Evaluation of the role of Nithyavirechana and Nayopayam kashaya in Tamaka Shwasa.

Man has been in steady attempt to find the solutions for the life-threatening and distressing disorders, which afflict the human race. One of such condition is "Tamaka Shwasa," which is recognized by the name bronchial asthma in contemporary discipline, wherein episodic attacks are the characteristic features, leaving the patient in pathetic situation. Therefore management of this acute respiratory condition is the long mission in the medical society of all types. There is abundance of medicines explained for Tamaka Shwasa in Ayurveda, and it is mentioned that combined Shodhana and Shamana therapy is more effective. Hence the present study is designed to evaluate the role of Nithyavirechana followed by Shamana in the form of Nayopayam kashaya in patients of Tamaka Shwasa. This was a single blind clinical study with pre-test and post-test design where in 20 patients suffering from Tamaka Shwasa of either sex between the age group of 16 and 60 years were subjected to the trial. These patients were treated with Nithyavirechana with Eranda thaila (castor oil) followed by oral administration of Nayopayam kashaya in a dose of 50 ml twice a day. The therapeutic effect of the treatment was assessed based on specific subjective and objective parameters. Results obtained were analyzed for the statistical significance by adapting paired 't' test. Statistical analysis established that Eranda thaila and Nayopayam kashaya are highly effective in counteracting the symptoms of Tamaka Shwasa.

Association of control and risk of severe asthma-related events in severe or difficult-to-treat asthma patients.

BACKGROUND: Clinical tools for predicting poor outcomes in asthma patients are lacking. This study investigated the association of asthma control and subsequent severe asthma-related healthcare events in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. METHODS: The extent of asthma control problems was determined from baseline values of the Asthma Therapy Assessment Questionnaire (ATAQ). Patients self-reported the presence of severe asthma-related events at 6- and 12-month follow up. Poisson regression models determined the adjusted association between baseline control and the likelihood of severe asthma-related events. RESULTS: At baseline, 2942 patients (mean age, 49.6 years; female, 71.9%) had an ATAQ score (no control problems, 17.0%; 1 control problem, 20.0%; 2 control problems, 30.8%; 3 or 4 control problems, 32.2%) and at least one severe asthma-related event. After adjustment, subjects with three or four control problems were at greater risk for unscheduled office visits [relative risk (RR) = 2.8; 95% confidence interval (CI): 2.4-3.2], course of oral steroids (RR = 2.9; 95% CI: 2.5-3.3), emergency room visits (RR = 4.1; 95% CI: 2.7-6.2) or hospitalization (RR = 13.6; 95% CI: 7.4-24.9), vs no control problems. Progressively poorer levels of asthma control are associated with increasing risk of severe asthma-related events. CONCLUSIONS: This study provides evidence of an association between poor asthma control and future severe asthma-related healthcare events. A validated questionnaire may help clinicians identify patients requiring intervention to prevent future severe asthma-related events.

Extent, patterns, and burden of uncontrolled disease in severe or difficult-to-treat asthma.

BACKGROUND: Characterization of uncontrolled asthma burden in a natural treatment setting can influence treatment recommendations and clinical practice. The objective was to characterize and compare the economic burden of severe or difficult-to-treat asthma in uncontrolled and controlled patients. METHODS: Baseline patient data (age > or = 13 years; n = 3916) were obtained from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study. Disease control was assessed using two approaches: (i) applying criteria for control based on the Gaining Optimal Asthma Control study, and (ii) using the Asthma Therapy Assessment Questionnaire (ATAQ) to identify the number of asthma control problems. Assessments were performed at baseline, and at months 12 and 24. Monetary values were assigned to productivity loss and medical resource use. Direct and indirect costs were aggregated over 24 months and compared using Student's t-test for continuous measures and chi-squared for categorical variables. RESULTS: Throughout the study, most patients had uncontrolled asthma (83% uncontrolled; 16% inconsistent control; 1.3% controlled). Controlled patients experienced fewer work or school absences and less healthcare resource use than uncontrolled patients at all study time points. Using the multilevel ATAQ control score, asthma costs increased directly with the number of asthma control problems. Costs for uncontrolled patients were more than double those of controlled patients throughout the study (14,212 vs 6,452 US Dollars; adjusted to 2002 Dollars; P < 0.0001). CONCLUSIONS: This study demonstrated that few severe or difficult-to-treat asthma patients achieved control over a 2-year period and the economic consequence of uncontrolled disease is substantial.