Shwasa-roga Series-7 :Approach to Santamak & Pratamak-shwasa-roga by Prof. S. N. Ojha

Tamaka shwas exacerbarates with shita whereas shita is treatment for pratamaka shwas. Chakrapani has given 2 reasoning for the same. Pittanubanda in pratamaka pacifies by shita treatment or as in madatyaya wherein madyapana is treatment of mada which is caused by excessive alcoholic intake, similarly shita chikitsa by its viparitharthakari chikitsa helps in pratamka condition of tamaka shwas.

Features of Pratamaka and Santamaka Shvasa resembles exacerbations. Vata and kapha when associated with pitta lead to pratamaka wherein fever is the main symptom which explains the presence of pitta. Infection is main cause of exacerbation which leads to secretion of inflammatory factors which may stimulate prostaglandins and thereby fever cascade. Studies suggest that acquiring a new strain of bacteria is associated with increased near-term risk of exacerbation and that bacterial infection/superinfection is involved in over 50% of exacerbations. Viral respiratory infections are present in approximately one-third of COPD exacerbations. Whereas smoke (rajō), exposure to dust and fumes at work. Several specific occupational exposures, including coal mining, gold mining, and cotton textile dust, have been suggested as precipitating factors for chronic airflow obstruction. 

Klinna kayo means old aged patient. It is not uncommon for adults in their 70s or 80s to develop asthma symptoms for the first time. When asthma does occur at a later age, the symptoms are much like those experienced by anyone else. The most common causes of an asthma flare up are a respiratory infection or virus, exercise, allergens, and air pollution (an irritant). Allergens and irritants are substances found in our everyday environment. Clinical presentation usually involves an adult patient indicating recurrent episodes of wheezing, chest tightness, shortness of breath, or nocturnal coughing. 

Asthma creates a much greater risk for older adults because they are more likely to develop respiratory failure as a result of the asthma, even during mild episodes of symptoms.

A causal mechanism of aging, implicating the endogenously generated oxygen free radicals as the agents of damage. More recently, in a major conceptual shift, reactive oxygen species have been found to be physiologically vital for signal transduction, gene regulation, and redox regulation, among others, implying that their complete elimination would be harmful. In summary, the immune system declines with age, and elderly asthma patients are more prone to airway infection than younger subjects.

Lung function decreases with age due to increased stiffness of the chest wall, reduced respiratory muscle function and an increase in residual volume from loss of elastic recoil. The decline in the elasticity of the airway is considered the major contributor to the increase in fixed airflow obstruction and work of breathing with age. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137434/)

In this shlok Caraka mentions both type of asthma: Intrinsic asthma which is  usually  secondary  to  chronic  or  recurrent  infections  of  the  bronchi, sinuses, or tonsils and adenoids. There is evidence that this type develops from a hypersensitivity to the bacteria or, more commonly, viruses causing the infection. Attacks can be precipitated by infections, emotional factors, and exposure to nonspecific

irritants.

Atopic Asthama/ extrinsic asthma: asthma caused by some factor in the environment, usually atopic in nature. Atopic asthma is one of the most common forms of asthma and is triggered by exposure to an allergen. Upon exposure to the allergen, the airways become constricted and inflamed which affects breathing. The severity of symptoms is variable. This form of asthma is more common in children than adults.

Majjatastamasīvā'sya Vidyāt: Explanation is similar to cough syncope which is observed in COPD. Post-tussive syncope is a consequence of markedly elevated intrathoracic pressures induced by coughing. A typical profile of the cough syncope patient emerging from the literature is that of a middle-aged, large-framed or overweight male with obstructive airways disease. Presumably, such an individual would be more likely to generate the extremely high intrathoracic pressures associated with cough-induced fainting. The precise mechanism of cough syncope remains a matter of debate. Theories proposed include various consequences of the marked elevation of intrathoracic pressures induced by coughing: diminished cardiac output causing decreased systemic blood pressure and, consequently, cerebral hypoperfusion; increased cerebrospinal fluid (CSF) pressure causing increased extravascular pressure around cranial vessels, resulting in diminished brain perfusion; or, a cerebral concussion-like effect from a rapid rise in CSF pressure. More recent mechanistic studies suggest a neurally mediated reflex vasodepressor-bradycardia response to cough.(http://www.ncbi.nlm.nih.gov/pubmed/24238768)

Patients with advanced COPD, those with a history of hypercarbia, those with mental status changes (confusion, sleepiness), or those in significant distress explains phase of santamaka caused due to hypercabnia.

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Prof. Satyendra Narayan Ojha  

MD PhD

(Kayachikitsa)
Director,

Yashwant Ayu. College & P.G.Training & Research Center, 

Kodoli, Kolhapur, Maharashtra, India.

Mobile No.- +91 9822177155     

email: drsnojha@rediffmail.com