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Role of Ayurveda and Yoga to Improve Respiratory Volumes and Capacities in COVID Pandemic

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Abstract

COVID-19 has once again given a tough competition. The new strain of infection caused by the virus is much more lethal than the old because it continues to attack the lungs of patients in many cases. Yes, there are many people infected who have damaged up to 25% of their lungs before showing symptoms of COVID-19. Once they get themselves tested, many are facing problems like breathing problems. About 60-65 per cent of COVID-19 patients are finding it difficult to breathe normally as their oxygen level is rapidly depleting. In many cases, the oxygen level of infected people drops below 80 within just two to three days, which can lead to an urgent need for oxygen could be serious. Even after recovering from corona infection, its effect on the lungs is visible for a long time. Negative patients are facing problems like difficulty in breathing, excessive fatigue, lack of improvement in oxygen saturation, frequent shortness of breath, dry cough. Not only this, many patients are in need of oxygen even after being discharged from the hospital. Pulmonary embolism is another problem that patients who have recovered from covid-19 are facing. There is a blockage in the arteries of the lungs, which obstructs the flow of blood to the lungs. This is a very serious problem whose consequences can be fatal. 1 Your lungs are constantly working to provide your body with all the oxygen it needs to function well. The respiratory system is vital for you to live. However, just like all other systems of our body, even the respiratory system is prone to wear and tear, more so due to high levels of toxins and pollutants in the air. Lung health also varies from season to season. In Ayurvedic context, when too much Vata (space +air) accumulates in the lungs we experience breathlessness, dry coughs, asthma, hoarseness of the voice, weak voice, pain when breathing and even lung allergies. If you are experiencing any of these, your lung health might be out of balance. Ayurveda has effective remedies to bring an agitated dosha back into balance through diet, lifestyle and herb concoctions. To ensure the health of our lungs, let's dive into ancient wisdom that's highly effective even today. 2 Pranayama improved lung functions in numerous studies. Yoga involve isometric contraction and improves skeletal muscle strength. Yoga training improves the strength of expiratory as well as inspiratory muscles.Since ageing is associated with a decline in pulmonary function, heart rate variability and spontaneous baroreflex, and recent studies suggest that yoga respiratory exercises may improve respiratory and cardiovascular function, we hypothesised that yoga respiratory training may improve respiratory function. 3
Role of Ayurveda and Yoga to Improve Respiratory Volumes and Capacities in COVID... 25
Role of Ayurveda and Yoga to Improve Respiratory
Volumes and Capacities in COVID Pandemic
1
Chauhan Saurabh, Pandey K.K. 
Abstract: COVID-19 has once again given a tough competition. The new strain of infection
caused by the virus is much more lethal than the old because it continues to attack the lungs of
patients in many cases. Yes, there are many people infected who have damaged up to 25% of
their lungs before showing symptoms of COVID-19. Once they get themselves tested, many are
facing problems like breathing problems. About 60-65 per cent of COVID-19 patients are finding
it difficult to breathe normally as their oxygen level is rapidly depleting. In many cases, the
oxygen level of infected people drops below 80 within just two to three days, which can lead to
an urgent need for oxygen could be serious. Even after recovering from corona infection, its effect
on the lungs is visible for a long time. Negative patients are facing problems like difficulty in
breathing, excessive fatigue, lack of improvement in oxygen saturation, frequent shortness of
breath, dry cough. Not only this, many patients are in need of oxygen even after being discharged
from the hospital. Pulmonary embolism is another problem that patients who have recovered from
covid-19 are facing. There is a blockage in the arteries of the lungs, which obstructs the flow of
blood to the lungs. This is a very serious problem whose consequences can be fatal.1
Your lungs are constantly working to provide your body with all the oxygen it needs to
function well. The respiratory system is vital for you to live. However, just like all other systems
of our body, even the respiratory system is prone to wear and tear, more so due to high levels of
toxins and pollutants in the air. Lung health also varies from season to season. In Ayurvedic
context, when too much Vata (space +air) accumulates in the lungs we experience breathlessness,
dry coughs, asthma, hoarseness of the voice, weak voice, pain when breathing and even lung
allergies. If you are experiencing any of these, your lung health might be out of balance. Ayurveda
has effective remedies to bring an agitated dosha back into balance through diet, lifestyle and herb
concoctions. To ensure the health of our lungs, let’s dive into ancient wisdom that’s highly
effective even today.2
Pranayama improved lung functions in numerous studies. Yoga involve isometric
contraction and improves skeletal muscle strength. Yoga training improves the strength of
expiratory as well as inspiratory muscles.Since ageing is associated with a decline in pulmonary
function, heart rate variability and spontaneous baroreflex, and recent studies suggest that yoga
respiratory exercises may improve respiratory and cardiovascular function, we hypothesised that
yoga respiratory training may improve respiratory function.3
Key words:- COVID-19 pandemic, Lung Volumes, Lung Capacities, Bhramari Pranayama.
Ph.D (Yoga), Research Scholar, Professor& Head, Dept. of Sangyaharan, Faculty of
Ayurveda, I.M.S. B.H.U. Varanasi.
Sangyaharan Shodh: International Peer Reviwed: Feb. 2022, Vol. 25, No.1/ ISSN 2278-8166, IJIFACTOR: 4.68 25
26 Sangyaharan Shodh: International Peer Reviwed: Feb. 2022, Vol. 25, No.1/ ISSN 2278-8166, IJIFACTOR: 4.68
Introduction : - COVID-19 is a disease caused by viruses belonging to the family of Corona
viruses 4, which in turn belong to the group of viruses causing common cold and associated fever5.
Common cold is a viral upper respiratory infection caused primarily by Rhinovirus, Coronavirus,
Influenza, etc. Corona virus causes direct infection in respiration system, without going through
conventional blood infection, where immunity plays a major role to resist the infection. Therefore
the disease caused by such virus is classified as Severe Acute Respiratory Syndrome (SARS).
Due to its nature of direct infection in respiration system and causing suffocation and breathing
disorders, such virus can also be considered as meticulously engineered biological warfare
weapon, by reconstruction and mutation of existing virus genes 6. Bio-warfare is not new. Such
use of warfare can be traced back to past millennium 7. In a bio-war, the army which is using such
bio-war weapon will have a medicine or cure for their safety, but they keep it in secret. It means,
even if one considers COVID-19 as a bio warfare weapon, the medicine or treatment procedure
exists.
The knowledge on respiratory infections caused by micro-organisms and treatment
procedure existed thousands of years back. In Indian traditional Ayurvedic medical system, such
diseases are handled by the method of Dhumapana 8, in which a patient or a group of patients are
subjected to direct or indirect inhalation of smoke produced by burning herbal medicines in ghee.
In this article, various types of preventive measures and treatment under the broad heading of
Dhumapana is discussed. A simple Dhumapana preparation method is also described, which is
suggested as a treatment procedure for COVID-19 like diseases.
Lung volumes are also known as respiratory volumes. It refers to the volume of gas in
the lungs at a given time during the respiratory cycle. Lung capacities are derived from a
summation of different lung volumes. The average total lung capacity of an adult human male is
about 6 litres of air. Lung volumes measurement is an integral part of pulmonary function test.
These volumes tend to vary, depending on the depth of respiration, ethnicity, gender, age, body
composition9 and in certain respiratory diseases. A number of the lung volumes can be measured
by Spirometry- Tidal volume, Inspiratory reserve volume, and Expiratory reserve volume.
However, measurement of Residual volume, Functional residual capacity, and Total lung capacity
is through body plethysmography, nitrogen washout and helium dilution technique.
LUNG VOLUMES
Tidal Volume(TV):- It is the amount of air that can be inhaled or exhaled during one respiratory
cycle10. This depicts the functions of the respiratory centres, respiratory muscles and the
mechanics of the lung and chest wall11. The normal adult value is 10% of vital capacity (VC),
approximately 300-500ml (6‐8 ml/kg)11; but can increase up to 50% of VC on exercise12
Inspiratory Reserve Volume (IRV):-It is the amount of air that can be forcibly inhaled after a
normal tidal volume.IRV is usually kept in reserve, but is used during deep breathing. The normal
adult value is 1900-3300ml.
Role of Ayurveda and Yoga to Improve Respiratory Volumes and Capacities in COVID... 27
Expiratory Reserve Volume (ERV):-It is the volume of air that can be exhaled forcibly after
exhalation of normal tidal volume. The normal adult value is 700-1200ml. ERV is reduced with
obesity, ascites or after upper abdominal surgery11
Residual Volume (RV);- It is the volume of air remaining in the lungs after maximal exhalation.
Normal adult value is averaged at 1200ml (20‐25 ml/kg) .It is indirectly measured from
summation of FRC and ERV and cannot be measured by spirometry.
In obstructive lung diseases with features of incomplete emptying of the lungs and air
trapping, RV may be significantly high. The RV can also be expressed as a percentage of total
lung capacity and values in excess of 140% significantly increase the risks of barotrauma,
pneumothorax, infection and reduced venous return due to high intra thoracic pressures as noticed
in patients with high RV who require surgery and mechanical ventilation thus needs high peri-
operative inflation pressures. 13
LUNG CAPACITIES
Inspiratory capacity(IC):- It is the maximum volume of air that can be inhaled following a
resting state. It is calculated from the sum of inspiratory reserve volume and tidal volume. IC =
IRV+TV
Total Lung Capacity (TLC):- It is the maximum volume of air the lungs can accommodate or
sum of all volume compartments or volume of air in lungs after maximum inspiration. The normal
value is about 6,000mL (4‐6 L). TLC is calculated by summation of the four primary lung
volumes (TV, IRV, ERV, RV).
TLC may be increased in patients with obstructive defects such as emphysema and
decreased in patients with restrictive abnormalities including chest wall abnormalities and
kyphoscoliosis14.
Vital Capacity (VC):- It is the total amount of air exhaled after maximal inhalation. The value
is about 4800mL and it varies according to age and body size. It is calculated by summing tidal
volume, inspiratory reserve volume, and expiratory reserve volume. VC = TV+IRV+ERV.
VC indicates ability to breathe deeply and cough, reflecting inspiratory and expiratory
muscle strength.VC should be 3 times greater than TV for effective cough15. VC is sometimes
reduced in obstructive disorders and always in restrictive disorders15
Function Residual Capacity (FRC):- It is the amount of air remaining in the lungs at the end of
a normal exhalation. It is calculated by adding together residual and expiratory reserve volumes.
The normal value is about 1800 2200 mL. FRC = RV+ERV.
FRC does not rely on effort and highlights the resting position when inner and outer
elastic recoils are balanced. FRC is reduced in restrictive disorders. The ratio of FRC to TLC is
an index of hyperinflation16. In COPD, FRC is upto 80% of TLC11.
28 Sangyaharan Shodh: International Peer Reviwed: Feb. 2022, Vol. 25, No.1/ ISSN 2278-8166, IJIFACTOR: 4.68
MEASUREMENT OF LUNG VOLUMES
Measurements of lung volume are important for a correct physiological diagnosis,
however, its role in the assessment of disease severity, functional disability, the course of disease
and response to treatment remains controversial.17 Measurement can be done using Spirometry
see, Body plethysmography, Nitrogen washout and Helium dilution with the latter three
techniques used in measuring static lung volumes14.
Body Plethysmography:- Plethysmography is derived from Greek word meaning enlargement .
Body plethysmography primarily measures FRC using Boyle's law. It is particularly appropriate
for patients who have air spaces within the lung that do not communicate with the bronchial tree.
The person is seated comfortably in an airtight box(Static lung volumes can be obtained
either by measuring the changes in pressure in a constant volume box or volume in a constant
pressure box) in which changes in pressure and volume can be measured accurately.
Nitrogen Washout:- This technique is based on washing out the N2 from the lungs, while the
patient breathes 100% O2 using dilution properties of gases.
The patient breathes 100% oxygen, and all the nitrogen in the lungs is washed out. The
exhaled volume and the nitrogen concentration in that volume are measured.
The difference in nitrogen volume at the initial concentration and at the final exhaled
concentration allows a calculation of intrathoracic volume, usually FRC.
Helium Dilution;- The method for measuring lung volumes is based on the equilibration of gas
in the lung with a known volume of gas containing helium. This technique involves the subject
being connected to a spirometer filled with 10% helium in oxygen. After the subject re-breathes
the heliumoxygen mixture and equilibrates with the spirometer, the helium concentration in the
lungs will become the same as in the spirometer. From the conservation of mass principle, we can
write that: C1 × V1 = C2 (V1 + V2) Where C1 equals the initial concentration of helium in the
spirometer,
V1 equals the initial volume of heliumoxygen mixture in the spirometer,
C2 equals helium concentration after equilibration,
V2 equals unknown volume in the lungs.
V2=V1 (C1-C2)/C2
If the test begins at the end of a normal tidal volume (end of expiration), the volume of
air remaining in the lungs represents FRC.
If the test begins at the end of an FVC, then the test will measure RV.
Similarly, if the test starts after a maximal inspiration, then V2 would equal Total lung
capacity.
Traditional Ayurvedic Concept:-
Ayurveda is a science of life. A medical science with well-established scientific and
engineering principles developed and practiced in India for several thousand years 18. Ayurveda
Role of Ayurveda and Yoga to Improve Respiratory Volumes and Capacities in COVID... 29
follows holistic approach on treatment of diseases. The foundation of present day Ayurveda is
based on original texts such as Sushruta Samhita, Charaka Samhita, Astanga Hirudaya, etc, which
were written in Sanskrit language thousands of years before. In this article, Sushruta Samhita is
used as reference.
According to Ayurveda, the entire universe is made up of only Panchabhutas- five
fundamental elements namely, Prithvi (earth or solid matter), Jala (water or liquid), Agni (heat
and fire), Vayu (air), and Akash (space). Different matters are evolved out of Panchabhutas,
through different combination and proportion. Ayurveda considers human body, mind and spirit
as a single system and it is also made up of the same five elements. Three doshas or humors are
formed out of the five elements: earth and water join to form Kapha Dosha, fire forms Pitta Dosha,
and, air and space join to form Vata Dosha. At the time of birth of a child, based on space, time
and parents‟ body-mind-spirit constitution, the child acquires definite proportion of the three
doshas, and they will be in balance with each other. This proportion is called “Prakriti” of the
person, and it does not change with space and time. But the entire universe is also made up of
same five elements and these elements are associated with the three doshas. Therefore, the food,
lifestyle, surroundings or environment, etc., of the person continuously influence on the person‟s
Prakriti. Because of this, the proportion between the doshas may change, and this will cause a
deviation in Prakriti of the person. This deviation is called “Vikriti,” which is responsible for
diseases. The Ayurvedic treatment procedures involve in finding out the Prakriti and Vikriti of
the person and treat him accordingly to bring back the system to the original condition. The
change of environment (mainly thermal environment), space (person‟s movement to another
place) and time (season) are the main causes of infection through micro-organisms and thereby
outbalancing the three doshas.19
Ayurvedic treatment procedure basically involves in balancing the three doshas and
thereby regaining health. Doshas balance naturally when the toxins from the body is removed.
Removal of toxins from the body is done through Panchakarma treatment. Panchakarma is carried
out in three steps- poorva karma or preparation, prathan karma (main treatment) and paschat
karma (post panchakarma treatment). Poorva karma consists of two main processes to dislodge
the accumulated poisonous substances in the body: Snehana or oleation (body massage with oil)
and Swedana or fomentation (sweating using medicated steam), after oleation. 20
In main panchakarma treatment, elimination of toxins from the body is carried out in
five parts:
(i) Vamana or therapeutic emesis to cleanse the upper gastro till the duodenum and upper part
of the respiratory tract
(ii) Virechana or therapeutic purgation to cleanse the lower gastro from the duodenum till the
exit
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(iii) Anuvasana or enema using medicated oil to take out all the lipid soluble waste out through
the anus by lubricating the rectal area
(iv) Nasyam: intake of medicated substances through nasal to cleanse the respiratory tract and
para-nasal sinuses
(v) Astapana Vasti or therapeutic enema to cleanse the area from the transverse colon till the
anus
Not all the five treatments are given to all the patients. Depending upon the disease, few of the
above treatment are given. It is seen that Vamana is suggested for diseases of upper
respiratory tract like COVID-19. But, in order to carry out Vamana, the poorva karma or
preparatory treatment is to be given. But, poorva-karma takes minimum one to two weeks
depending upon the disease and it is not practical for COVID-19 patients especially when
they have breathing suffocation. 21
Apart from panchakarma, Ayurveda suggests two inhalation methods for treatment of
common cold and associated respiratory disorders: (i)Swedana: Indirect inhalation of vapor from
herbs in boiled water, practiced as medicated steam bath, after body massage, (part of Poorva-
karma as mentioned above) and (ii)Dhumapana: direct inhalation of smoke by burning some
herbal preparation in ghee.
Though Swedana is effective in treatment of upper respiratory infectious diseases, it has
the disadvantage that the steam inhaled may condense in lungs and it is not desirable. Only
Dhumapana is effective in curing respiratory disorders caused by external infection like COVID-
19. 22
YOGA FOR LUNG CAPACITY
The word yoga means 'union': union of mind, body and spirit - the union between us and
the intelligent cosmic spirit of creation- 'the oneness of all things’ 23. So pranayamaliterally,
"control of prana"isn't just breathing exercises. Through pranayama, you use the breath to affect
the constellation of energy that is your body- mind 24.
Prana - "life force" or "life energy"
Yama - "discipline" or "control"
Ayama - "expansion", "non-restraint", or "extension
The five principles of yoga are relaxation, exercise (asanas), pranayama (breathing
control), nourishing diet, and positive thinking and meditation, pranayama are yogic breathing
techniques that increase the capacity of lungs. Pranayama which is control of inspiration and
expiration 25. The inspiration of prana-vayu is shwasa and expiration is prashwasa and cessation
of both is characteristic of pranayama. Pranayama improves overall performance of the body. The
regular practice of pranayama increases chest wall expansion and almost all lung functions. The
beneficial effect of different pranayama is well reported and has sound scientific basis 25,26.
Role of Ayurveda and Yoga to Improve Respiratory Volumes and Capacities in COVID... 31
Pranayama makes efficient use of abdominal and diaphragmatic muscles and improves the
respiratory apparatus 27. Yoga strengthens the respiratory musculature due to which chest and
lungs inflate and deflate to fullest possible extent and muscles are made to work to maximal extent
28,29.
Sectional breathing:-
Nadisuddi: Close the right nostril with the right thumb. Now inhale slowly through the left nostril
and fill your lungs. After inhalation, close the left nostril with ring finger of right hand. Open the
right nostril, exhale slowly. After complete exhalation, again inhale through right nostril and close
it with right thumb. Open the left nostril, breathe out slowly. This is one round of Nadisukthi
Pranayama. Students were given Nadisuddi training for 5 mins daily for two months 30.
Kapalbhati: Kapalbhati Pranayama is a type of breathing exercise that helps you rid of various
ailments over a period of time 31. "Kapal" means forehead and "bhati" means shining. Kapalabhati
is done in a sitting posture 32. Focus on "exhaling". Inhale as normal. Exhale and simultaneously
contract the abdomen muscles with each exhalation. Students were given Kapalbhati training for
5 mins daily for 2 months.
Bhastrika: Bhastrika is a Sanskrit word which means bellows. In Bhastrika pranayama, the
breathing pattern resembles the blowing of bellows. Bhastrika pranayama is all about inhaling
and exhaling completely so that your body gets maximum amount of oxygen 33. Students were
given Bhastrika training for 5 mins daily for 2 months.
Bramhari: The word "Bramhari" comes from the Sanskrit name bhramar which is humming
black bee 34. The practice of bramhari breathing calms the mind, reduces the stress or fight - flight
response. In this pranayama one needs to create a sound while exhaling and inhaling in the throat.
The sound is similar to chanting of Om, especially the long mmm. in Omkar. The sound should
be deep, steady and smooth. Students were given Bramhari training for 5 mins daily for 2 months.
Pranava Pranayama: The Pranava is the full cosmic Om (or AUM), represented as the three
distinct vibratory sounds of 'A' (ah), 'U' (oh) and 'M' (mm). The 'Ahh' sound originating from the
solar plexus is related to lower lung breathing 35. The 'Ohh' sound originating from the chest
region corresponds to mid-chest breathing. The 'Mmm' sound, as it moves upward and transcends
its auditory character is associated with upper lung breathing. Students were given Pranava
Pranayama training for 5 mins daily for 2 months.
Surya Namsakar: Surya Namaskar has a deep effect in detoxifying the organs through copious
oxygenation and has a deeper relaxing effect. It is a series of 12 physical postures 36. These
alternating backward and forward bending postures flex and stretch the spinal column giving a
profound stretch to the whole body 37. Students were given Surya Namaskar training for 3 mins
daily for 2 months. OM Chanting was done at the end of the yoga session daily 2 mins for 2
months.
32 Sangyaharan Shodh: International Peer Reviwed: Feb. 2022, Vol. 25, No.1/ ISSN 2278-8166, IJIFACTOR: 4.68
Conclusion :- Based on the literature review and search of published research works, the analysis
establishes the possible potential of AYUSH guidelines in prophylaxis, management and in easing
post infective convalescence. Through Ayurveda, lungs can be strengthened and their capacity
can be increased. Ancient methods like Ayurvedic provide immense benefits in the covid-19
epidemic. Ayurveda and Yoga play an important role in all the problems related to breathing,
especially related to lungs. Various types of yoga practice and Ayurvedic treatment prove to be
useful in reducing the problems caused by covid-19. Ayurveda and may possible pave way for an
integrated approach in fighting COVID-19 in ‘flattening the curve’ by modulating the host
immune response and prevention of disease.
Pranayama helps in bringing the sympathetic and parasympathetic nervous system into
harmony. Through breathing we can influence the nervous system. Pranayama may allow
bronchio-dilatation by correcting abnormal breathing patterns & reducing muscle tone of
respiratory muscles. Yoga training improves the strength of expiratory as well as inspiratory
muscles. Bhastrika Pranayama is a bellows type breathing in which one breath forcefully and
rapidly and thus, exercises inspiratory as well as expiratory muscles . In breathing exercises like
Kapalbhati, short powerful strokes of exhalation in quick succession with contraction of
abdominal and diaphragmatic muscles train the subject to make full use of diaphragm and
abdominal muscles in breathing. It also helps in removal of secretions from bronchial tree,
clearing up respiratory passages and the alveoli making room for more air. Thus this present study
indicates that the regular practice of pranayama improves pulmonary function and is beneficial to
improve respiratory efficiency.
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