“CLINICAL STUDY ON HOMEOPATHIC MANAGEMENT OF

BRONCHIAL ASTHMA WITH REFERENCE TO LUNG

VOLUME CAPACITY USING SPIROMETRY”.

A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE

REQUIREMENT

FOR THE AWARD OF THE DEGREE OF

DOCTOR OF MEDICINE IN HOMOEOPATHY M.D. (Hom.)

IN

PRACTICE OF MEDICINE

By
Dr. AYYALAMMAI. M

Under the guidance of

Dr. N.V SUGATHAN, M.D. (Hom.)

Professor, Department of Practice of Medicine

SARADA KRISHNA HOMOEOPATHIC MEDICAL COLLEGE,

KULASEKHARAM, TAMIL NADU

SUBMITTED TO
THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI

2019
 ENDORSEMENT BY THE HEAD OF THE DEPARTMENT AND THE

INSTITUTION

This is to certify that the dissertation entitle “CLINICAL STUDY ON

HOMEOPATHIC MANAGEMENT OF BRONCHIAL ASTHMA WITH

REFERENCE TO LUNG VOLUME CAPACITY USING SPIROMETRY ”.

is a bonafide work carried out by Dr. AYYALAMMAI. M, a student of

M.D.(Hom.) in PRACTICE OF MEDICINE in the SARADA KRISHNA

HOMOEOPATHIC MEDICAL COLLEGE under the supervision and guidance of

Dr. N.V SUGATHAN M.D.(Hom.), Professor Department Of Practice of

Medicine in partial fulfilment of the Regulations for the award of the Degree of

DOCTOR OF MEDICINE (HOMOEOPATHY) in PRACTICE OF

MEDICINE. This work confirms to the standards prescribed by THE

TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI.

This has not been submitted in full or part for the award of any degree or diploma

from any university.

DR. N. V. SUGATHAN M.D ( HOM)., DR. N.V.SUGATHAN M.D(HOM).,

Professor, PRINCIPAL,

PRACTICE OF MEDICINE
 CERTIFICATE BY THE GUIDE

This is to certify that the Dissertation entitled “CLINICAL STUDY ON

HOMEOPATHIC MANAGEMENT OF BRONCHIAL ASTHMA WITH

REFERENCE TO LUNG VOLUME CAPACITY USING

SPIROMETRY” is a bonafide work of Dr. AYYALAMMAI.M, all his work has

been carried out under my direct supervision and guidance. His approach to the

subject has been sincere, scientific and analytic. This work is recommended for the

award of degree of DOCTOR OF MEDICINE (HOMOEOPATHY) in

PRACTICE OF MEDICINE of THE TAMILNADU DR.M.G.R MEDICAL

UNIVERSITY, CHENNAI.

Place: Kulasekharam Dr. N.V. SUGATHAN M.D.(Hom.),

Professor,

Department Of Practice of Medicine

 DECLARATION

I, Dr.AYYALAMMAI. M do hereby declare that this Dissertation entitled

“CLINICAL STUDY ON HOMEOPATHIC MANAGEMENT OF

BRONCHIAL ASTHMA WITH REFERENCE TO LUNG VOLUME

CAPACITY USING SPIROMETRY is a bonafide work carried out by me

under the direct supervision and guidance of

Dr.N.V.SUGATHAN M.D.(Hom.), Professor, Department Of Practice of

medicine, in partial fulfillment of the Regulations for the award of degree of

DOCTOR OF MEDICINE(HOMOEOPATHY) in PRACTICE OF

MEDICINE of The Tamil Nadu Dr. M.G.R Medical University, Chennai. This has

not been submitted in full or part for the award of any degree or diploma from any

University.

Place: Kulasekharam
 ABSTRACT

Bronchial asthma is airway inflammatory, increased hyper reactivity and

obstructive airway disease 5-10% globally health problem . “Asthma is a chronic

inflammatory disorder of the airways hyper responsiveness (AHR) that leads to

recurrent episodes of wheezing, breathlessness, chest tightness and coughing,

particularly at night or in the early morning. These episodes are usually associated

with widespread, but variable, airflow obstruction within the lung that is often

reversible either spontaneously or with treatment”lung volume changes are observed

by spirometry before and after treatment of homoeopathy.

MAERIALS AND METHODS:

METHODOLOGY: Total sample of 30 patients are selected from the Out

Patient Department, In Patient Department, RHC department of Sarada Krishna

Homoeopathic Medical College Based on inclusive criteria. The patient will be

categorized 1-30 before treatment, 1A -30A After treatment underwent spirometry.

The cases were analyzed, evaluated and remedy was prescribed. Assessment was

done in every one-month and the symptoms were recorded for the pre and posttest

assessment. ‘Paired t test' was accomplished for the Statistical Analysis.

RESULT & CONCLUSION:

Evidently, among the 30 cases under study, 25 cases (87%) shows marked

improvement, Majority of screened patients in which 20 were Females and 10 were

males. The common associated complaints are difficulty in breathing, cough almost

dry, sneezing , obstruction in nose. All the cases were evaluated frequently in 6

months interval and changes were recorded. The medicines, which are found to be
more effective, are ARS ALB and NATRUM SULPH. Medicines are more effective

while they are administered in 50 millesimal potency in frequent dose than dry dose.

Females are more prone for family history of BA, suppression of skin disease is most

important factor for development of BA through layers of suppression. This study

provides an evidence to show that there is significant reduction in the disease

intensity scores , reduced recurrence of attack and Forced expiratory volume

markedly increased after administering Homoeopathic Medicines. Hence, we can

infer that Homoeopathic medicines have a very predominant role in effect to change

the lung volume capacity in the treatment of bronchial asthma. It is also effective in

the reducing recurrence of episodes and improved lung volumes also. In addition, the

results are statistically significant.

KEYWORDS:

Bronchial asthma, forced expiratory volume, vital capacity, forced vital capacity,

predictive value, Spirometry DisabilityAdjustedLifeYears, American Thoraxic

Society Standard. .
 ACKNOWLEDGEMENT

The Dissertation work has been completed with the kind support and help of

many individuals. I take this opportunity to thank each and everyone for having

completed my dissertation effectively on time.

First, I feel grateful to My Dad Mr.V.Muniyandi ., RS (RTD) who is a king maker

of my family, earning an honest living for us for supporting and encouraged me and

my brothers and sisters believed me whose Grace strengthened me to complete this

work on time successfully.

I would like to express my special thanks of gratitude and deep regards to our

Chairman, Dr. C. K. MOHAN, B.Sc, M.D (Hom), for providing me the

opportunity to study in this Institution and for providing me with necessary facilities

in the making of this work.

I am highly indebted to Dr. N.V. SUGATHAN ,principal & Professor of Dept of

Practice of Medicine, Sarada Krishna Homoeopathic Medical College, Kulasekharam,

for the guidance and constant supervision as well as for his exemplary guidance,

monitoring and constant encouragement throughout the course of the dissertation.

I forwarded this work to my GURU Dr. KALAIARASAN MD., who is the ocean

of knowledge in medicine, enlighten the interest in the field of medicine.

I express my sincere thanks to the Advisor DR. RAVI M. NAIR, for their kind

support and encouragement for the research works.

I am thankful to DR. T. AJAYAN M.D(HOM)., Prof & Head, Dept of Practice of

medicine for his support throughout my study, and timely valuable advice.

I would like to express a deep sense of gratitude to DR. WINSTON VARGHEESE,

PG coordinator, for his valuable information and guidance, which helped me in

completing this task through various stages.

I am equally grateful to my teacher Dr C. V. Chandraja, Research Officer, for being

kind enough and patient to correct my doubts despite her busy schedule.

I express my heart full thanks to my respected and beloved teacher

Dr. A. S. Suman Sankar, M.D. (Hom.), Department of Repertory, for his valuable

and timely advices.

I express my heart full thanks to my beloved teachers Dr. Hari Sankar, for their

timely support and encouragement. I would like to express my sincere thanks to all

my kind teachers who lit the lamp of knowledge in me.

I convey my thanks to Dr Sisir Prof & HOD Dept Of Paediatrics, librarians, nurses

and all college staffs, hospital and registration staffs for providing the ample support

in the collection of the data and towards the preparation of the work.
I would also like to thank all the members of the Ethical Committee for their valuable

suggestions.

I would like to express a deep sense of gratitude to CCRH for selecting my topic for

scholarship

I also extend my thanks to Dr. Frettypaul, Dr.Brigit , Dr. Asif ali ,Dr.Sudhir singh

phD, Dr.Varun M.D.,

I also extend my sincere thanks to the patients who participated in the study.

Dr. Ayyalammai

Practice of medicine, SKHMCH.

 TABLE OF CONTENTS

Sl. No CONTENTS Page. No

1 INTRODUCTION 1-2

2 AIMS & OBJECTIVES 3

3 REVIEW OF LITERATURE 4-25

4 MATERIALS AND METHODS 26-29

5 OBSERVATIONS AND RESULTS 30-38

6 STATISTICAL ANALYSIS 39-42

7 DISCUSSION 43-44

8 LIMITATIONS AND RECOMMENDATIONS 45-46

9 CONCLUSION 47

10 SUMMARY 48

11 BIBLIOGRAPHY 49-51

12 APPENDICES 52-86
 LIST OF FIGURES:

FIGURE DESCRIPTON PAGE NO

NO
1 STAGE OF DEVELOPMENT OF LUNG 5

2 STRUCTURE OF ALVEOLI 7
3 LUNG VOLUMES AND CAPACITY 13

4 BRONCHIAL ASTHMA PATHOLOGY 15

5 FEATURES OF BA 17
6 TYPES OF BA 19
7 SPIROMETRY 20
8 SPIROMETRY GRAFE NORMAL CURVE 21

9 PULMONARY FINDINGS IN ASTHMA 22

10 PREVALENCE OF DISEASE 29
11 DISTRIBUTION BASED ON FAMILY HISTORY 30
12 DISTRIBUTION BASED ON FAMILY HISTORY 29

13 DISTRIBUTION BASED ON PAST HISTORY 30

14 DISTRIBUTION BASED ON MEDICINE 31

PRESCRIBED
15 OBSTRUCTIVE FACTORS FOR ASTHMA 32
16 DISTRIBUTION OF CASES BASED ON 33
OCCUPATION
TABLE
17 SHOWS THE DISTRIBUTION OF CASES 34
ACCORDING TO SYMPTOMS OF BRONCHIAL
ASTHMA
18 FEV1 VALUES OF PATIENTS BEFORE AND AFTER 35
TREATMENT
 LIST OF TABLES:
TABLE NO DESCRIPTION PAGE NO
1 DISTRIBUTION OF CASES 29
BASED ON AGE
2 DISTRIBUTION BASED ON 30
FAMILY HISTORY

3 DISTRIBUTION BASED ON 31
PAST HISTORY

4 DISTRIBUTION BASED ON 32
MEDICINE PRESCRIBED
5 OBSTRUCTIVE FACTORS FOR 33
ASTHMA
6 DISTRIBUTION OF CASES 34
BASED ON OCCUPATION
TABLE
7 SHOWS THE DISTRIBUTION
OF CASES ACCORDING TO
SYMPTOMS OF BRONCHIAL
ASTHMA
8 FEV1 VALUES OF PATIENTS 35
BEFORE AND AFTER
TREATMENT

9 PREDICTIVE % OF 36
SPIROMETRY VALUE
BEFORE AND AFTER
TREATMENT

1
 LIST OF ABBREVIATIONS USED

SL. NO. ABBREVIATION EXPANSION

1. % Percentage

2. < Aggravation

3. > Amelioration

4. =,A/F Ailments from

5. Aqua Water

6. D Dose

7. Dr Doctor

8. gtt Drops

9. H/O History of

10. hrly Hourly

11. bd Twice a day

12. mnths Months

13. No. Number

14. OPD Outpatient department

15. IPD In patient department

16. SG Sara globule

17. SD Sara disket

18. SL SaccharumLactis

19. yrs Years

20. wks Weeks

21. C/O Care of

22. Kgs Kilograms

23. i.e., That is

24. eg. Example

25. R Regular

26. NR Nothing Relevant

0
27. C Degree Celsius

28. Σ Sum

29. m Meter

30. § Aphorism

31. FEV1 Forced expiratory volume in 1 mint

32. VC Vital capacity

33. FVC Forced volume capacity

34. BA Bronchial asthma

35. DM Diabetes Mellitus

36. HT hypertension

37. T2DM Type 2 Diabetes Mellitus

38.
CAM Complementary Alternative Medicine

39. Sl.No. Serial Number

 LIST OF APPENDICES

SR.NO APPENDICES PAGE NO

1 GLOSSARY 52

2 CASE RECORD FORMATE 53-63

3 SCORING CHART 64

4 CONSENT FORM 65-67

5 PATIENT CASE RECORD 68-78

6 MASTER CHART 79-83

7 SPIROMETRY VALUE 84-86

 1. INTRODUCTION

Asthma is dynamic clinical syndrome of body + mind+ spirit. Have

cough, wheezing, tightness of chest, shortness of breath intermittent or variable

more at night called nocturnal asthma. Exaggerated by dust, pollens , allergens,

occupational, intrinsic factors, diet and stress.

Among 7.5 billion of world population counted by worldometer, 325

millions of people are suffered by asthma. “ASTHMA” a greek word meaned

breathless or breath on open mouth in adulthood. WHO declared that DALY

(Disability Adjusted Life Years) lost 15 million/year by asthma , among

1%globally lost. This is 3 rd commonest cause of death among 10 worldwild. By

means of extreme pollution, stressful life style modification, poor unhealthy

modernist diet, unwanted vaccination, drug resistance from childhood onwards

and more and more suppression.[1][5]

In wonderful homoeopathic remedy can give complete rapid recovery

from asthma sufferer have very effective changes in bronchospasm and airway

inflammation,not only equal and also more than that of conventional treatment

which is proved by lung function test named spirometry.

SPIROMETERY is device to make measurement of FVC (forced volume

capacity-total amount of air blow out in breath), FEV1(Forced expiratory volume

–Amount of air blow out within mint). TVC (Total volume capacity –ratio

between FEV1/FVC).This is more specific and more accurate than peak flow

meter. It moniter prognosis of asthma.Depend upon the measurement it lung

function is classified as normal/restrictive/obstructive /combined by American

Thoraxic Society Standard.

1
NEED FOR THE STUDY:

Asthma is airway inflammatory, hyper sensitivity and obstructive lung

disease due to allergen, stress, suppression, occupational, seasonal, hereditary as

etiological background. From previous researches, it is clear that asthma is

getting more prevalent and keeping on increasing. Homeopathic constitutional

remedy can give rapid, effective recovery for asthma in various type successfully.

CORTICOSTEROID inhalers have user defect, side effects, dependency and high

expensive to asthma sufferer. To avoid this and to establish homeopathic

management in asthma proved by lung function test, which is non invasive, in

expensive and more accurate than peak flow meter called spirometry which one

equal and more than that of conventional corticosteroid inhalers.

Homoeopathy faced criticism in world wide due to high dilution medicine

and lack of credible clinical evidence. Its important to provide data on modern

scientific parameter, also should retain the confidence of public. In this study

gave the evidence of how homoeopathy not only improve the case clinically , but

also improved on scientific parameter through spirogram in the management of

BA.

2
 2. AIMS AND OBJECTIVES

AIMS :

spirometry after dynamic homoeopathic remedy

OBJECTIVES:

know the Homeopathic remedy have equal and more effective than other
conventional treatment in asthma.

prognosis of asthma in its severity and control.

3
 REVIEW OF LITERATURE

The respiratory system plays a vital role in the exchange of respiratory gases

of O2 and CO2 in the human body. It allows for the inhalation of gases such as

oxygen in the air, transported by the blood around the body to supply tissues and

cells, and the exhalation of waste gases such as carbon dioxide into the air.

Respiration can be divided into four major functions: (1) pulmonary

ventilation, which means the inflow and outflow of air between the atmosphere and

the lung alveoli (2) diffusion of oxygen and carbon dioxide between the alveoli and

the blood (3) transport of oxygen and carbon dioxide in the blood and body fluids to

and from the body’s tissue cells (4) regulation of ventilation and other facets of

respiration [3].

Structurally, the respiratory system consists of two parts: The upper

respiratory system includes the nose, pharynx, and associated structures. The lower

respiratory system includes the larynx, trachea, bronchi and lungs. The respiratory

zone consists of tissues within the lungs, where gas exchange occurs. These include

the respiratory bronchioles, alveolar ducts, alveolar sacs and alveoli. [2]

3.1. EMBRYOLOGY

The respiratory system does not carry out its physiological function (of gas

exchange) until after birth. At about four weeks of development, the respiratory

system begins as an outgrowth of the foregut just anterior to the pharynx.This

outgrowth is called the respiratory diverticulum or lung bud.(14)

4
 The respiratory system develops from the diverticulam of the foregut, first as

midline groove tracheobronchial groove. It has 6 pharyngeal arches. Distal part

separated from esophagus, cranial part developed as pharynx. Free caudal end become

bifid each subdivision called lung bud. It forms the bronchi and lung parenchyma.

Cranial part form larynx and trachea. 2 primary division of the respiratory division

form right and left principal bronchi. Left division more transverse and divided 2

lobar bronchioles, rt have 3 lobar bronchioles. Lungs formed by further subdivision of

lobar bronchi .Totally 17 number of division of each bronchus before birth. 6 more

after birth . Bronchial tree alveoli formed by expansion of terminal part of tree. Lung

parenchyma developed from lobar bronchi, separated from mesoderm by connective

tissue called pleura separated by fissures. IN FETAL LIFE all division Of bronchial

tree lined by cubical epithelium. It is canalicular phase of lung development. After

birth alveoli become dilated and lining epithelium become thin. Some cells produce

surfactant form thin layer of alveoli which reduce surface tension. Alveoli continue to

multiply until 300 million have formed. This number is reached when the child is

about 8 years old.[21]

5
3.2. FUNCTIONAL ANATOMY AND PHYSIOLOGY:

The lungs occupy the upper two-thirds of the bony thorax, bounded medially

by the spine, the heart and the mediastinum and inferiorly by the diaphragm. During

breathing, free movement of the lung surface relative to the chest wall is facilitated by

sliding contact between the parietal and visceral pleura. [13]

Inspiration involves downward contraction of the dome-shaped diaphragm

(innervated by the phrenic nerves originating from C3, 4 and 5) and upward, outward

movement of the ribs on the cost vertebral joints, caused by contraction of the

external intercostals muscles (innervated by intercostal nerves originating from the

thoracic spinal cord).[26]

Expiration is largely passive, driven by elastic recoil of the lungs. The

conducting airways from the nose to the alveoli connect the external environment

with the extensive, thin and vulnerable alveolar surface. As air is inhaled through the

upper airways, it is filtered in the nose, saturated with water vapour; partial recovery

of this heat and moisture occurs on expiration. Total airway cross-section is smallest

in the glottis and trachea, making the central airway particularly vulnerable to

obstruction by foreign bodies and tumors. Normal breath sounds originate mainly

from the rapid turbulent airflow in the larynx, trachea and main bronchi. The

multitude of small airways within the lung parenchyma has a very large combined

cross-sectional area (over 300 cm2 in the third-generation respiratory bronchioles),

resulting in very slow flow rates. Airflow is normally silent here, and gas transport

occurs largely by diffusion in the final generations. The acinus is the gas exchange

unit of the lung and comprises branching respiratory bronchioles and clusters of

6
alveoli. Here the air makes close contact with the blood in the pulmonary capillaries

(gas-toblood distance < 0.4 µm), and oxygen uptake and CO2 excretion occur.

The alveoli are lined with flattened epithelial cells (type I pneumocytes) and a

few, more cuboidal, type II pneumocytes. The latter produce surfactant, which is a

mixture of phospholipids that reduces surface tension and counteracts the tendency of

alveoli to collapse under surface tension. Type II pneumocytes can divide to

reconstitute type I pneumocytes after lung injury. [3], [17]

STRUCTURE OF ALVEOLI [3]

LUNGS:

The lungs are a pair of respiratory organs situated in the thoracic

cavity. The right and left lung are separated by mediastinum. The right lung

weighs about 700g; it is about 50-100g heavier than left lung.[5] Each lung has

a blunt apex, which projects upward into the neck for about 1in. (2.5cm) above

the clavicle; a concave base that sits on the diaphragm; a convex costal

7
surface, which corresponds to the concave chest wall; and a concave

mediastinal surface, which is moulded to the pericardium and other

mediastinal structures. At about the middle of this surface is the hilum[6] Each

lung is enclosed and protected by pleural membrane. The superficial layer,

called the parietal pleura, lines the wall of the thoracic cavity; the deep layer,

the visceral pleura, covers the lungs. Between the visceral and parietal pleurae

is a small space which contains a small amount of lubricating fluid secreted by

the membranes which reduces friction between the membranes, allowing them

to slide easily over one another during breathing.

Lungs are divided into lobes by fissures. Both lungs have an oblique

fissure, which extends inferiorly and anteriorly; the right lung also has a

horizontal fissure. The oblique fissure in the left lung separates the superior

lobe from the inferior lobe. In the right lung, the superior part of the oblique

fissure separates the superior lobe from the inferior lobe; the inferior part of

the oblique fissure separates the inferior lobe from the middle lobe, which is

bordered superiorly by the horizontal fissure. Each lobe receives its own

secondary (lobar) bronchus. The right primary bronchus gives rise to three

secondary (lobar) bronchi called the superior, middle, and inferior secondary

(lobar) bronchi and the left primary bronchus gives rise to superior and

inferior secondary (lobar) bronchi. Within the lung, the secondary bronchi

give rise to the tertiary (segmental) bronchi, which are constant in both origin

and distribution there are 10 tertiary bronchi in each lung. The segment of

lung tissue that each tertiary bronchus supplies is called a Broncho pulmonary

segment. Each Broncho pulmonary segment of the lungs has many small

compartments called lobules; terminal bronchioles subdivide into microscopic

8
 branches called respiratory bronchioles. Respiratory bronchioles in turn

subdivide into several (2–11) alveolar ducts. [2]

An alveolus is a cup-shaped out pouching lined by simple squamous

epithelium and supported by a thin elastic basement membrane. The walls of alveoli

consist of two types of alveolar epithelial cells as type I alveolar cells are simple

squamous epithelial cells that form a nearly continuous lining of the alveolar wall.

Type II alveolar cells, also called septal cells, are fewer in number and are found

between type I alveolar cells. The thin type I alveolar cells are the main sites of gas

exchange. Type II alveolar cells, rounded or cuboidal epithelial cells with free

surfaces containing microvilli, secrete alveolar fluid, which keeps the surface between
[2]
the cells and the air moist. , The pulmonary arteries, through their capillary plexus,

are entirely concerned with alveolar gaseous exchange, while the nutrient supply of

the lung parenchyma is provided by the bronchial arteries. The pulmonary vein

tributaries derive partly from the capillaries of the bronchial and the pulmonary

arteries. The bronchial veins drain the larger bronchi. The lymphatics of the lungs

drain into the nodes lying at the bifurcations of the larger bronchi, then to the

tracheobronchial nodes and then into the broncho mediastinal lymph trunk on each

side. These usually drain directly into the junction of the internal jugular and

subclavian veins on each side, but may drain, on the right, into the right lymph trunk

and, on the left, into the thoracic duct. If the subcarinal node is the site of secondary

deposits it gives the typical bronchoscopic sign of widening of the carina .The

principal function of the sympathetic (T2-T4) supply to the lung is broncho dilatation,

while the vagus fibres act as stretch receptors.[7]

9
 Lung mechanics:

Healthy alveolar walls contain a fine network of elastin and

collagen fibres . The volume of the lungs at the end of a tidal (‘normal’) breath

out is called the functional residual capacity (FRC). At this volume, the

inward elastic recoil of the lungs is balanced by the resistance of the chest

wall causing negative pressure in the pleural space. Elastin fibres allow the

lung to be easily distended at physiological lung volumes, but collagen fibres

cause increasing stiffness as full inflation is approached so that, in health, the

maximum inspiratory volume is limited by the lung .Within the lung, the

weight of tissue compresses the dependent regions and distends the uppermost

parts, so a greater portion of an inhaled breath passes to the basal regions,

which also receive the greatest blood flow as a result of gravity. Elastin fibres

in alveolar walls maintain small airway patency. Even in health, however,

these small airways narrow during expiration because they are surrounded by

alveoli at higher pressure. The volume that can be exhaled is thus limited

purely by the expiratory muscles to distort the chest wall inwards.

Control of breathing :

The respiratory motor neurons in the posterior medulla oblongata are

the origin of the respiratory cycle.

• Central chemoreceptors in the ventrolateral medulla sense the pH of

the cerebrospinal fluid (CSF) and are indirectly stimulated by a rise in arterial

PCO2.

4
 • The carotid bodies sense hypoxaemia but are mainly activated by

arterial PO2 values below 8 KPa (60 mmHg). They are also sensitised to

hypoxia by raised arterial PCO2.

• Muscle spindles in the respiratory muscles sense changes in

mechanical load .

• Vagal sensory fibres from the lung may be stimulated by stretch, by

inhaled toxins or by disease processes in the interstitium.

• Cortical (volitional) and limbic (emotional) influences can override

the automatic control of breathing. [16], [17]

Ventilation/perfusion matching and the pulmonary circulation :

To achieve optimal gas exchange within the lungs, the regional

distribution of ventilation and perfusion must be matched. Hypoxia constricts

pulmonary arterioles and airway CO2 dilates bronchi, helping to maintain

good regional matching of ventilation and perfusion. The pulmonary

circulation in health operates at low pressure (approximately 24/9 mmHg).

Pulmonary hypertension occurs when vessels are destroyed by emphysema,

obstructed by thrombus, involved in interstitial inflammation or thickened by

pulmonary vascular disease.

5
 Lung defences:

Upper airway defences:

Large airborne particles are trapped by nasal hairs, and smaller

particles settling on the mucosa are cleared towards the oropharynx by the

columnar ciliated epithelium which covers the turbinates and septum

During cough, expiratory muscle effort against a closed glottis

results in high intrathoracic pressure, which is then released explosively.

The flexible posterior tracheal wall is pushed inwards by the

high surrounding pressure, which reduces tracheal cross-section and thus

maximises the airspeed to achieve effective expectoration.

The larynx also acts as a sphincter, protecting the airway

during swallowing and vomiting.

Lower airway defences:

 The sterility, structure and function of the lower airways are

maintained by close cooperation between the innate and adaptive

immune responses.

 The innate response in the lungs is characterised by a number of

non-specific defence mechanisms.

 Inhaled particulate matter is trapped in airway mucus and cleared

by the mucociliary escalator.

 Airway secretions contain an array of antimicrobial peptides (such

as defensins, immunoglobulin A (IgA) and lysozyme),

antiproteinases and antioxidants.

6
  Many assist with the opsonisation and killing of bacteria, and the

regulation of the powerful proteolytic enzymes secreted by

inflammatory cells.

 In particular, α1antiproteinase (A1Pi) regulates neutrophil

elastase, and deficiency of this may be associated with premature

emphysema.

 Macrophages engulf microbes, organic dusts and other particulate

matter. They are unable to digest inorganic agents, such as

asbestos or silica, which lead to their death and the release of

powerful proteolytic enzymes that cause parenchymal damage.

 Neutrophil numbers in the airway are low, but the pulmonary

circulation contains a marginated pool that may be recruited

rapidly in response to bacterial infection.

 Adaptive immunity is characterised by the specificity of the

response and the development of memory.


Lung dendritic cells facilitate antigen presentation to T and B

lymphocytes. [3],[2]

LUNG VOLUMES, CAPACITIES AND ALVEOLAR VENTILATION

Volume of air taken in and given out Tidal volume

during normal

Tidal volume calculated by Inspiratory capacity

minus inspiratory reserve

volume

Tidal Volume in both Men and women 500 ml

7
 Resting tidal ventilation 5 L/min

Expiratory reserve volume 1000 ml

Inspiratory reserve volume 3300 ml

Residual volume 1200 ml

Inspiratory capacity (TV + IRV) 3800 ml

Normal vital capacity (TV + IRV + 4800 ml

ERV)

Functional residual capacity (ERV + RV 2200 ml

Total lung capacity 6000 ml

Amount of air in lungs at the end of tidal FRC

breath

Functional residual capacity is Volume remaining of

normal respiration

Functional residual capacity ERV + RV= 2.2 L

Total alveolar volume in litre per minute 4.4 L

Pulmonary volumes

1.The tidal volume is the volume of air inspired or expired with each normal

breath; it amounts to about 500 millilitres in the adult male.

2.The inspiratory reserve volume is the extra volume of air that can be inspired over

and above the normal tidal volume when the person inspires with full force; it is

usually equal to about 3000 millilitres.

8
3.The expiratory reserve volume is the maximum volume of air that can be expired

after the end of a normal tidal expiration; this normally amounts to about 1100

millilitres.

4.The residual volume is the volume of air remaining in the lungs after the most

forceful expiration; this volume averages about 1200 millilitres. [2]

Pulmonary capacities:

1. The inspiratory capacity equals the tidal volume plus the inspiratory reserve

volume. This is the amount of air (about 3500 millilitres) a person can breathe

in, beginning at the normal expiratory level and distending the lungs to the

maximum amount.

The functional residual capacity equals the expiratory reserve volume plus the

residual volume. This is the amount of air that remains in the lungs at the end

of normal expiration (about 2300 millilitres).

2. The vital capacity equals the inspiratory reserve volume plus the tidal

volume plus the expiratory reserve volume 4600 millilitres. [16], [17]

3. The total lung capacity is the maximum volume to which the lungs can be

expanded with the greatest possible effort (about 5800 millilitres); it is equal

to the vital capacity plus the residual volume. [2]

9
 LUNG VOLUMES AND CAPACITY
BRONCHIALASTHMA

Respiratory disease is responsible for a major burden of morbidity and untimely

death, with conditions such as tuberculosis, pandemic influenza and pneumonia the

most important in world health terms. The increasing prevalence of allergy, asthma

and chronic obstructive pulmonary disease (COPD) contributes to the overall burden

of chronic disease in the community. By 2025, the number of cigarette smokers

worldwide is anticipated to increase to 1.5 billion, ensuring a growing burden of

tobacco-related respiratory conditions. Respiratory disease covers a breadth of

pathologies, including infectious, inflammatory, neoplastic and degenerative

10
processes. Bronchial asthma is airway inflammatory, increased hyper reactivity and

obstructive airway disease 5-10% globally health problem. According to the Global

Initiative for Asthma Management and prevention (GINA), a definition of Asthma is

given as; “Asthma is a chronic inflammatory disorder of the airways in which many

cells and cellular elements play a role.

The chronic inflammation is associated with airway hyper responsiveness (AHR) that

leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing,

particularly at night or in the early morning. These episodes are usually associated

with widespread, but variable, airflow obstruction within the lung that is often

reversible either spontaneously or with treatment”

EPIDIMYOLOGY:

The National Health Interview Survey (NHIS) data on asthma prevalence

in the United States of America demonstrate an almost doubling of asthma prevalence

over the last quarter century, from 3.2 percent per 100 population in 1981 to 5.5

percent per 100 in 1996. One third of those affiliated with asthma are children under

the age of 18 years. A study conducted in 2006 by Sidney S Burman shows that there

has been a sharp increase in the global prevalence, morbidity, mortality, and

economic burden associated with asthma over the last 40 years, particularly in

children12. Approximately 300 million people worldwide currently have asthma, and

its prevalence increases by 50% every decade. According to the National Family

Health Survey-2 report the estimated prevalence of asthma in India is 2468 per

100,000 persons. The increasing number of hospital admissions for asthma, which are

most pronounced in young children, reflect an increase in severe asthma, poor disease

11
management, and poverty. Worldwide, approximately 180,000 deaths annually are

attributable to asthma, although overall mortality rates have fallen since the 1980s

[11] [14], [21]

TYPES OF ASTHMA:

RISK FACTORS:

-IgE antibody production against house dust, mites, fungi,

pollen, animal derived protein.

es[1]

12
ETIOLOGICAL FACTORS:

Allergens: Allergic asthma is dependent on an IgE response controlled by T and B

lymphocytes and activated by the interaction of antigen with mast cell–bound IgE

molecules.

Pharmacologic Stimuli: The drugs most commonly associated with the Induction of

acute episodes of asthma are aspirin, coloring agents such as tartrazine, adrenergic

antagonists, and sulfiting agents.

Environment and Air Pollution: climatic conditions that promote the concentration

of atmospheric pollutants and antigens [15].

Occupational Factors: acute and chronic airway obstruction have been reported to

follow exposure to a large number of compounds used in many types of industrial

processes.

Infections: Respiratory viruses and not bacteria or allergy to microorganisms are the

major etiologic factors. In young children, the most important infectious agents are

respiratory syncytial virus and parainfluenza virus [13

PATHOGENESIS :

Airway inflammation produced IgE linked with FcE receptors release mast

cell protease, histamine and pro inflammatory cytokinase, esinophil produce charcot-

leyden crystals found in sputum, lymphocytes, mast cell, neutrophils more in near

fatal asthma, occupational asthma leads poor response in corticosteroids.

Oedema,hypertrophy of smooth muscle leads airway remodeling. Thickened

basement membrane, epithelial damage leads creola bodies and curschmanns spiral

found in asthma. Mucous plugging, airway hyperreactivity and non-adrenergic non-

13
cholinergic nerve defect leads broncho constriction and reversible airway limitation.

In acute severe asthma leads remodeling, irreversible changes in lung may occur.

3.4.2. PATHOPHYSIOLOGY:

The pathophysiologic hallmark of asthma is a reduction in airway

diameter brought about by contraction of smooth muscle, vascular congestion, edema

of the bronchial wall, and thick, tenacious secretions. The net result is an increase in

airway resistance, a decrease in forced expiratory volumes and flow rates,

hyperinflation of the lungs and thorax, increased work of breathing, alterations in

respiratory muscle function, changes in elastic recoil, abnormal distribution of both

ventilation and pulmonary blood flow with mismatched ratios, and altered arterial

blood gas concentrations. Thus, although asthma is considered to be primarily a

disease of airways, virtually all aspects of pulmonary function are compromised

during an acute attack [13].

PATHOLOGICAL CHANGES IN ASTHMA:

14
FEATURES OF BRONCHIAL ASTHMA :

Asthma is dynamic clinical syndrome of body + mind+ spirit. Have

cough, wheezing, tightness of chest, shortness of breath intermittent or

variable more at night called nocturnal asthma. Exaggerated by dust, pollens

, allergens, occupational, intrinsic factors, diet and stress.[4] Asthma is a

syndrome rather than a condition. It is an episodic disease, with acute

exacerbations, interspersed with symptom-free periods. Typically most attacks

are short lived, lasting minutes to hours, and clinically the patient seems to

recover completely after an attack. However there can be a phase in which the

patient experiences some degree of airway obstruction daily which is termed

as chronic asthma. This phase can be mild, with or without superimposed

severe episodes, or much more serious with severe obstruction persisting for

days or weeks, the latter condition is known as acute severe asthma. [26]

INVESTIGATION :

 Pulmonary function test-PFM, SPIROMETER.

 Allergic test-skin prick test

 Nitric oxide test

 Arterial blood gas analysis

 Sputum esinophil

 Xray chest ,CT

 bronchoscopy, Laryngoscopy,Positron emission tomography

 Provacative testing for exercise and cold induced test

15
 LUNG FUNCTION TEST:

Measurements of lung function provide valuable information.

 Helps to diagnosis

 Severity of the condition

 Disease prognosis

 Regular monitoring in lung function.

 To measure the size of the lung

 Measure the air into and out of the airway

 Efficiency of lung in process of gas exchange.

PEAK EXPIRATORY FLOW METERS: Here patient should be instructed to

record peak flow readings after rising in the morning and before retiring in the

evening. A diurnal variation (lowest in the morning) of more than 20% is

considered diagnostic. Normal reading as per mentioned in American lung

association reveals 80 to 100 L/min as mild level, 50 to 79 L/min as moderate

level and below 50 L/min as severe level. [17] Measurement of peak expiratory

flow rate gives an idea of how narrow or obstructed a person’s airways are by

measuring the maximum rate at which they can blow air into a peak flow

meter after a deep breath. [7], [9]

CLASSIFICATION OF ASTHMA : [29]

ICD-1O CC CODE:

- J45.2X

– J45.3X

- J45.4X [28]

16
 –J45.5X

Unspecified J45.90x

♦ X=0 uncomplicated

♦ X=1 WITH exacerbation

♦ X= 2 with status

MANAGEMENT GOALS: [10]

 Achieve control of symptoms

 Reduced asthma mortality

 Prevent remodeling

 Restore normal pulmonary function

 Avoid acute severe asthma /exacerbation

 Avoid abuse of medication and dependency

 Achieve best quality of life without limitation

17
Management –non pharmacological level:

-fish oil in third trimester reduce

risk of asthma in first 5 yrs of child ,Anti-oxidants ,alpha 3 fatty died ,vit D

[7] [9] [28]

CONVENTIONAL MANAGEMENT:

group-beta 2 sympathetic agents

–ICS (inhaled

corticosteroid ),LABA.

ADVERSE EFFECTS: :[9] [3]

o Fine tremor o Agitation o Tachycardia/palpitation o Oral thrush

o Hoarseness o Suppression of adrenocortical function o Hypertension

/sodium retention/worsening DM o Gastro esophageal reflex.

SPIROMETRY:

Spirometry is one of lung function test to monitor how the lung is work by

speed of breath and amount of air to inhale and exhale which is affected in Asthma,

COPD, Cystic fibrosis and bronchiectasis. SPIROMETER is device to make

measurement of FVC(forced volume capacity-total amount of air blow out in

breath), FEV1(Forced expiratory volume –Amount of air blow out within mint). TVC

18
(Total volume capacity –ratio between FEV1/FVC).This is more specific and more

accurate than peak flow meter. It moniter prognosis of asthma. [7], [9]

SPIROMETRY

measures the amount of air could exhale after a maximum inspiration.

Blow out into spirometry , this volume is called vital capacity. Amount of air after full

inspiration is called total lung capacity. Residual volume is amount of air remaining

after full expiration. FORCED VITAL CAPACITY is measured after the hard blow

into spirometry. VC and FVC are identical in normal lung but in obstructive lung

disease FVC is less than VC Compression of airway during expiration in BA , COPD.

VOLUME in litres in X axis time in second in Y axis. volume of air breathed out in

first second of forced expiration called as forced expiration in first second. FEV1 . in

normal lung FEV 1 is > 70%. In obstructive lungdisease FEVI/ FVC is reduced due to

prolonged expiration. In restrictive lung disease FEV1 and FVC reduced in propotion

of each others , so ratio is remains normal.

SPIROMETER

19
SPIROGRAM NORMAL CURVE :

INSTRUCTIONS FOLLOWED IN RECORDING A SPIROMETRY: [35]

Stand or sit up straight.

Make sure the indicator is at the bottom of the meter (zero).

Take a deep breath in, filling the lungs completely.

Place the mouthpiece in your mouth, lightly bite with your teeth and

close your lips on it. Be sure your tongue is away from the

mouthpiece.

Blast the air out as hard and as fast as possible in a single blow for

one mint than followed by deep inspiration.

Remove the meter from your mouth.

Graf recorded in the screen as per volume of air exhaled in spirometre.

Record the number that appears on the meter and then repeat the steps

two times.

Record the highest of the three readings. This reading gives the

peak expiratory flow (PEFR). [7], [9], [28]

20
 Spirometry is indicated for the following reasons:

- To measure bronchial responsiveness in patients suspected of

having asthma

- To diagnose and differentiate between obstructive lung disease and

restrictive lung disease.

- diagnose the vocal cord dysfunction[17][7],[9].

PULMONARY FINDINGS IN ASTHMA [23,24]:

Reduced FVC, Reduced FEV1, FEV1/FVC ratio < 80%, Increase in

Residual Volume and Total Lung Capacity.

DIAGNOSTIC CRITERIA FOR ASTHMA:

CLINICAL FEATURES THE PROBABILITY OF ASTHMA:

♦ more than one of following symptom like wheezing,

breathlessness, cough ,tightness of chest.

♦ More at night and in early morning.

21
 ♦ Symptoms in response to cold air, allergen, exercise.

♦ H/O of atopic disorder.

♦ Widespread wheeze heard while auscultation

♦ Unexplained peripheral blood eosinophilia.

Compatible clinical history

plus either/or:

• FEV1 ≥ 15%* (and 200 mL) increase

following administration of a bronchodilator/trial

of corticosteroids

• > 20% diurnal variation on ≥ 3 days

in a week for 2 weeks on PEF diary

• FEV1 ≥ 15% decrease after 6 mins of

exercise.

Limitation for spirometry:

 Recent eye surgery

 Myocardial infarction

 Abdominal and thoracic surgery

 Hypertension

 Smoking recently

22
3.4.6. DIFFERENTIAL DIAGNOSIS FOR ASTHMA:

Many other conditions can cause symptoms similar to those of

asthma. In children, other upper airway diseases such as allergic rhinitis and

sinusitis should be considered as well as other causes of airway obstruction

including: foreign body aspiration, tracheal stenosis or laryngo-tracheo-

malacia, vascular rings, enlarged lymph nodes or neck masses. In adults,

COPD, congestive heart failure, airway masses, as well as drug-induced

coughing due to ACE inhibitors beta blockers, NSAID, steroids aspirin,

eyedrops should be considered. Chronic obstructive pulmonary disease can

coexist with asthma and can occur as a complication of chronic asthma [16].

3.4.7. PREVENTION:

 Aggravating factors of bronchial asthma should be avoided which

includes

 Limiting or completely avoiding smoking and smoke exposure.

 Avoidance of Exposure to pets. It is recommended that pets should be

removed from the home if a person has allergic symptoms.

 Minimizing exposure to house dust mite by replacing carpets with

floor boards and using mite impermeable bedding.

Reduction of fungal exposure and elimination of cockroaches.[16]

23
Homoeopathic approach:

drug disease some group of condition which simulate real chronic disease

occur in persons ,

dissipation

heir health by over exertion of body and mind

ng in constant state of worry...in this state of ill health is bring

upon by removing these things .. Aphorism 210-230 in mental disease

management master told that almost all mental and emotional disease are

corporeal disease in which symptoms of derangement and disoistion each of

them increased while corporeal symptoms are decline .Eg suppression of lung

disease leads insanity…

Aphorism 38 teach about suppression …suppression of skin disease

may leads to lung disease. According to all these points we treat patient as a

whole depend upon totality, dynamic medicine which erradicate tedency of

hereditary also..[6] [26], [28]

24
RELAVENT RESEARCH STUDIES IN BRONCHIAL ASTHMA:

According to” asthma call back survey prevalence of disease among age”,

adolescence group are above 16 was high in percentage.Under age of 1 which one

exposure to bronchial allergy, respiratory infection, broncho pneumonia had more

focus of respiratory BA in adolacence have higher intencity.[30]

In the Study of Sex difference in bronchial asthma among 8 states in USA

by RHODES MOORMAN in” air pollution and respiratory health branch, division of

environmental health effects and hazard” , centre of disease controle and prevention

in atlando , study concluded that lifetime and current asthma prevalence are higher in

females, childhood asthma are reported more often in males in the journal of Asthma

volume 42 , 2005 issue 9.[31]

In the lung disease news.com , skin disease atopic dermatitis and

susceptibility to allergies have increase risk of asthma, study found that year old

infants who have skin disease known as atopic dermatitis are 7 times more likely to

developed ASTHMA which is found in the Canadian healthy infants longitudinal

developmental child study by Malcolm sears , one of professor in firestone institute of

respiratory health at st Joseph healthcare , Hamilton.[29]

In American journal of preventive medicine , this study shows that genetic

and hereditary exposure is risk factors for childhood asthma and atopic skin disease ,

need to preventive care to reduce exposure to environmental factors which is

triggering BA. Like this study in our study also had family history of BA for about

45% especially in female groups.[30]

25
 MATERIALS AND METHODS:

STUDY SETTING: This study is designed to evaluate and compare the effectiveness of

lung volume capacity before and after homeopathic constitutional remedy in asthma

tested by spirometry . The study will be carried out at Out Patient Department (OPD) and

Rural health centre (RHC) and In Patient Department (IPD) at Sarada Krishna

Homoeopathic Medical College and Hospital.

SELECTION OF SAMPLES: Sample Size: 30 cases

Sampling Technique: Random sampling

STUDY DESIGN: Cohort study

DATA COLLECTION

Medicine Prescribed

Pre test/ Before Medicine

Post test /After Homeopathic Medicine

PATIENT ALLOCATION:

From the Random Number Table:

-30 number given to Patient undergo spirometry before medication he/ she will be

administering homeo remedy he/ she will be allocated into post test. This allocation was

continued till last patient.

26
INCLUSION CRITERIA:

intrinsic factors.

assessment in part of rehabilitation programs .

EXCLUSION CRITERIA:[12]

o Recent myocardial infarction on just or one month duration /above 35 age first time

episode of dyspnea

o Recent stroke /unstable angina o Uncontrolled hypertension o Recent eye /abdominal

surgery o H/O hemoptysis

o Pnemothorax/ thoracic aortic anurysm

o Smoke prior 24 hours

METHODOLOGY: Total sample of 30 patients are selected from the Out Patient

Department, In Patient Department, RHC department of Sarada Krishna Homoeopathic

Medical College Based on inclusive criteria. The patient will be categorized 1-30 before

treatment, 1A -30A After treatment underwent spirometry.

27
OBSERVATION AND FOLLOWUP: The detailed case history is taken and it will be

recorded in a pre-structured case format. Patient diagnosed based on their symptoms like

cough, wheezing, chest tightness, dyspnea, allergic, occupational, hereditary criteria.

Basic routine investigation will do if necessary.Exclusive criteria is kept on mind while

selection of the patients for spirometry. Before doing spiometry height , weight, age and

smoking duration is considered. Ask the patient to get normal breathing, if needed nose

clip may given. Followed by deep breath, tight close mouth around clip, than ask to

exhale forcefully. Repeat the procedure 3 times best one is selected for record. Based on

the forceful expiratory volume, obstruction on lung will be classified in to normal, mild

obstructive ,moderate obstructive and severe obstructive . After complete case taking as

per guidelines of Master hahnemann, analysis,evalation followed by totality of case.

Correct similimam to be selected by use of appropriate repertory based on totality of case

.Selection of dose is based on susceptibility of patient and stage of disease.After giving

costitutional dynamic homeopathic remedy ,2-4 weeks followed by correct diet advice

,physical restriction, respiratory therapy,stress management and cessation from

smoking,allergens,hazards of occupation once again repeated the spirometry as like

before to compare the changes in obstructive airway lesion and improvement of forced

volume capacity where it is more than 12 % that is 200 ml will signifies good

improvement of lung volume after our homeopathic constitutional remedy which is equal

and higher efficacy than corticosteroid (ICS) like other conventional treatment which is

unsafe,costly,dependency treatment.

28
 –Case taking + Spirometr
Group B - After homeopathy medicine( 2-

Improvement assesed by vitalograph spirometry reference scale .

SELE

remedies for bronchial asthma

OUTCOME ASSESSMENT: Depend upon VITAL CAPACITY (VC)/PEAK

EXPIRATORY FLOW RATE (PEFR)/FORCED EXPIRATORY VOLUME (FEV1)

– -

79% Predicted - -59% Predicted - MODERATE

- SEVERE OBSTRUCTION After

medication if there is changes in FEV1 about 12% indicate good improvement after given

medication .

DATACOLLECTION:

STATISTICAL TECHNIQUES & DATA ANALYSIS: Pre-test and post-test assessment

will be done. Hypothesis will be analyzed by students paired “t” test will be used to

compare between the groups. Data will be represented by charts and graphs. Sample will

be analysed based on two way ANOVA.

29
 5.0. OBSERVATIONS AND RESULTS

A sample of 30 cases from the Out Patient Department and In Patient

Department of Sarada Krishna Homoeopathic Medical College Hospital
were selected for the study and divided into two groups A and B. All the
30 cases were followed up for a period of six months. These cases were
subjected to statistical study. The following tables reveal the observations
and results of this study.

TAB NO 1: DISTRIBUTION OF CASES BASED ON AGE

AGE GROUP MALE FEMALE

15-30 2 2

30-45 5 7

45-60 4 10

PREVALENCE OF DISEASE IN
45-60 AGE 10
30-45 7

FEMALE
15-30 2
MALE

0 5 10 15

From the above chart, it is inferred that maximum number of cases are
attained between the age group above 45 years and out of that 10 cases are
females , 5 male. Under the age group 30-40, 7 females ; 3 male patients.
Under the age group 20-30, 2 females and 2 males .
 TAB NO .3: DISTRIBUTION BASED ON FAMILY HISTORY

With family Without family

history history
Male 4 7
Female 11 8

DISTRIBUTION OF CASE BASED

ON FAMILY HISTORY

15
10 Male
5
Female
0
With family Without family
history history

From the above chart, it is clear that majority of the patients with Bronchial asthma in
both groups shows a family history of Asthma both Maternal as well as Paternal
origin.

TABLE NO.4: DISTRIBUTION BASED ON PAST HISTORY

With past H/O Without past

skin disorder H/O skin
disorder
Male 4 7
female 10 9

30
 BA PREVALENCE IN SUPPRESSION
OF SKIN DISEASE

10
8
6 Male
4
female
2
0
With past H/O skin Without past H/O
disorder skin disorder

From the above chart, it is inferred that majority of the patients show a
positive history of dermatitis, psoriasis, eczema followed by asthmatic attack.
Layers of suppression of skin disease enter into vital organ.

TABLE NO 5: DISTRIBUTION BASED ON MEDICINE

PRESCRIBED

MEDICINES NUMBERS OF CASE

ARS ALB 11
PULS 5

NATRUM SULPH 3

LYCOPODIUM 2
IPECAC 1
HEPARSULPH 1
ANTITART 1
RHUSTOX 1
IGNATIA 1
BRYONIA 1
PHOSPORUS 1
IPECAC 1

GRAND TOTAL 30

31
 REMEDIES
IPECAC 1
PHOSPORUS 1
BRYONIA 1
IGNATIA 1
RHUSTOX 1
ANTITART 1
HEPARSULPH 1
IPECAC 1
LYCOPODIUM 2
NATRUM SULPH 3
PULS 5
ARS ALB 11

0 2 4 6 8 10 12

From above chart most of the bronchial asthma cases are to be well response
by Arsanicum album constitutionally, puls, natrum sulph, lycopodium, ipecach,
ignatia, rhustox, antitart, phosphorus and bryonia. Most of the remedy given in 50
millesimal potency in frequent doses act well than dry doses.

TABLE NO 6: OBSTRUCTIVE FACTORS FOR ASTHMA:

Obstructive factors MALE FEMALE

Cold and dust exposure 5 15
Cold exposure 8 11
Cold in general 6 12
Cold in general and dust exposure 3 10
Dust and cold exposure 4 17
Dust exposure 8 9
Smoke and cold exposure 5 0
Smoke and dust exposure 4 0
Smoke exposure 5 4

32
 OBSTRUCTING FACTORS FOR MALE

ASTHMA FEMALE

20 17
15
15 11 12
10 9
10
4
5
0 0
0

From above study cold exposure and dust have most obstructive factors for
BA about 60%, smoking and smoke exposure had 30% of obstructive values in this
study.

TABLE NO 7: DISTRIBUTION OF CASES BASED ON OCCUPATION

TABLE
OCCUPATION TOTAL NO OF PERCENTAGE
CASES
Housewives 18 60
Students 3 10
Private Employees 7 23.33
Govt.Servants 2 6.66

33
 DISTRIBUTION OF CASES ACCORDING TO
OCCUPATION

OCCUPATION
Govt.Servants 2
Private Employees 7
Students 3
Housewives 18

0 5 10 15 20
NO OF CASES

From above study we could obsorbed that home maker which one exposure to smoke
, dust have high risk in prevalence of BA about 55% compare with other occupational
exposures.

TABLE NO 8: SHOWS THE DISTRIBUTION OF CASES ACCORDING TO

SYMPTOMS OF BRONCHIAL ASTHMA
Symptoms Of No. Of Percentage
Bronchial Asthma Patients
Breathing Difficulty 30 100
Cough 30 100
Wheezing 30 100
Shortness Of Breath 30 100
Mucous 20 66.66
Chest Pain 14 46.66
Weight On Chest 15 50

DISTRIBUTION OF CASES WITH

SYMPTOMS OF BRONCHIAL ASTHMA
NO OF CASES

40
20
0

34
 DISTRIBUTION BASED ON FEV1 VALUES
TABLE NO 9:
FEV1 VALUES OF PATIENTS BEFORE AND AFTER TREATMENT

SL
NO BEFORE TREATMENT AFTER TREATMENT
1 1.9 2.8
2 0.58 1.09
3 1.01 2.11
4 1.6 2.2
5 1.78 3.15
6 0.8 1.7
7 0.58 1.77
8 1.5 2.07
9 1.7 2.43
10 0.93 3.3
11 0.58 1.77
12 0.82 1.62
13 1.9 2.26
14 1.53 1.64
15 1.5 2.42
16 1.5 1.76
17 0.5 1.6
18 1.5 2.49
19 1.12 2.29
20 0.86 2.1
21 1.18 2.07
22 0.8 1.9
23 0.64 1.5
24 0.6 1.5
25 1.18 2.01
26 0.5 1.18
27 2.31 3.4
28 1.5 2.01
29 1.7 2.9
30 0.6 1.7

35
 4
FEV1 VALUE BEFORE AND AFTER
TREATMENTBEFORE
AFTER…
…

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29

TABLE NO 9: PREDICTIVE % OF SPIROMETRY VALUE BEFORE AND

AFTER TREATMENT
BEFORE AFTER
CASE TREATMENT TREATMENT
(%) %
1 45 65
2 72 88
3 55 85
4 65 88
5 70 87
6 60 75
7 65 80
8 69 90
9 78 88
10 55 78
11 76 91
12 55 75
13 50 76
14 62 85
15 45 55
16 48 70
17 25 36
18 65 77
19 50 72
20 60 76
21 75 81
22 65 82
23 60 72
24 50 62
25 73 85
26 66 78
27 80 98
28 49 52
28 70 93
30 72 85

36
 predictive % value before and after treatment
BEFORE TREATMENT (%) AFTER TREATMENT %

120
100 98
88 85 88 87 90 88 91 93
80 85 81 82 85 85
72 70 75 80 69 78 78 76 75 76 70
77 72 76 75 72 73 78 80
7072
60 65 65 60 65 62 65 60 65 60 62 66
55 55 55 50 55 50 50 52
49
40 45 45 48
36
20 25
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

From this study we could get that above data that is before and after FEV 1 &
PREDICTIVE % shows that about 75% case had good positive changes in expiratory
values after treatment, 10% have equal values and 15 % had negative , no changes in
lung volumes even after that effective treatment, its may due to some continuous
exposure to smoke and dust in low economic status in rural residence and also due to
difficulty in spirometry mouthpiece holding error to be absorbed

TYPES OF ASTHMA BEFORE AND AFTER TREATMENT

TYPES BEFORE TREATMENT AFTER TREATMENT

MILD 7 5

MODERATE 10 6

SEVERE 9 2
PERSISTANT 4 2

NORMAL 0 15

37
 TYPES OF ASTHMA BEFORE AND
AFTER TREATMENT
100%
80%
60%
40% AFTER TREATMENT
20% BEFORE TREATMENT
0%

According to ATS classification of bronchial asthma , prognosis of disease

before and after treatment classified as normal, mild, moderate, severe and persistant.
Mild type improved as 7%- 5%, moderate as 10%-6%, severe as 9%- 2%, persistant
from 4%-2%, 15% became normal as a whole study of 30 patients from this research

38
29
 STATISTICAL ANALYSIS

SL.NO BEFORE AFTER d=X-Y - - )2

1 45 65 -20 475 225625

2 72 88 -16 479 229441

3 55 85 -30 465 216225

4 65 88 -23 472 222784

5 70 87 -17 478 228484

6 60 75 -15 480 230400

7 65 80 -15 480 230400

8 69 90 -21 474 224676

9 78 88 -10 485 235225

10 55 78 -23 472 222784

11 76 91 -15 480 230400

12 55 75 -20 475 225625

13 50 76 -26 469 219961

14 62 85 -23 472 222784

15 45 55 -10 485 235225

16 48 70 -22 473 223729

17 25 36 -11 484 234256

18 65 77 -12 483 233289

19 50 72 -22 473 223729

39
 20 60 76 -16 479 229441

21 75 81 -6 489 239121

22 65 82 -17 478 228484

23 60 72 -12 483 233289

24 50 62 -12 483 233289

25 73 85 -12 483 233289

26 66 78 -12 483 233289

27 80 98 -18 477 227529

28 49 52 -3 492 242064

29 70 93 -23 472 222784

30 72 85 -13 482 232324

∑ - )2 =
TOTAL ∑ =-
495 686994

X= Score before treatment

Y= Score after treatment

d= Difference between before and after score

A. Null hypothesis

There is no difference between the scores taken before and after the

Homoeopathic treatment.

B. Alternate hypothesis

There is difference between the scores taken before and after the

Homoeopathic treatment.

40
 C. Standard error of the mean difference

The mean of the differences, = Σ d/n

=-495/30

=-16.5

The estimate of population standard deviation is given by,

SD =

= 486.7182

Standard error, (S.E) = S.D / = 486.7182/ = 88.8621

Clinical ratio, t =

= 16.5/88.8621

= 14.82

T test: paired sample test for two means

41
 t-Test: Paired Two Sample for Means

AFTER BEFORE

Mean 77.500 61.000

Variance 175.638 150.621

Observations 30.000 30.000

Pearson Correlation 0.889

Hypothesized Mean Difference 0.0001

df 29.000

t Stat 14.826

P(T<=t) one-tail 0.0001

t Critical one-tail 1.699

P(T<=t) two-tail 0.000

t Critical two-tail 2.045

Comparison with tabled value:

This critical ratio, t follows a distribution with n-1 degrees of freedom. The tabled t

value at 5% significance level is 2.045 and 1% level is 2.756 for 29 degrees of

freedom. Since the calculated value 14.82 is greater than the tabled t value at 5% and

1% level, the null hypothesis is rejected.

Inference

This study shows significant reduction in the FEV1 PREDICTIVE % scores after

giving the homoeopathic medicines for management of bronchial asthma. Therefore,

homoeopathic medicines are effective in managing the pain of bronchial asthma.

42
DISCUSSION

The study was conducted on Random selection of 30 cases of patient Symptoms from the OPD, IPD

and RHC’s of SKHMC Hospital. The case details are recorded in a standardized pre structured case

format of Sarada Krishna Homoeopathic Medical College. To study the effectiveness of

Homoeopathic remedy which changes in lung volume especialy FEV 1 in the condition of bronchial

asthma patient evidenced by spirometry.

Patient selected for the study based on inclusive criteria. Complete chronic case taking took under the

guidance of Dr.Hanemann , which one explained in the aphorism of 83-104. By this could be

analysed the past history , familial and hereditary background, miasmatic prevalence of disease. By

the intensity of symptoms based, totality formed and constitutional remedy was selected .Patient

adviced to do spirometry before administering remedy .Acute severe asthma is excluded. SPO2 level

less than 85 % of the patients are excluded. Based on totality constitutional remedy was selected,

based on susceptibility correct potency was selected and medicine given for a week. Followup taken

in a week and progress uptained till 6 month. Patient adviced to took spirometry once again to study

the lung volume changes after end of treatment. In-between symptoms severity, episode of recurrence

of disease to be analysed after expose to some exiting causes and maintaining causes to be try to

avoided. .

AGE: According to” asthma call back survey prevalence of disease among age”adolescence

group are above 16 was high in percentage.Under age of 1 which one exposure to bronchial allergy,

respiratory infection, broncho pneumonia had more focus of respiratory BA in adolacence have higher

intencity[30]. In this way in our study maximum number of cases under the age of 15-30 both gender

equal in affected, 30-45 yrs of age group had 15% male 35 % female. Above 45 age group 60% are

female in the total 30 cases of study.

SEX: In the Study of Sex difference in bronchial asthma among 8 states in USA by RHODES

MOORMAN in” air pollution and respiratory health branch, division of environmental health effects

and hazard” , centre of disease controle and prevention in atlando , study concluded that lifetime and

current asthma prevalence are higher in females, childhood asthma are reported more often in males

42
in the journal of Asthma volume 42 , 2005 issue 9.[31] Like this study , in our study among 30 cases

70% are female were affected by asthma which is higher prevalence than male under this study.

Skin disease relavence in BA: In the lung disease news.com , skin disease atopic dermatitis and

susceptibility to allergies have increase risk of asthma, study found that year old infants who have

skin disease known as atopic dermatitis are 7 times more likely to developed ASTHMA which is

found in the Canadian healthy infants longitudinal developmental child study by Malcolm sears , one

of professor in firestone institute of respiratory health at st Joseph healthcare , Hamilton. Based on this

study likewise in our study group also have 50% of previous episode of atopic dermatitis and

suppression of this leads development asthma in adolescence stage is proved evidence From the

above study, it is inferred that majority of the patients 50 %show a positive history of dermatitis,

psoriasis, eczema followed by asthmatic attack. Layers of suppression of skin disease enter into vital

organ

FAMILY HISTORY OF BA:

In American journal of preventive medicine , this study shows that genetic and hereditary

exposure is risk factors for childhood asthma and atopic skin disease , need to preventive care to

reduce exposure to environmental factors which is triggering BA. Like this study in our study also

had family history of BA for about 45% especially in female groups. From the above study, it is clear

that majority of the patients with Bronchial asthma in both groups shows a family history of Asthma

both Maternal as well as Paternal origin.

ACOS: Asthma and COPD Overlapping syndrome.Modifiable risk factors for asthma and COPD

overlap encouraging healthy living, , issue nov 01, 2018 .In the month issue ofAnnals American

Thoraxic Soceity pg-1304-1310 , shows that asthma ans COPD overlap is burden of disease which

leads frequent exacerbation rate and higher morbidity rate either by asthma or COPD.42% among

women have developed co –occurance of BA and COPD also. Like this someother obstructive factors

are Ageing, > 5 pack year smoking history, unemployment, higher body mass, lower educational,

rural residence are evidenced in our study. From above study we could obsorbed that home maker

which one exposure to smoke , dust have high risk in prevalence of BA about 55% compare with

other occupational exposures.[30]

43
MANAGEMENT OF BA: life style modification , avoiding risk factors, prevention of disease

which one exposure to family history and atopic skin disease with constitutional remedy will gave

better improvement to the patient and reduce recurrence also. Arsanicum album , natrum sulph,

pulsatilla , lycopodium gave good results in 50% cases. Remaining cases covered by phosphorus,

bryonia, rhustox, antimonium tart and ipecac .Many of the case 55%have good prognosis while

administered in 50 millesemal potency in water dose in frequent intravel had higher effect than the dry

dose.

SPIROMETRY : One of lung function test which is shows the forced expiratory volume rate in one

mint of the patient, shows vital capacity, total lung capacity. By means of ATS value pre and post

FEV1 AND PREDICTIVE % are absorbed score to be calculated for statistical T value which shows .

in this study patient had difficulty in user defect which also may affect the lung volume changes may

produce error in the value. Cost of this device may difficult to advice all those patient. 15% of case

among this study shows negative prognosis , 10% have equal values and 75% are have good

prognosis of FEV 1 changes in lung volume capacity which is improved from severe obstructive to

moderate , mild obstruction . Grade of dyspnea IV also changed to grade 2 . Intensity of symptoms

are reduced.

44
45
 8.0 LIMITATIONS

 A study for a longer period and larger population will have been

more useful.

 Some good cases could not be included in this study because of

their discontinuity during the study period.

 In some cases, necessary information’s were lacking and the study

was based on the available data.

 There were no standard studies done in Homoeopathy to compare or

take guidance from therefore some errors are expected.

 Full pulmonary function tests using spirometry, serum IgE and skin

prick tests are not done in this study due to the lack of availability

and patients’ unaffordability (Ethical standards).

45
 8.1 RECOMMENDATIONS.

Extended time of research would provide better results.

Universal standardized scale can be used, so that evaluation of

outcome of the study would become precise.

Full pulmonary function tests, IgE and skin prick tests if done

during the study would have provided valuable results

regarding the type of asthma and degree of bronchoconstriction.

Comparative study between other treatments and homoeopathy

is needed to prove homoeopathy prior to them.

Comparative study needed between conventional treatment and

homoeopathy.

46
47
 9.0. CONCLUSION

There were a total number of 30 cases selected randomly from the patients based on
inclusive criteria who attended the Outpatient as well as Inpatient Departments of Sarada
Krishna Homoeopathic Medical College Hospital and rural health centre. Chronic case
taking followed by repatriation based on totality, constitutional remedy is selected. Pre
and post spirometry values are observed after 4-6 weeks of followup. Conclusions were
made after statistical analysis of patients with Bronchial Asthma. The following
conclusions were drawn from the study as follows:

The prevalence of bronchial asthma is more in females than males.

Females in the age group 35-45 years have more prevalence.

Most of the patients with bronchial asthma are housewives who are constantly
exposed to biomass fuel exhaust house hold smoke and dust.

Major causative factor for Bronchial asthma is dust exposure followed by cold
and smoke exposure.

Most of the patients 60-70 % who had asthma had strong past history of
suppression of skin disease by other conventional treatment and external ointments.

From this study, it was understood that most of the patients have a strong family
history of asthma, which has a strong genetic predisposition.

 In BA, uncontrolled smoking, diet, exposure to dust , occupational and

psychological stress comes under the category of exiting cause. So according to
our pioneer Master Hahnemann, “the exciting cause must be removed in order to
attain rapid gentle and permanent cure”.

Arsenicum Album is found to be the most utilized remedy followed by

lycopodium, sulphur, Pulsatilla, Natrum Sulph and phosphorus.

By means of observation, it shows that indicated medicine act well in millesimal

potency in repeated doses in BA.

46
 After end of this study, its clear about that some patient have difficulty in utilize
mouthpiece while doing spirometry which leads some error in the report value , long
expiration leads difficulty in complete the procedure.

FEV markedly improved after administered our homoeopathic remedy in patients

of BA.

The Homoeopathic medicines given along with life style modification is found to
be highly efficacious in management and treatment of Bronchial Asthma, it reduced
recurrent of episode of attack and severe complication, reduce the dependency of
inhalers’ also.

47
 10.0 SUMMARY

A sample of 30 cases from the patients who visited Sarada Krishna Homoeopathic

Medical College Hospital OPD, RHC and IPD were selected randomly as per the

inclusion criteria. The samples for the study constituted of patients who presented with

the common symptoms of bronchial asthma. Prescription was based on symptom

similarity. The cases were followed up for a period of six months. On the basis of before

treatment and after treatment scores obtained from spirometry FEV1 value,FEV1/FVC

ratio as well as reduction or complete absence of symptoms, recurrence of episode. The

study was subjected to statistical analysis of “paired t test” and result where obtained

from the observation. This study provides an evidence to show that there is a significant

reduction in the disease progression, with improvement of lung volume capacity after

administering Homoeopathic Medicines.

48
 BIBILIOGRAPHY

1. HUTCHISONS clinical methods.Saunders publication Toronto Sydney 2002,21

st international edition .respiratory system,lung function test,Pg no.69,70

2. KV.Krishnadas ,Textbook of medicine ,jaypee brothers medical publication ,5 th

edition 2008,respiratory system general consideration,spirometry pg no.891-893

/respiratory system – allergic disorder of lung-bronchial asthma pg no:917-923

3. DAVIDSONS principles @ practice of medicine,Churchill livingstone Elsevier

publication 2006,20 th edition,respiratory system pg no:656,obstructive

pulmonary disease ,asthma pg no:670-678

4. National Journal of homeopathy jan.2014 mixed bag,understanding effects of

psychological stress on exacerbation of asthma in children,pg no 18-21

5. R.Beasley et al.2000.prevalance and etiology of asthma .journal of allergy and

clinical immunology

6. Hahnemann Samuel. Organon of medicine. 5th&6th edition. New delhi. B.jain

publications.

7. .www.verywell.com-how spirometry is used to diagnose and manage asthma

8. https://patient.info-spirometry

9. www.nhlbi.nih.gov national heart ,lung,blood institute,asthma

10. www.aaaai.org.asthma symptoms,diagnosis

11. www.mayoclinic.org,disease and condition asthma.

12. National Journal of Homeopathy respiratory medicine ,case section –case of

allergic asthma pg no:25

51
13.Asian Journal of Homeopathy-CME-Asthma clinical aspect and homeopathic

management pg no:56 Hall & Guyton; Textbook of Medical Physiology; Unit VII.

Respiration; Noida: Elsevier; Eleventh edition, Indian Reprint 2008; p. 471-476,

479-480.

14. Tortora Gerard J.;Derrickson Bryan H. Principles of Anatomy and Physiology; Asia:

John Wiley & Sons, Inc. vol 2, 12th edition 2009; p. 875, 957.

15. Moore & Persaud. The developing human: clinically oriented embryology 7th edition

2003–Chapter 12, p. 271-302.

16. Chaurasia B.D; Human Anatomy Regional and Applied Dissection and Clinical

Volume 3, Head and Neck, Brain; Chapter 15 Nose and Paranasal Sinuses; New

Delhi: CBS Publishers Pvt Ltd; Fifth edition 2010; p.223

17. Snell Richard S; Clinical Anatomy by Regions; Chapter 3, The thorax: part ii-

the thoracic cavity, New Delhi: Wolters Kluwer (India) Pvt. Ltd.; Eighth edition first

Indian reprint, 2008 ;p.87-98

18. http://www.anaesthesiajournal.co.uk/article/S14720299(08)001951/abstract?

19. Sembulingam K, Sembulingam Prema; Essentials of Medical Physiology; New

Delhi:,Jaypee Brothers Medical Publishers (P) Ltd; 5th edition reprint 2011. p.645

20. http://www.nature.com/gimo/contents/pt1/full/gimo73.html

21. http://www.ginasthma.org/documents/1/Pocket-Guide-for-Asthma-

Management - and-Prevention

22. http://www.uptodate.com/contents/epidemiology-of-asthma.

23. http://www.cdc.gov/nchs/data/databriefs/db94.html.Goldman Lee, Ausiello Dennis:

Cecil Medicine. Vol 1, 23rd ed. Saunder: Elservier; 2008.chapter 96, Respiratory

diseases;p.612-618.

24. Boon Nicholas A, Colledge Nicki R, Walker Brain R , Hunter John

51
 AA. Davidson’s Principles & Practice of Medicine, 20th ed. United States of

America: Elsevier Limited; 2006.p 670-678.

25. http://www.webmd.com/asthma/guide/bronchial-asthma.

26. Allen T.F. The Principles and Practicability of Boenninghausen’s Therapeutic

Pocket Book for Homoeopathic Physicians to Use at the Bedside and in the Study of

Materia Medica. Reprint Edition. New Delhi : B. Jain

Publishershttp://emedicine.medscape.com/article/1413347-overview#a3

27. Advancement in homoeopathic research, vol 2, feb 2017-april 2017

28. Asthma clinical aspect and homoeopathic management, vol 2 aug-oct 2008

29. HOMOEOPATHY heritage march 2018, remedy selection in obstructive and

restrictive lung disease through spirometry analysis.dr.partha pratim pal

30. Significance of pulmonary function test in homoeopathic management .of BA.

Homoeopathy heritage aug 2017. Dr.abdulrahuman, dr,sitharthan.

31. www.aaaai.org, American academy of allergic asthma & immunology.

32. WWW.ncbi.nlm.nih.gov. modifiable risk factors for asthma and COPD, encouraging

healthy living.

33. lungdiseasenews.com , skin disease atopic dermatitis and susceptability to allergies

increase risk of asthma study finds.

51
 APPENDIX-I

GLOSSARY

1. Constitution- The physical body and mental temperament that is

expressive of the natural traits and predisposition of the individual.

2. Concomitant- Refers to symptoms that happen at the same time as the

chief complaint.

3. Aggravation (Homoeopathic aggravation, symbolized by <) A situation in

which the patient feels worse from or symptoms are increased by a
remedy.

4. Amelioration- (Homoeopathic amelioration, symbolized by >) an

improvement of the patient or decrease in symptoms.

5. Materia Medica- Means materials of medicine in Latin. A reference that

lists the curative indications and therapeutic actions of homoeopathic
medicines.

6. Proving- The most accurate method of ascertaining the action of

medicines on human health. Medicines are administered to healthy people
to discover the symptoms they are capable of producing and thereby able
to cure.

7. Modality- A condition that makes a person or their symptoms better or

worse.

8. Doctrine of Signatures- The concept that any organic substance carries

within itself the likeness of some organ or part of the human economy, as
a sign that this particular substance was applicable to disturbances of that
organ.

52
 Appendix - II
“Case records are our valuable asset”

SARADA KRISHNA

HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL

KULASEKHARAM, KANYAKUMARI DIST, TAMIL NADU- 629161

CHRONIC CASE RECORD

O.P. No: …………………… Unit…………. Date: ……….

Name:
………………………………………………………………………………….............
Age: ………Years, Sex: ……. Religion: …………. Occupation: ……………………
Address: ………………………………………………… ……………………………
…………………………………………………..……………………………………..
Phone No (Land): ……………………………………. (Mobile): ……………………

Sl.No. Dt. of Admn. Dt. of Disch Dt. of Review I.P. No. Ward Bed No. Remarks

FINAL DIAGNOSIS:

Homoeopathic

Disease

RESULT: Cured Relieved Referred Otherwise Expired

53
 1. INITIAL PRESENTATION OF ILLNESS
PATIENT’S NARRATION (in the very
Expressions used by him / she) & PHYSICIAN’S OBSERVATION
PHYSICIAN’S INTERROGATION

54
 2.PRESENTING COMPLAINTS

LOCATION SENSATION& MODALITIES Accompanying

&DURATION PATHOLOGY Symptoms

53
 3. HISTORY OF PRESENTING ILLNESS & TREATMENT

4. HISTORY OF PAST ILLNESS & TREATMENT ADOPTED

5. HISTORY OF FAMILY ILLNESS:

6. PERSONAL HISTORY:

54
7. LIFE SPACE INVESTIGATION:

8. PSYCHIC FEATURES:

55
 9. PHYSICAL FEATURES:

A. APPEARANCE

B.REGIONAL

C.GENERALS

D.PHYSICAL EXAMINATION

i) General

Jaundice: Anaemia: Oedema:

Cyanosis: Clubbing: Lymphadenopathy:

Skin colour: Discolouration: Skin eruption:

Height: Weight: B.M.I:

Pulse rate: Resp.rate: Temp:

B.P:

56
ii) Systemic

1. Respiratory System:

2. Cardio Vascular System:

3. Gastro Intestinal System:

4. Urogenital System:

5. Musculo-skeletal System:

6. Central Nervous System:

7. Skin:

8. Endocrine:

9. Eye/ENT:

57
10. MENSTRUAL HISTORY:

11. OBSTETRICAL HISTORY:

12. LABORATORY FINDINGS:

58
 13. ANALYSIS & DIAGNOSIS OF DISEASE:

A. Provisional Diagnosis:

B. Differential Diagnosis:

C. Final Diagnosis (Disease)

14. DIAGNOSIS OF THE PATIENT

A. Analysis:

B. Evaluation of Symptoms/Totality of Symptoms:

C. Miasmatic Expressions:

D. Repertorial Totality:

E. Final Diagnosis (Homoeopathic):

59
 15. MANAGEMENT & TREATMENT

A. Plan of Treatment:

B. General/Surgical/Accessory:

C. Restrictions (Diet, Regimen etc):

Disease Medicinal

D. Medicinal: First Prescription:

BASIS OF SELECTION

i) Medicine:

ii) Potency:

iii) Dose:

60
 16. PROGRESS & FOLLOW UP

DATE SYMPTOM CHANGES INFERENCE PRESCRIPTION

53
 SCALE CHART:
OUTCOME ASSESSMENT:

Depend upon VITAL CAPACITY (VC)/PEAK EXPIRATORY FLOW

RATE (PEFR)/FORCED EXPIRATORY VOLUME (FEV1) Lung function is

classified as,

–NORMAL

-79% Predicted -MILD OBSTRUCTION

40-59% Predicted - MODERATE OBSTRUCTION

- SEVERE OBSTRUCTION

After medication if there is changes in FEV1 about 12% indicate good improvement after

given medication.

DATACOLLECTION:

By interview technique and observation

ation

64
 APPENDIX VI

CONSENT FORM

INFORMATION FOR PARTICIPANTS OF THE STUDY

1. Title of the project: “Clinical study on homeopathic management of bronchial asthma

with reference to lung volume capacity using spirometry.
2. Name of the investigator/guide : Dr. N. V. SUGATHAN MD,
Professor,
Department of Practice of medicine,
Sarada Krishna Homoeopathic Medical College,
Kulasekharam.
3. Purpose of this project/ study: To study on homeopathic management of bronchial
asthma with reference to lung volume capacity using spirometry.
4. Procedure/methods of the study: Total sample of 30 patients are selected from the
Out Patient Department, In Patient Department, RHC department of Sarada Krishna
Homoeopathic Medical College Based on inclusive criteria. The patient will be
categorized 1-30 before treatment, 1A -30A After treatment underwent spirometry .

5. Expected duration of the subject participation : 1 to 2 months with follow up

6. The benefits to be expected from the research to the participant or to others and
the post trial responsibilities of the investigator: The participant who takes part in
this study are contributing towards the management of bronchial asthma by
homeopathy without adverse effects. Through this study the participant get best quality
of improvement in lung volume capacity by Homoeopathic treatment for their
complaints tested by accurate lung function test called spirometry.
7. Any risks expected from the study to the participant: For the treatment best
selected Homoeopathic medicines will be given. So there will not be any adverse effect
or risk because of the study.
8. Maintenance of confidentiality of records: I will not disclose identity of the research
participants at any time , during or after the study period or during publication.
Securely store data documents in locked locations and Encrypt identifiable

65
 computerized data. All information revealed by you will be kept as strictly
confidential.
9. Freedom to withdraw from the study at any time during the study period without
the loss of benefits that the participant would otherwise be entitled : Your
participation in the study is voluntary and you are free to refuse treatment or withdraw
from the study at any time if you are not satisfied.

10. Possible current and future uses of the biological material and of the data to be
generated from the research and if the material is likely to be used for secondary
purposes or would be shared with others, this should be mentioned : Future uses of
the biological material and of the data to be generated from the research and if the
material is likely to be used for secondary purposes or will be shared with others only
with your consent.

11. Address and telephone number of the investigator and co-investigator/guide :

Investigator: Dr.Ayyalammai M, P.G. Scholar,

Department of Practice of medicine,
Sarada Krishna homoeopathic medical college and hospital,
Kulasekharam, Mobile no: 8056817022.
Guide: Dr. N. V. SUGATHAN, MD,
Professor.
Department of Practice of medicine,
Sarada Krishna Homoeopathic Medical College,
Kulasekharam.

12. Signature of investigator:

66
 FORM - 4 : CONSENT FORM (B)

Participant consent form

Informed Consent form to participate in a clinical trial

Study Title: “Clinical study on homeopathic management of bronchial asthma with reference to
lung volume capacity using spirometry”.

Study Number:
Subject’s Initials: Subject’s Name:
Date of birth/Age:
Please initial
Box (Subject)

i. I confirm that I have read and understood the information sheet dated []
___july 2017_______ for the above study and have had the opportunity to ask question.
ii. I understood that my participation in the study is voluntary and that I am []
free to withdraw at any time’ without giving any reason. Without my medical care or
legal rights being affected.
iii. I understand that the sponsor of the clinical trial,others working on the sponsor’s []
behalf the Ethics Committee and the regulatory authorities will not need my permission
to look at my health records both in respect of the current study and any further research
that may be conducted in relation to it, even if I withdraw from the trial. I agree to this
access. However, I understand that my identity will not be revealed in any information
released to third parties or published.
iv. I agree not to restrict the use of any data or result that arise from this study []
Provided such a use only for scientific purpose(s)
v. I agree to take part in the above study.

Signature (or Thumb impression of the subject/legally acceptable

Representative:___________________
Date _______/________/___________
Signatory’s Name: ________________
Signature of the Investigator: ______________
Study Investigator’s Name: Dr Ayyalammai.M
Signature of the Witness______________ Date: _______/_________/_______
Signature of the Witness _______________Date _______/__________/______

67
 Appendix - VII

“Case records are our valuable asset”

SARADA KRISHNA

HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL

KULASEKHARAM, KANYAKUMARI DIST, TAMIL NADU- 629161

CHRONIC CASE RECORD

O.P. No: 325/17 Unit: III B Date: 22.11.2016

Name: Mrs. selvi

Religion: Occupation:
Age:48Years, Sex: female christian housewife

Address: kattupuli,
Thuckalay.
Phone No (Land): 04651-252875 (Mobile):
FINAL DIAGNOSIS:

Homoeopathic CHRONIC MIASMATIC DISEASE- SYCOSIS

Disease Bronchial asthma

RESULT: Cured Relieved Referred Otherwise Expired

INITIAL PRESENTATION OF ILLNESS:

PATIENT’S NARRATION (in the very

expressions used by him / she) &
PHYSICIAN’S INTERROGATION PHYSICIAN’S OBSERVATION

Dark complexion, well

The patient narrated that he has built, cooperative,
Difficult in breathing, chest pain, cough,
watery from nose, sneezing since 1
week. Recurrent attack at cold climate
Steady gait.

62
63
PRESENTING COMPLAINTS:

LOCATION & SENSATION & MODALITIES ACCOMPANIMENTS

DURATION PATHOLOGY

Respiratory Difficulty in <night, dust,

system breathing exposure to cold Heaviness of chest

chest burning pain <ascending stairs

Watery from nose,

nose sneezing <rising from seat Headache heaviness +
>rest
> early morning,
open air

Since 1 ½ yrs

HISTORY OF PRESENTING ILLNESS & TREATMENT

The patient complaints started as difficulty in breathing, chest tightness more since 10

days , persist for about 1 ½ years. Aggravated at lying down, night, exposure to cold

climate, dust with heaviness of chest. Burning pain in chest more at ascending stairs.

No sweating, no palpitation. No vomiting. Waterying of nose since 15 days more at

early morning, open air with heaviness of head present. . Had allopathic treatment

temporary relief only.H/O dust allergy+ , no drug allergy, no relavent surgical history

no H/O epistaxis, no fever, no history of weightloss.

HISTORY OF PAST ILLNESS & TREATMENT ADOPTED

Had dust allergy, no H/O HT,DM,PT,JAUNDICE, MUMPS.

HISTORY OF FAMILY ILLNESS:

H/O eczema to her mother had allopathic management.Father had

hypertension.
PERSONAL HISTORY:

Place of birth: kattupuli Dwellings: Thuckalay

Religion: hindu occupation: housewife

64
 Education: +2

Economic status: Moderate

Social status :Good

Nutritional status: Moderate

Marital status: Married Yr. Of marriage: 24yrs

Family status: Nuclear

Father: Died Mother: Died Siblings: 2 M:3 F:3 Children:2

HABITS AND HOBBIES:

Food: Non.veg

Addictions: Tea 2cups/day

Sleep: Good

DOMESTIC RELATIONS:

With family members: Good

With other relatives: Good

With neighbours/ friends/ colleagues: Good

LIFE SPACE INVESTIGATION:

The patient was born in a moderate family at thuckalay. His father was an business
man and mother was an house wife. He had 1 brother and 1 sister. He studied upto
BA.,BL. He got married at 24yrs of age. He had 2 children. His wife was died one
month back so he is having grief about that.

PSYCHIC FEATURES:

Reserved
Obstinate
Easily angered for small things
Grief about his wife’s death
Increased sexual desire

PHYSICAL FEATURES

APPEARANCE:

Dark complexion

Moderate stature

65
Steady gait

66
REGIONAL:

Blackish discoloration on right big toe

GENERALS:

Appetite: Normal 3times/day

Thirst: Decreased

Sleep: Disturbed

Stool: Regular

Urine: Normal

Sweat: Increased over upper part of the body

REACTION TO:

Desires: cold season

Aversion: Sweet

Desires: Warm food & drinks

Desires: Spicy foods, Alcohol

Desires: Egg

Desires: Fish

PHYSICAL EXAMINATION

i) General

Jaundice: Not icteric

Anaemia: Pallor present

Oedema: Nil

Cyanosis: Nil

Clubbing: Nil

Lymphadenopathy: Nil

67
Skin colour: Dark discolouration: present on rt big toe

Skin eruption: Nil

Weight: 67.2kgs

Pulse rate:88/min

Resp.rate: 20/min

Temp: Afebrile

B.P: 130/70 mm of Hg

ii) Systemic

1. Respiratory System:

Inspection: No DNS, No hypertrophied turbinate, No scar, No

discoloration, No polyp, normal shape of the chest.

Palpation: No local warmth, no tenderness , vocal fremitus equal on both

sides, trachea normal in position, no tenderness over paranasal sinuses

Percussion: Normal lung resonance heard

Auscultation: bilateral wheeze heard all over auscultatory area+

2. Cardio Vascular System:

Inspection: No scar, no discoloration, no pallor, no cyanosis

Palpation: No local warmth, apex beat palpable at normal position

Percussion: Normal cardiac dullness

Auscultation: Normal heart sound S1, S2 heard tachy+

68
LABORATORY FINDINGS:

spirometry value:

ANALYSIS & DIAGNOSIS OF DISEASE

A. Provisional Diagnosis:

BRONCHIAL ASTHMA

B. Differential Diagnosi
CHRONIC BRONCHITIS
BRONCHIECTASIS
C. Final Diagnosis (Disease): Bronchial asthma
DIAGNOSIS OF THE PATIENT

A. Analysis:

COMMON UNCOMMON

>Warm drinks.
 Reserved
Difficulty in breathing  Burning in chest

Obstinate

Cough dry Easily angered for small things,

< night, lying

Sneezing, watery nose < early
morning

D: egg, fish, Warm food &

>rest drinks, Spicy food

A: Sweets

D: Cold season

69
 B. Evaluation of Symptoms/Totality of Symptoms:

MENTAL GENERALS PHYSICAL PARTICULARS

GENERALS
Difficulty in breathing
better warm drinks.
Reserved D: Egg, fish, warm < night , dust, cold seaon
Obstinate, Increased food& drinks, spicy
food, Heart burn+
Easily angered for small D: Cold season
things A: sweets Sneezing < early morning
Headache heayness+

C. Miasmatic Expressions:

PSORA SYCOSIS SYPHILIS

Easily angered
Sneezing > early Tightness of chest
morning, dust Reserved Cold season

Obstinate <night
Heaviness of head
Cold season

D. Non-Repertorial Totality:

Difficulty in breathing
Cough dry
< night, lying
Sneezing, watery nose < early morning
<rising from seat
Spicy foods, Alcohol
Easily angered, Increased Sexual Desire

E. Final Diagnosis (Homoeopathic):

CHRONIC MIASMATIC DISEASE – PSORA SYCOSIS

MANAGEMENT & TREATMENT:

A. Plan of Treatment:

Medicinal management
70
71
 B. General/Surgical/Accessory:


 Take protein rich food in diet



C. Restrictions (Diet, Regimen etc):

Disease Medicinal
Avoid exposure to dust Avoid tea, coffee and other medicinal
stimulants

D. Medicinal:

First Prescription:

Rx

1. Ars alb 0/3/ 1D (HS)

2. SD 1 – 1- 1.

3. SG 3 – 3 -3.

BASIS OF SELECTION

i) Medicine:

Difficulty in breathing,Easily angered,

Desire spicy foods, > night ,
increased thirst

ii) Potency:

Based on the susceptibility of the patient 0/3 potency is selected

iii) Dose:

Based on the Homoeopathic principles single dose is given

72
PROGRESS & FOLLOW UP:

DATE SYMPTOMS CHANGES INFERENCE PRESCRIPTION

19.12.16 Difficulty in breathing reduced Complaints Rx
Heart burn better reduced 1. Ars alb 0/3/1D(HS)
Sneezing reduced 2.SG 3- 3- 3
Generals: improved 3.SD 1- 1- 1
Sleep:disturbed
Stool:once in 2 days, hard
stool
BP:100/70mm of hg
RS- WHEEZE + Bilatral

21.1.17 Complaints Rx
Difficulty in breathing better reduced 1. Ars alb 0/4/1D
<lying down 2. SG 3- 3- 3
Generals: 3. SD 1- 1- 1
Stool: difficult to pass
BP:110/70 mm of hg

Cough dry at night, difficulty in

28.2.17 breathing, sneezing Complaints feels RX
feels better than better than 1. Ars alb 0/5/1D
before before but 2. SG 3- 3- 3
Generals: Good persists 3. SD 1- 1- 1
BP: 110/70 mm of hg
RS- CREPTS+
22.4.17 Difficulty in breathing better Complaints feels Rx
better 1. PL/1D in 10 ml aqua
10gtt 2hrly
2. SG 3- 3- 3
3. SD 1- 1- 1
Generals: Good
BP: 100/70 mm of hg
RS- NVBS
Cough reduced , no difficulty in
30.5.17 breathing, feel better Complaints feels Rx
better 1. PL/1D in 10 ml aqua
Generals: Good 10gtt 2hrly
BP: 110/70 mm of hg 2. SG 3- 3- 3
RS- NVBS 3. SD 1- 1- 1

73
74
 APPENDIX V

MASTER CHART

Sl Op no: Age Sex Occupati Dwelling Socio Family Diet BMI Medicine Potency HbA1c

Result
N In on economic history
o: yrs status BT AT

1 11925/8 29 M Teacher Urban High Mother, Non-veg 27 Phosphorus 200 5.9 4.8

Improved
Father:
Diabetic

2 9321/18 27 F Clerk Rural High Father, Non-veg 29 Lachesis 200 6.3 5.0

Improved
mother:
diabetic

3 1951/18 50 M Security Rural Middle Father: Non-veg 25 Nux 30 6.2 5.3

Improved
gaurd diabetic vomica

4 3805/17 36 F Carpenter Rural Middle Mother, Veg 32.8 Sulphur 0/3 6.4 5.2

Improved
Brother:
diabetic

5 2664/18 47 F Housewif Rural Middle Mother: Non-veg 37 Sulphur 200 6.4 5.2

Improved
e hypertensi
on

6 336/18 52 M Business Rural Middle Father: Non-veg 32 Sulphur 200 6.2 5.9

Improved
man diabetic

100
7 5994/17 46 M Coolie Rural Low nil Non-veg 30 Calcarea 0/1 5.9 5.0

Improved
carb

8 10230/1 55 M Auditor Urban High Father, Non-veg 31 Lycopodiu 0/3 6.1 5.5

Improved
7 Mother: m
diabetic

9 711/18 42 M Coolie Rural Low Father: Non-veg 23 Lycopodiu 30 6.3 5.6

Improved
diabetic m

10 12646/8 52 M Driver Rural Middle Mother, Non-veg 25 Fluoric 200 6.2 5.4

Improved
Fther, acid 4
Brother:
diabetic

11 5775/17 53 M Business Rural High Mother, Non-veg 24.8 Flouric 30 6.4 5.1

Improved
man father: acid
diabetic

12 9047/18 45 M Driver Rural Middle Father: Non-veg 25 Lachesis 200 5.9 6.1

improved
diabetic

Not
13 5984/18 51 M Mechanic Rural High Mother, Non-veg 22 Lycopodiu 0/3 6.4 5.1

Improved
al Father: m
engineer diabetic

14 5696/18 48 F House Rural Middle Father: Non-veg 37 Pulsatilla 30 6.3 4.8

Improved
Wife Diabetic

101
15 5770/18 33 F House Urban High Father, Non-Veg 33.4 Phosphorus 0/1 6.4 5.2

Improved
Wife Mother,
Brother:
Diabetic

16 6518/17 49 M Bank Rural High Mother, Non-Veg 27 Sulphur 0/1 6.2 5

Improved
Employee Sister:
Diabetic

17 1550/17 55 M Business Urban High Father: Non-Veg 28 Natrum 200 6.4 5.4

Improved
Man Diabetic mur

18 1879/18 55 M Business Rural Middle Father: Non-Veg 31 Acid Phos 30 6 6.2

Improved
Man Diabetic

Not
19 10162/1 39 F House Rural Middle Mother, Non-Veg 30 Calc Carb 200 6.2 4.9

Improved
7 Wife Brother:
Diabetic

20 4756/17 51 M Religious Rural Middle Father: Non-Veg 32 Pulsatilla 200 6.4 5.2

Improved
Person Diabetic

21 62/17 45 M Coolie Rural Lower Father: Non-Veg 28 Sulphur 30 6.1 5.4

Improved
Diabetic

22 8689/18 55 F Religious Rural Middle Mother : Non-Veg 30 Sulphur 0/3 6.3 5.0

Improved
Person Diabetic

102
23 8046/17 52 F House Rural High Father: Veg 29 Sulphur 200 5.9 4.7

Improved
Wife Diabetic

24 675/18 51 F Teacher Rural Middle Father, Non-Veg 32 Lycopodiu 200 6 4.9

Improved
Mother: m
Diabetic

25 1686/18 48 M Govt. Urban High Father: Non-Veg 28 Sulphur 200 6.1 4.6

Improved
Employee Diabetic

26 6026/17 47 F Teacher Rural High Mother, Non-Veg 26 Staphysagri 200 5.9 5.4

Improved
Brother: a
Diabetic

27 6527/18 43 F House Rural Middle Mother: Non-Veg 25 Nitric acid 30 6.4 5.1

Improved
Wife Diabetic

28 4858/18 54 F House Rural Middle Father, Non-Veg 33 Nuxvom 200 6.2 6.6

Improved
Wife Mother,

Not
Sister:
Diabetic

29 2176/18 36 M Teacher Rural High Mother, Non-Veg 32 Sulphur 0/3 6 4.7

Improved
Uncle,
Brother:
Diabetic

30 2187/18 48 M Army Rural Middle Father: Non-Veg 25 Arsalb 200 6.3 5.4

Improved
Diabetic

103
104
 DISTRIBUTION BASED ON FEV1 VALUE:

FEV1 VALUES OF PATIENTS BEFORE AND AFTER TREATMENT

SL
NO BEFORE TREATMENT AFTER TREATMENT

1 1.9 2.8

2 0.58 1.09

3 1.01 2.11

4 1.6 2.2

5 1.78 3.15

6 0.8 1.7

7 0.58 1.77

8 1.5 2.07

9 1.7 2.43

10 0.93 3.3

11 0.58 1.77

12 0.82 1.62

13 1.9 2.26

14 1.53 1.64

15 1.5 2.42

16 1.5 1.76

17 0.5 1.6

18 1.5 2.49

19 1.12 2.29

20 0.86 2.1

84
 21 1.18 2.07

22 0.8 1.9

23 0.64 1.5

24 0.6 1.5

25 1.18 2.01

26 0.5 1.18

27 2.31 3.4

28 1.5 2.01

29 1.7 2.9

30 0.6 1.7

PREDICTIVE % OF SPIROMETRY VALUE BEFORE AND AFTER TREATMENT

CASE BEFORE AFTER

TREATMENT (%) TREATMENT %

1 45 65

2 72 88

3 55 85

4 65 88

5 70 87

6 60 75

7 65 80

8 69 90

9 78 88

10 55 78

11 76 91

85
12 55 75

13 50 76

14 62 85

15 45 55

16 48 70

17 25 36

18 65 77

19 50 72

20 60 76

21 75 81

22 65 82

23 60 72

24 50 62

25 73 85

26 66 78

27 80 98

28 49 52

28 70 93

30 72 85

86