International Journal of Trend in Scientific Research and Development (IJTSRD) Volume 5 Issue 6, September-October 2021 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470 @ IJTSRD | Unique Paper ID – IJTSRD47539 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 929 An Observational Study on Epidemiology of Tamaka Shwasa W.S.R to Bronchial Asthma Dr. Harsha Radhakrishnan1, Dr. Jaya Saklani Kala2, Dr. Pranavukumar. C. K3 1MD Final Year, Department of Kaya Chikitsa, Rishikul Campus, UAU Haridwar, Uttrakhand, India 2Associate Professor, Department of Kaya Chikitsa, UAU Campus, Harrawala, Uttrakhand, India 3R.M.O, Ayurswaasthyam Ayurveda Hospital, Thrissur, Kerala, India ABSTRACT Tamaka Shwasa is a major disease of Pranavaha srotas which may disturb the daily activities of an affected individual. The chief doshas involved in pathogenesis of this disease are Vata and Kapha. Ayurvedic explanations under Tamaka Shwasa closely resembles with Bronchial asthma. Asthma is defined as a chronic inflammatory disease of airways which is characterized by hyper responsiveness of the tracheobronchial tree to various stimuli. It is manifested physiologically by wide spread narrowing of the air passages, which can be eased spontaneously or as a result of therapy, and clinically by paroxysms of dyspnoea, wheezing and cough. The etiological factors of this disease hints on few epidemiological indicators that has to be revisited in the present scenario. This observational study was conducted in 27 patients to evaluate the epidemiology of Tamaka Shwasa. Datas regarding age, sex, religion, habitat, marital status, socioeconomic status, education, occupation, family history, dietary habit, bowel habit, sleep, addiction, treatment history, chronicity, Deha Prakriti, Manasa Prakriti, Sara, Samhanana, Pramana, Satmya, Satva, Status of Agni, Abhyavaharana Shakti, Jarana Shakti and Vyayama Shakti are thoroughly analysed in this study. KEYWORDS: Tamaka Shwasa, Bronchial Asthma, Epidemiology How to cite this paper: Dr. Harsha Radhakrishnan | Dr. Jaya Saklani Kala | Dr. Pranavukumar. C. K "An Observational Study on Epidemiology of Tamaka Shwasa W.S.R to Bronchial Asthma" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6, October 2021, pp.929-934, URL: www.ijtsrd.com/papers/ijtsrd47539.pdf Copyright © 2021 by author (s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0) INTRODUCTION Ayurveda is one of the most ancient and well- documented systems of medicine which is still relevant in present era. Tamaka Shwasa, being explained in ancient Ayurvedic scripts has improvised in its clinical interpretation according to the recent advancement, modernization, lifestyle and other evolving social circumstances. The disease is called Tamaka as attack of the illness precipitate during night and during the state of attack dyspnoea becomes so severe that patient feels entering into the darkness. Tamaka Shwasa is one among the 5 types of Shwasa roga which is KaphaVatatmaka, Pitta sthana samudbhava1 and Pranavaha srotovikara. Respiratory diseases are increasing rapidly in this current era of pandemics. So, Bronchial Asthma which is one among the respiratory diseases has to be addressed with care. Asthma is a chronic inflammatory disorder of the airways in which breathing is periodically rendered difficult by widespread narrowing of the bronchi. It is clinically characterized by recurrent episodes of wheezing, breathlessness, tightness of the chest and cough2. An estimated 300 million individuals worldwide are affected with Asthma. According to WHO, 15 million disability-adjusted life-years are lost and 250,000 asthma deaths are reported worldwide annually3. Mode of onset, course, aggravating factors and relieving factors of Tamaka Shwasa vary from person to person. This points out to the need of individualised treatment protocol that is to be adopted here. Tamaka Shwasa is considered as a Yapya vyadhi4. The disease which can be managed or maintained by appropriate interventions is called a Yapya vyadhi. Basically the patient stays alive on the virtue of practicing wholesome dietetic and lifestyle regimens. It becomes Sadhya if it is of recent origin. Epidemiology recognizes the distribution of diseases, factors underlying their source and cause, and methods for their control5. Epidemiologists help us to IJTSRD47539 International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47539 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 930 understand where the disease is coming from, and who it is most likely to impact when a disease occurs in a population. The data collected can then be used to control the disease and prevent future reccurrences. Acharya Vagbhata said that physician should treat the disease as early as possible after examining the characteristics of the disease, its regional alterations and diversity of causes. This can be achieved by minutely observing dushya (tissues/systems involved), desa (region-both of the body and the locality of the patient), bala (stength, immunity), kala (season), anala (digestion), prakriti (constitution), vaya (age), satva (mind), satmya (habits), ahara (dietary regimen) and the various avasthas (stages) of the diseases which can help in epidemiological study of a disease as per Ayurveda and also help in deciding the treatment to be adopted6. Here an observational study was carried out in 27 patients of Tamaka Shwasa to analyse epidemiological data of the disease. The interpretation of the obtained data shown that some of the epidemiological factors have direct interconnection with the disease. MATERIALS AND METHODS Aims and Objectives: To evaluate the epidemiology of Tamaka Shwasa. Study design: Observational study Selection of Patients: 27 Patients with classical features of Tamaka Shwasa attending the Kayachikitsa OPD of Rishikul Campus Hospital, UAU Haridwar were selected randomly for this clinical study. A detailed Proforma was prepared on the basis of the Ayurvedic texts and allied sciences. The patients fulfilling the inclusion and exclusion criteria were registered on this Proforma and scoring of the different clinical features were done on the assessment criteria. Inclusion Criteria:  Patients presenting with signs and symptoms of Tamaka Shwasa for equal to and more than one year as described in Ayurvedic texts.  Patients presenting with 3 or more of the following associated symptoms- Pinasa, Ghurghurak, Aasya Udhvansa, Kantodhvansa, Vak kricchrata, Lalata Sweda, Parshvagraha, Ushnabhiprayata, Aasya Shushkata, Vepathu, Aruchi and Annadvesh.  Mild intermittent, mild persistent, moderate persistent Asthma according to Global Initiative for Asthma (GINA)7 guidelines.  Blood Oxygen saturation (spO2)>90%.  PEFR >100 litre/min.  Age 20-60 years. Exclusion criteria:  Severe persistent Asthma according to Global Initiative for Asthma (GINA) guidelines  H/O Tuberculosis, COPD, Emphysema, Other complicated respiratory diseases.  Known case of Hypertension and Cardiac involvement.  PEFR < 100 litre/min.  Blood Oxygen saturation (spO2< 90%)  H/O Endocrine disorders like Diabetes Mellitus.  Patients with frequent H/O hospitalization due to Status Asthmaticus. OBSERVATIONS CONTENT DETAILS NO. OF PATIENTS PERCENTAGE Age 20-30 Years 6 22.22% 30-40 Years 2 7.41% 40-50 Years 7 25.93% 50-60 Years 12 44.44% Sex Female 13 48.15% Male 14 51.85% Religion Hindu 25 92.59% Muslim 2 7.41% Habitat Rural 8 29.63% Urban 19 70.37% Marital Status Married 22 81.48% Unmarried 2 7.41% Widow 3 11.11% International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47539 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 931 Socio Economic Status Middle class 10 37.04% Lower Middle class 5 18.52% Upper Middle Class 9 33.33% Very Poor 3 11.11% Education Primary 5 18.52% High School 6 22.22% Intermediate 2 7.41% Graduated 6 22.22% Post Graduated 4 14.81% Uneducated 4 14.81% Occupation Labourer 6 22.22% Business 5 18.51% Office 5 18.51% Housewife 10 37.04% Student 1 3.70% Family History Present 14 51.85% Absent 13 48.14% Dietary Habits Vegetarian 15 55.56% Mixed 12 44.44% Bowel Habits Constipated 19 70.37% Irregular 3 11.11% Regular 4 14.81% Loose 1 3.70% Sleep Sound Sleep 12 44.44% Disturbed 14 51.85% Insomnia 1 3.70% Addiction Smoking 7 25.92% Tobacco 2 7.40% Alcohol 3 11.11% None 15 55.56% Treatment History Taken 17 62.96% Not Taken 10 37.04% Chronicity < 2 Years 8 29.62% 2 -5 Years 10 37.04% 6-10 Years 5 18.51% 11-15 Years 3 11.11% >15 Years 1 3.70% Deha Prakriti Vata-Pitta 6 22.22% Vata-Kapha 12 44.44% Pitta-Kapha 9 33.33% Manasa Prakriti Satvika 2 7.40% Rajasa 10 37.04% Tamasa 15 55.56% International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47539 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 932 Sara Pravara 2 7.40% Madhyama 22 81.48% Avara 3 11.11% Samhanana Pravara 2 7.40% Madhyama 21 77.77% Avara 4 14.81% Pramana Pravara 2 7.40% Madhyama 21 77.77% Avara 4 14.81% Satmya Pravara 2 7.40% Madhyama 23 85.18% Avara 2 7.40% Satva Pravara 2 7.40% Madhyama 20 74.07% Avara 5 18.51% Agni Vishama 8 29.60% Tikshna 2 7.40% Sama 6 22.22% Manda 11 40.70% Abhyavaharana Shakti Pravara 4 14.81% Madhyama 9 33.33% Avara 14 51.85% Jarana Shakti Pravara 4 14.81% Madhyama 9 33.33% Avara 14 51.85% Vyayamshakti Pravara 2 7.40% Madhyama 19 70.37% Avara 6 22.22% DISCUSSION Age Maximum patients i.e,44.44% were belonging to the age group of 50-60 years. People coming under the age group of 50-60 years are prone to develop the disease since the ageing process advances. Also the patency of airways will be reduced due to decrease in respiratory muscle strength with age 8 which cannot be compensated by the bala of patient. Sex Maximum patients i.e,51.85% were males followed by 48.15% of females. The males were more exposed to dust, allergens and pollutants in the outdoor environment. Religion In the present study maximum number of patients i.e., 92.59% were from Hindu community. It is due to geographical predominance of Hindus in Haridwar. Habitat Maximum number of patients i.e., 70.37% were belonging to urban area. The intensity of air pollution is more in urban areas9 and industrialized regions which triggers the asthma symptoms. Marital status In the present study, maximum number of patients 81.48% were married. Majority of the patients were found to be in the age of 50-60 years and people of this age group were usually married. This might be due to the anxiety, panic, anger and sexual excitement in married persons. Socioeconomic status Maximum number of patients were belonging to middle class i.e., 37.04% this may be due to less sample size. Also these people are more exposed to International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47539 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 933 unhygienic atmosphere which can cause infections than that of high economic group10. Education Two groups i.e., High school and Graduated constituted 22.22%. People with High school qualification might be getting low salary jobs which leads to stress in them. Graduated people were also stressed due to hectic work schedule. It is seen that stress is a triggering factor of asthma. Occupation The housewives (37.04%) are more prone to develop the disease because they are constantly exposed to dust, fumes, allergens, pollens and all. The increased incidence of Tamaka Shwasa in housewives11 may be due to modifiable risk factors like prolonged kitchen stay, irregular dietary pattern, conventional cooking methods, day-sleep etc. which causes Ama formation. The next prone class were labourers12 (22.22%) and it is seen that the Asthmatic symptoms aggravates on exercise and strain. Family history In the present study, relevant family history was present in 51.85%. A family history of asthma in a first degree relative is the best recognised risk factor for asthma13. Dietary habit In the present study, maximum number of patients i.e., 55.56 % were vegetarians whereas 44.44% were having mixed dietary habit. This is because of the vegetarian dietary habit which is been practiced in this geographical area. Bowel habit In the present study, maximum number of patients were having constipated bowel habits i.e., 70.37%. The constipated bowel habit signifies the involvement of Annavaha srothodushti in the disease pathology. The Vayuvaigunya happening in the Shwasa roga may results in the Rukshata and Shoshana which causes constipation. Sleep pattern In the present study, maximum number of patients were having disturbed sleep i.e., 51.85%. The Shwasa vegas which disturb sleep are commonly seen during night time. Moreover, Tamaka Shwasa patients are comfortable in sitting position (Asino labhate saukhyam)14 than lying as inhalation and exhalation becomes easier in this posture. This also can lead to reduced sleep in a Tamaka Shwasa patient. Addiction In the present study, 25.92% patients were addicted to Smoking. There is a definite relationship between Smoking15 and Asthma since it aggravates the disease. Treatment history Maximum no. of patients had treatment history i.e., 62.96%. This shows the chronic and relapsing nature of disease. Chronicity In the present study, maximum number of patients were having 2-5 years of chronicity of the disease i.e., 37.04%. This emphasizes the chronic nature of the disease and yapyathwa of the disease. As the disease becomes chronic, its impact causes the gradual deterioration of the internal channels and it can be maintained by the usage of upashayas or pathyas. Deha Prakriti In the present study, maximum number of patients were having Vata-Kapha Deha Prakriti i.e., 44.44%. Since Tamaka Shwasa is a disease of Vata Kapha origin, it is more likely to occur in patients with Vata- Kapha Prakriti. Vata and Kapha plays a key role in the pathogenesis of the disease16. Manasa Prakriti In the present study, maximum number of patients were having Tamasika Manasa Prakriti i.e., 55.56%. Tamasika Prakriti is Kapha predominant which is the one of the major doshas of the disease. Sara, Samhanana, Pramana, Satmya, Satva Out of 27 patients of this study, maximum i.e. 81.48 % patients were having Madhyama Sara,77.77 % patients Madhyama Samhanana, 77.77 % patients Madhyama Pramana, 85.18 % patients Madhyama Satmya, 74.07 % patients Madhyama Satva as the patients registered were of middle age. Status of Agni Status of Agni in maximum number of patients were found to be Mandagni (40.7%). Mandagni leads to the formation of Ama which has a major role in Samprapti of Tamaka Shwasa. Abhyavaharana shakti In the present study, maximum number of patients were having Avara Abhyavaharanashakti i.e., 51.85%. This corresponds with the fact that Aruchi is found in Tamaka Shwasa because of Sama condition. Jarana shakti In the present study, Maximum number of patients were having Avara Jaranashakti i.e., 51.85%. This is due to Agnimandya which leads to the manifestation of the disease. Vyayama shakti In the present study, maximum number of patients were having Madhyama Vyayama Shakti i.e., 70.37%. International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47539 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 934 This may be due to insufficiency to cope up with the disease producing dyspnoea & discomfort in physical activities that exacerbate asthma17. CONCLUSION Tamaka Shwasa was epidemiologically assessed through this observational study. The prevalence of Asthma analysed here points towards the interconnection of some of the epidemiological factors with the disease. Analysis of data like age, habitat, marital status, occupation, family history, bowel habit, sleep, addiction, treatment history and chronicity are having direct link. Gender, religion, socioeconomic status, education and dietary habit shown no appreciable connection with the disease in this study. Majority of Ayurvedic parameters like Deha Prakriti, Manasa Prakriti, Sara, Samhanana, Pramana, Satmya, Satva, Status of Agni, Abhyavaharana Shakti, Jarana Shakti and Vyayama Shakti also shown some relevant connection with the disease. REFERENCES: 1Agnivesa, Caraka Samhita (vol IV). Translated by Dr.Ram Karan Sharma, Vaidya Bhagwan Dash. Varanasi: Chowkhamba Sanskrit Series Office; Reprint, 2011; 118. 2Archith Boloor Ramdas Nayak,Exam Preparatory Manual for Undergraduates (Medicine),2nd Edition 2018,6th chapter, page No : 252. 3medscape.com/answers/296301-7945/what-is-the- worldwide-prevalence-of-asthma, date of access: 6- October-2021 4Vagbhata, Ashtanga Hrdayam (vol II). Translated by Prof. K. R. Srikantha Murthy. Varanasi: Chowkhamba Krishnadas Academy; Reprint edition- 2012.p 38. 5 https://www.nature.com/articles/s41467-018-04243- 3, date of access: 6-october-2021 6 Vagbhata, Ashtanga Hrdayam (Verses with Index), Compiled by Dr. T. 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Abhilash, Impact of Biogas as Predisposing Factors upon Bronchial Asthma (Ba) and Chronic Obstructive Pulmonary Disorder (Copd) Among Housewives, International Journal of Pharmaceutical Sciences And Research, Published: 01 January 2019, DOI: 10.13040/IJPSR.0975-8232.10(1).445-50 12Stefano R. Del Giacco, Davide Firinu, Leif Bjermer, Kai-Håkon Carlsen, Exercise and asthma: an overview, Eur Clin Respir J. 2015; 2: 10.3402/ecrj.v2.27984. Published online 2015 Nov 3. doi: 10.3402/ecrj.v2.27984 13 Archith Boloor Ramdas Nayak,Exam Preparatory Manual for Undergraduates (Medicine),2nd Edition 2018,6th chapter, page No : 254. 14 Agnivesa, Caraka Samhita (vol IV). Translated by Dr. Ram Karan Sharma, Vaidya Bhagwan Dash. Varanasi: Chowkhamba Sanskrit Series Office; Reprint edition-2011.Page No 131. 15R. Piipari, J.J.K. Jaakkola, N. Jaakkola, M.S. Jaakko la, Smoking and asthma in adults, European Respiratory Journal 2004 24: 734- 739; DOI: 10.1183/09031936.04.00116903 16 Agnivesa, Caraka Samhita (vol IV). Translated by Dr.Ram Karan Sharma, Vaidya Bhagwan Dash. Varanasi: Chowkhamba Sanskrit Series Office; Reprint, 2011; 118. 17 Stefano R. Del Giacco, Davide Firinu, Leif Bjermer, Kai-Håkon Carlsen, Exercise and asthma: an overview, Eur Clin Respir J. 2015; 2: 10.3402/ecrj.v2.27984. Published online 2015 Nov 3. doi: 10.3402/ecrj.v2.27984