BHUBANESWAR: In 2016, the health transformation of a billionaire scion had left everyone amazed. He had lost over 100kg in one-and-a-half years following rigorous physical exercise and a strict diet. The very next year, it was revealed that he was severely asthmatic, and the steroids he was prescribed to manage his condition had led to obesity.
Asthma is a chronic respiratory condition that is caused by inflammation and narrowing of the airways in lungs leading to difficulty in breathing. It can affect people of all ages and begins in childhood. Many celebrities including Big B of Indian cinema Amitabh Bachchan, Bollywood diva Priyanka Chopra Jonas and legendary footballer David Beckham live with asthma.
Senior pulmonologist at Manipal Hospitals, Bhubaneswar, Dr Sarat Kumar Behera says some of the medications can lead to weight gain among patients, depending on the specific drug and the response mechanism. “Oral corticosteroids, which are widely used to treat severe asthma, can slow down metabolism and enhance appetite, leading to weight gain,” he added.
No cure, only control
Like any other allergy, asthma has no cure but can be controlled with regular medication. The treatment options for asthma depend on its severity and phenotype. It ranges from a simple SOS inhaler to oral antihistamines (anti-allergic), inhaled steroids, oral steroids, injectable steroid shots, bronchodilators, biological therapy and subcutaneous or sublingual immunotherapy. It may also include allergy medications if the asthma is triggered or worsened by allergies.
Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control and make it less likely you’ll have an asthma attack. “Inhalers are extremely safe and provide 100% control over asthma symptoms. A few those who have severe asthma require frequent doses of oral or injectable steroids to keep their asthma in control.
The problem occurs when asthma is under or over-treated, which worsens the condition with side-effects of the medication,” said Dr Akshay Budhraja, head of department (respiratory and sleep medicine) at Aakash Healthcare Superspeciality Hospital in New Delhi. Steroids and other anti-inflammatory drugs work by reducing inflammation, swelling, and mucus production in the airways of a person with asthma.
Obesity also indirectly leads to an increase in asthma severity and many develop obesity-induced asthma. “Obesity and asthma are a deadly combination. Obese people develop sleep disorders like obstructive sleep apnea which, in turn, worsens asthma and leads to further increase in body weight as well as development of metabolic disorders like diabetes,” said Dr Budhraja.
Patients suffering from asthma-related weight gain are prescribed weight loss medication, alongside dietary modifications and behavioural therapy. “Inhalational corticosteroids and long acting bronchodilators are better treatment options. Regular physical exercise and a balanced diet with annual flu vaccination are advised to prevent weight gain,” said Dr Behera.
Contributing factors
The burden of asthma, which is broadly of two types - allergic and non-allergic, is on a rise, says Dr Budhraja. The reason for the consistent rise is mainly linked to air pollution, increasing viral respiratory infections, especially in childhood leading to poor lung development and obesity, apart from genetic factors.
According to the latest Global Burden of Disease report, the prevalence of asthma in India is about 3% with around 34.3 million people, accounting for over 13% of the global burden, living with the non-communicable disease (NCD). An estimated two lakh people die due to the disease every year in the country, which contributes to around 46% of global asthma deaths.
The national family health survey (NFHS-V) revealed that the percentage of people with asthma is more in West Bengal, Odisha, north-eastern states of Mizoram, Meghalaya, Tripura, Manipur, Assam, and southern states of Kerala, AP, Telangana, and Puducherry.
Ayurveda, traditional therapy
Since corticosteroids, which remain a cornerstone in asthma management, can cause obesity in some, patients can explore alternative treatments, including ayurveda and complementary medicines that offer potential benefits for managing both asthma and its associated side effects.
Central Council for Research in Ayurvedic Sciences (CCRAS) Director General Dr Rabinarayan Acharya said asthma can be managed by moving excess kapha (phlegm) back to the stomach and removing it through therapeutic procedures like swedana (sudation), vamana (therapeutic vomiting) and virechana (therapeutic purification).
“Herbs like pushkarmula, pippali, kantakari, gojihva, yashtimadhu and talispatra are used as bronchodilator, antitussive, expectorant, digestive, and rejuvenating properties. Rasayana formulations like kushmanda rasayana, agastya haritaki avaleha, mridvikadi leha, dashamula rasayana, and kantakari avaleha are recommended as per the chronicity of the disease,” he said.
SKM Ayurvedic Medical College, Azamgarh, director Dr Santanu Das said asthma is approached through a holistic lens in ayurveda, focusing on diet, lifestyle and balancing the body’s doshas (vital energies) and promoting overall well-being.
“Both herbal and herbomineral medicines can treat respiratory distress. Key herbs like kantakari, vasa, shirisha, haritaki, shati (kapurkachari), pushkaramula, tulsi, bharangi, bhumyamalaki and bahada can be taken individually or combined into a decoction. Drugs like sitopaladi churna, vasadi kasaya, vasavaleha, kanakasava, vyaghri haritaki, shwaskas chintamani and shwaskuthar rasa are advised to avoid steroids,” Dr Das added.