title: Dosha phenotype specific Ayurveda intervention ameliorates asthma symptoms through cytokine modulations: Results of whole system clinical trial.
abstract: BACKGROUND
  Over the past few decades, there have been significant scientific advances leading to improved understanding of asthma as a disease and treatment providing immediate relief. However, prevention of recurrent attacks, exacerbations and disease cure remains a challenge. Ayurveda refers to bronchial asthma as Tamaka Swasa and it is well explained in Charaka Samhita. Management of asthma in Ayurveda includes removal of vitiated Kapha through Shodhana, Shamana procedures, herbal and herbomineral formulations in addition to advising a healthy lifestyle and diet. Several clinical trials on Ayurvedic formulations for treatment of asthma are reported, however, whole system management of asthma has rarely been studied in the manner in which it is actually being practiced. Ayurveda therapeutics provides Dosha specific approaches, which needs biological investigation.
  
  
  OBJECTIVE
  The objective of our study was to investigate lung functions and cytokine changes in Asthmatic individuals in response to Ayurvedic intervention.
  
  
  METHODS
  The study design was approved by the Institutional Ethics Committee of Tilak Ayurveda Mahavidyalaya (TAMV) & Sheth Tarachand Ramnath Charitable Ayurveda Hospital and followed guidelines of the Declaration of Helsinki and Tokyo for humans. It was conducted as a whole system individualized pragmatic clinical trial and written consent of patients was collected before enrollment. One hundred and fifteen patients with mild-to-moderate asthma were divided into 2 sub-groups depending on their disease subsets and administered phenotype specific ayurvedic interventions. Seventy six asthma patients completed the treatment. Serum IgE levels, blood eosinophil counts, spirometry and blood cytokine levels were measured before the start of treatment and six months at the end of treatment. Age and sex matched healthy participants (n=69) were recruited in the study for comparison of cytokines levels.
  
  
  RESULTS
  Significant improvements in FEV1(% predicted) (p<0.0001) and FVC (% predicted) (p=0.0001) was observed in asthmatic patients who underwent Ayurvedic treatment. Circulating levels of IgE (p<0.03) and eosinophil numbers (p=0.001) reduced significantly in the asthmatics after Ayurvedic treatment. This was associated with significant reduction in levels of circulating cytokines. Levels of Th2, Th1 and inflammatory cytokines in the peripheral blood were higher than healthy control participants at baseline (p values <0.0001) and reduced significantly after ayurvedic intervention.
  
  
  CONCLUSIONS
  This proof of concept study highlights the potential benefits and possible mechanism of Ayurvedic interventions in patients with mild-to-moderate asthma. The interventions significantly reduced IgE and eosinophil count, also improved lung function and reduced levels of circulating Th2 cytokines.
authors.affiliation: Department of Biotechnology, Sinhgad College of Engineering, University of Pune, Pune, Maharashtra, India. Electronic address: joshikalpana@gmail.com.
authors.forename: Kalpana S
authors.initials: KS
authors.lastname: Joshi
authors.affiliation: Department of Dravyaguna,Tilak Ayurved Mahavidyalaya, Pune, Maharashtra, India.
authors.forename: Tanuja M
authors.initials: TM
authors.lastname: Nesari
authors.affiliation: Department of Dravyaguna,Tilak Ayurved Mahavidyalaya, Pune, Maharashtra, India.
authors.forename: Amrish P
authors.initials: AP
authors.lastname: Dedge
authors.affiliation: Department of Dravyaguna,Tilak Ayurved Mahavidyalaya, Pune, Maharashtra, India.
authors.forename: Vikram R
authors.initials: VR
authors.lastname: Dhumal
authors.affiliation: Department of Biotechnology, Sinhgad College of Engineering, University of Pune, Pune, Maharashtra, India.
authors.forename: Sushant A
authors.initials: SA
authors.lastname: Shengule
authors.affiliation: Department of Biotechnology, Sinhgad College of Engineering, University of Pune, Pune, Maharashtra, India.
authors.forename: Maithili S
authors.initials: MS
authors.lastname: Gadgil
authors.affiliation: Department of Pulmonary Medicine, Chest Research Foundation, Pune, Maharashtra, India.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Salvi
authors.affiliation: School of Life Sciences, Manipal University, Manipal, Karnataka, India.
authors.forename: Marthanda Varma Sankaran
authors.initials: MV
authors.lastname: Valiathan
mesh_terms: D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D016207:Cytokines / Q000097:blood*; D004032:Diet; D004804:Eosinophils / Q000187:drug effects; D005260:Female; D000070497:Healthy Lifestyle; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007958:Leukocyte Count / Q000379:methods; D008168:Lung / Q000187:drug effects; D008297:Male; D008515:Medicine, Ayurvedic; D010641:Phenotype; D028321:Plant Preparations / Q000627:therapeutic use*; D010946:Plants, Medicinal / Q000737:chemistry
chemical_list: D016207:Cytokines; D028321:Plant Preparations; D007073:Immunoglobulin E
keywords: Asthma; Ayurveda; Cytokines; FEV; FVC; IgE