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MY EXPERIENCE WITH CONSTITUTIONAL PRESCRIBING IN BRONCHIAL ASTHMA: CASE REPORT FROM DELHI GOVT HOMOEOPATHIC DISPENSARY

Dr. Pradip Kumar Roy MD(Hom.) Senior Medical Officer (H), DGHD Meethapur; Senior Lecturer, Department of Materia Medica, Dr. B.R. Sur Homoeopathic Medical College & Hospital, Dte. of AYUSH, Govt of NCT of Delhi. Email: roydr.pradipkumar@yahoo.in

Abstract Bronchial asthma is a very common clinical presentation, which requires early diagnosis and proper intervention to prevent complications. A 41 years old male consulted at Delhi Government Homoeopathic Dispensary at Meethapur with paroxysmal attacks of shortness of breath. Other clinical features along with spirometry confirmed the diagnosis. On the basis of totality of symptoms, Pulsatilla was prescribed in centesimal potency, which provided marked relief and he discontinued the use of bronchodilator after six months of homoeopathic treatment. The patient was followed for another six months and did not report any further episode of bronchial asthma. Keywords Bronchial asthma, homoeopathy, constitutional medicine, pulsatilla Introduction Bronchial asthma is a syndrome characterized by specific chronic inflammatory disorder of lung airways leading to airflow obstruction. It has three characteristics: a)Airflow limitation which is usually reversible spontaneously or with treatment. b) Airway hypersensitiveness to a wide range of stimuli. C) Inflammation of the bronchi with eosinophils, T lymphocytes and mast cells with associated plasma exudation, oedema, smooth muscle hypertrophy, mucus plugging and epithelial damage.[1] Bronchial asthma can be divided into- a) Extrinsic type-having a definite external cause, b) Intrinsic or cryptogenic- when no causative agent can be identified.[1] Symptoms of bronchial asthma are cough, wheeze, chest tightness and episodic shortness of breath, which are often worse at night. Nocturnal cough can be a presenting feature. Signs of bronchial asthma include high-pitched wheezing respiration especially during expiration. In an acute attack, the respiratory rate is rapid and tachycardia is common. There is tremendous variation in the frequency and duration of the attacks. Attacks may be precipitated by different factors such as a) Allergens- dust mites,mold spores,animal dander,cockroaches,pollen,indoor and outdoor pollutants,irritants (smoke,perfumes,cleaning agents), b) Pharmacologic agents (ASA, beta-blockers), c) Physical triggers (exercise,cold air), d) Physiologic factors (stress,GERD, bacterial and viral URI, rhinitis).[1] The diagnosis of bronchial asthma is usually apparent from the symptoms of variable and intermittent airway obstruction. Simple spirometry confirms airflow

limitation with a reduced FEV1, FEV1/FVC ratio and PEF. Total serum IgE and specific IgE to inhaled allergens may be measured in some patients. Chest X-ray is usually normal but in more severe cases may show hyper-inflated lungs. Skin prick test to common inhalant allergens are positive in allergic asthma and negative in intrinsic asthma, but are not helpful in diagnosis.[2] Asthmatics are advised to avoid allergens, trigger factors, not to exercise outdoors during periods of poor air quality. Short- and long-term measures are required to reduce air pollution, stop active smoking and passive smoking.[1] Breathing exercises may be advised. In acute severe asthma patient-family education and participation in treatment is required. There are many homoeopathic medicines used in bronchial asthma depending upon the nature of the disease condition and availability of peculiar as well as generic signs and symptoms of the patient. During acute episode/ paroxysm some short acting medicines may be used, but in order to cure, the constitutional medicine is required, which is prescribed during the phase of remission. For acute prescription, prime importance should be given to the most probable exciting cause and most striking acute totality of the patient, but for chronic prescription the most significant points of the whole history of the patient to discover the fundamental cause which is generally due to a chronic miasm is to be ascertained. Here the constitution of the patient, the mental make-up, as well as the accessory circumstances are to be considered.[3,4] Case report A 41 years old male school-teacher consulted at Delhi Govt. Homoeopathic Dispensary, Meethapur, on 25.04.2012, for episodic attacks of shortness of breath, wheezing and chest tightness since one year. He was observed to be of average built, gentle in conversation and mild in temperament. His complaints were<during evening and after dinner, > slow walking during attack in open air. His cough was usually dry in the evening and loose (productive) in the morning. He was under treatment with bronchodilator, which provided temporary relief. He was also suffering with GERD (Gastro-oesophageal reflux disease) since few months. Past illnesses: Recurrent attacks of common cold from changes in weather. Dysentery- recurrent attacks till 10 years of age. Urinarytract infection @ 16 years of age. Family history: Father-DM, HT Mother-Asthma

Generals: Appetite-Good. Thirst- Decreased normally, felt thirsty only after eating. Desire- cold foods, warm drinks. Perspiration especially over chest. Bowels Irregular timings especially after taking spicy, fatty food. Thermal reaction- Easily catches cold from cold weather, change of weather but prefers open air; cold air and cold room. Mind &disposition: He was a mild yielding and good natured person, who was fearful of his ailments and darkness. On Auscultation: Vesicular breath sound with prolonged expiration and occasional rhonchi at b/l mid and lower zones. Investigations undergone 15.03.2012:Spirometry- Report:
PARAMETERS FVC FEV1 FEV1/FVC PEF (L) (L) (%) (L/sec) PREDICTED VALUES 3.70 3.21 86.75 8.1 OBSERVED VALUES PRE 3.24 2.12 65.43 5.8 %PRED 88 66 75 72

INTERPRETATION: MILD AIRFLOW LIMITATION. OBSRTUCTIVE ABNORMALITY

Analysis: The most striking symptoms were Mind & disposition- Mild,yielding. Modalities- < evening, after dinner,>open air, slow walking during attack. Thirstlessness. Thermal reaction- always wants open air, cold room, cold air. These are also characteristic features of the homoeopathic remedy, Pulsatilla, which was therefore prescribed. Prescription & follow up Rx Pulsatilla 200 single dose followed by Rubrum 30 He improved after the first dose and used bronchodilator only once within first 15 days of treatment. He was followed up after 2 months and his breath sounds on auscultation were vesicular without prolonged expiration or rhonchi.

Another dose of Pulsatilla 200 was prescribed after 2 months and Rubrum was continued. After 6 months he did not require the use of bronchodilator. He was thenprescribed a dose of Pulsatilla 1M and Rubrum was continued. He was followed by for nearly one year and needed no further repetition of the remedy. The patient has so far not repeated spirometry. During his treatment he reported that his fear of ailments had also disappeared and his bowel movements became regular. Improvement was simultaneously noticed in GERD symptoms with reduction in heartburn, water-brash and regurgitation of food. Discussion & Conclusion A constitutional disease like bronchial asthma demands a deep acting constitutional medicine, if we intend to achieve a cure. Dr.Francisco Eizayaga, one of the most respected South American homoeopathic physician, has written, when diseases are at full functional changes, it demands fundamental remedy..[5]. In the absence of pathological changes lies the best scope for prescribing the constitutional medicine, and this was confirmed in above mentioned case study. It is also important to remember that GERD is common in asthmatic patients. Although acid reflux might trigger reflex bronco-constriction, it rarely causes asthmatic symptoms. Dr. Hering, has mentioned the following symptoms of asthma under Pulsatilla: Tension and constriction in chest with dyspnoea and asthmatic symptoms Oppression of chest on walking first, ascending an eminence or exercising (both of these symptoms were verified by cures); Asthma of children., in evening especially after a meal as from vapor of sulphur (this symptom was repeatedly verified). [6] A clinical research study on bronchial asthma was conducted by Central Council for Research in Homoeopathy over a sample size of 2107. The outcome of the observational study stated that Pulsatilla has a role in managing acute attacks of bronchial asthma and in controlling recurrent attacks. [7] The case study also verifies the scope of Pulsatilla in bronchial asthma. References 1. Kumar P, Clark M. Clinical Medicine, 5th Edition, London. Saunders Ltd., 2002, pp 874-884.

2. Harrison. Principles of Internal Medicine.Vol. II, 16th ed. Mc Graw Hill 2005, pp 1511 and 1551. 3. Hahnemann S. Materia Medica Pura, Vol. II, New Delhi: Indian Books & Periodicals Publishers, pp 345. 4. Hahnemann S. Organon Of Medicine, 5th Edition, Translated by Dudgeon R E, Reprint Edition, New Delhi: B Jain Publishers (P) Ltd,1996, pp32,33,111. 5. Khan L M. Pleasure Of Prescribing, Ist Edition, New Delhi:B Jain Publishers (P) Ltd, 2003, pp 79. 6. Hering C. The Guiding Symptoms Of Our Materia Medica. Vol. VIII, Reprint Edition, New Delhi: B Jain Publishers (P) Ltd., 2000, pp 617. 7. Available http://www.ccrhindia.org/dossier/content/page 59.html [Last accessed on 2014 January 29].

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