms. Firstly, the pressure fluctuation in the airways stimulate the activity of the ciliated epithelium of the bronchi, thereby intensifying the excretion of mucus. Secondly, an increase in respiratory rate shifts the autonomic tone in the part of sympathetic activation, which contributes to bronchodilation and improvement of the level of endogenous (natural), glucocorticoids, anti-inflammatory effect. Separate authoritative sources (Potapchuk AA, Matveev SV Didur MD, 2007) suggest the use of forced breath types in specific embodiments: the so-called “bow Gymnastics” includes active and passive exhalation breaths committed with frequency of 1 breath per second. The patient is encouraged to make an active forced breath nose (about 20-30% less active of the maximum possible). After each forced inspiratory air is discharged passively nose, without fixing attention on exhalation. If done correctly, the forced inhalation of the nose wings are pulled to the nasal septum, which is accompanied by a characteristic symptom – “shmyganem”. This embodiment (embodiment differs from common Kapalabhati, wherein the active exhalation done) favorable for patients with asthma, since it helps restore the physiological balance between the inspiratory and expiratory respiratory muscles, as well as the respective groups of neurons of the respiratory center. Leading experts believe that inspiratory training shows most patients with BA to increase the strength and endurance of the respiratory muscles (Zilber, 1996). In practice, however, used in traditional embodiments Kapalabhati (active and passive exhalation breath) and bhastrika (both are equally active phase of the respiratory cycle) in the complex practice yogaterapii usually give a good effect. On the possibilities of the different variants of the forced breaths should be remembered for individual selection yogaterapii practice in complex, hard-to-case. It should also be remembered that in severe asthma attack can be triggered by anything, including frequent and sharp breath; so start mastering Kapalabhati and bhastrika need with the softest option.
3) In practice postures should shift the focus of the prevalence of troughs ( bhudzhangasana , sarpasana, matsiasana etc.). This may contribute to, firstly, stimulation of the sympathetic nervous system (activation may assume adrenal function due to changes in blood flow and the mechanical compression of this zone; high probability of activating effects and paravertebral sympathetic ganglia). Secondly, deflections contribute to the formation of motor automatisms and distribution of muscle tone, more preferred at BA.
4) The introduction of the full breath and achieves several goals. As mentioned above, in patients with asthma in the first place is suffering ventilation of the lower parts of the lungs (until the complete cessation), a transition to the thoracic breathing, disrupts the normal ratio between the blood supply to the lungs and ventilation. Diaphragm during expiration does not completely relaxes and is flattened; during inhalation so the diaphragm is developing a smaller force. Train diaphragmatic breathing allows you to restore a normal part of the diaphragm in breathing, ventilation-perfusion ratio (ie the ratio of the blood supply / ventilation), and ultimately optimize gas exchange. To reduce the pressure in the abdominal cavity and the normalization of motor activity of the diaphragm is necessary to pay attention to the quality of bowel function and regularity of the chair; in the presence of constipation, an appropriate laxative diet and technology, aimed at normalizing bowel function (pavanamuktasana, abdominal manipulation, inverted postures, etc.). Skill uniform inclusion in the breath of all muscle groups, with full breathing psychologically very useful for patients with asthma: the knowledge that he can control his breathing, significantly changes the attitude to the disease, creates a favorable psychological attitude.
5) Breathing ujjayi yogaterapii used in bronchial asthma, as well as other embodiments of breathing resistance, in the modern school physical rehabilitation. Ujjayi promotes more uniform incorporation in the expiratory breathing process and inspiratory respiratory muscles ujjayi inspiratory trains typically attenuated inspiratory muscles ujjayi exhalation promotes more uniform emptying of the airway from the exhaust air, prevents the collapse of small airways exhale. You should start with the proportion itself, vritti (1: 1, ie breath is breathing in), it is expedient in connection with the initially increased tone of the parasympathetic nervous system. Increased tone parasimpatiki undesirable because it activates parasimpatika bronchospasm. However further general calming parasympathetic action may help normalize the overall CNS tone removal general psychological stress, so to say gradual transition Visam-vrtti proportion (1: 2) with an overall positive dynamics of disease.
6) For stimulation ciliated epithelium and mucus from bronchial excretion into practice include vibrating machinery. For this purpose, used singing vowel sounds that can be combined with tapping the chest with your fingers and palms.
7) From Shatkarmas need to stop attention to Neti and vamana- dhauti . First, it should normalize nasal breathing as mucosal stimulation of upper airway entails extension reflex bronchi and bronchioles (SN Popov, 2007). To normalize the nasal breathing applied Jala – and sutra -NO and Kapalabhati and bhastrika mentioned above. In cases resistant to therapy with the use of asana, vyayam and breathing practices, an essential tool can be Vama dhauti: When induce vomiting discharge vomiting center of medulla oblongata change activity in the immediate vicinity of the nuclei of the respiratory, cough centers and nuclei of the vagus nerve – the main nerve of the parasympathetic nervous system. This leads to a modulation of the activity of the major central mechanisms governing respiration processes and ultimately positive effect on bronchial asthma: decreasing the frequency and duration of attacks, increased duration of remission of the disease. Vämana-dhauti may be performed as for relief beginning attack, and as their prevention courses; the systematic application of Vama dhauti should be done after consultation with a specialist, and taking into account the contraindications.
8) Practice muscle relaxation it is necessary to pay attention, since it contributes to the normalization of psychophysiological tone, reduction of situational and personal anxiety, fear of the next attack. However, it should be remembered that in the early stages of practice must be aimed at the maintenance of sympathetic tone; For these reasons it is not necessary to make excessively long sessions shavasana (just 5-7 minutes), it makes sense to also apply to the formation of lung Shavasana trough (between the shoulder blades is enclosed Bolster, brick or folded mat). Apply the practice to local relaxation of the muscles of the shoulder girdle and hands: inspiratory pressure, expiratory relaxation.
So, the main directions yogaterapii practice in asthma are: dynamic asana practice with a predominance of deflections, Kapalabhati and bhastrika, technology full breath and ujjayi draining exercise in the form of singing of vowels and vibratory self-pleasuring, Neti and Vamana-dhauti, technicians voluntary muscular relaxation. When practicing yoga systematically built on the above principles for asthma is improved in most cases. Reduced doses of drugs, often manage to abandon drug therapy altogether. The disease often comes in stable remission with an extremely rare attacks or their complete absence.
Author: Artem Frolov