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REVIEW Svasa:Different Patterns of Breathing Abnormalities Dr IGWAI 2004 (I) I: 13-16 REVIEW Svasa:Different Patterns of Breathing Abnormalities Dr. Chandrasiri, W.A.L. Abstract - The condition Svasa is described in Ayurvedic text as a difficulty Lecturer in Clinical in breathing of any cause and divided into five types. A particular type Pathology represents particular stage of abnormal respiration. Mahasvasa and I Apartment of Cikitsa VWAI Urdhvasvasa are compatible with Kussmaul Respiration and Central President- HCRF Neurogenic Hyperventilation respectively. Chinnasvasa includes the Cheyne-Stokes Respiration and Ataxic Respiration. Prognosis of these conditions is poor. Tamakasvasa includes all the diseases characterized by Bronchial Asthma. Kshudrasvasa which is an initial stage of the other four types of Svasa, is similar to Dysponea on Effort. Especial consideration on Kshudrasvasa prevents serious life threatening disorders. Svasa, a major pathological condition mentioned produce spontaneous respiration regulated by in the classical texts of Ayurveda, comprises neural and chemical factors. The voluntary and different patterns of breathing abnormalities of autonomic controls on respiration are mediated organic defects. Breathing, a key physiological via the neural factors. Cerebral cortex, where the function, is controlled by integrated complexities voluntary system is located, discharges the of biochemical, mechanical and neurological impulses to the respiratory motor neurons through factors. The severity and pattern of breathing corticospinal nerves. Autonomic system, which is abnormalities depend upon the degree of defect located in medulla and pons, provides impulses of respective organs. Mahasvasa Urdhvasvasa to the respiratory motor neurons. The area in the Cinnasvasa, Tamakasvasa and Kshudr-asvasa, medulla that is responsible for respiration is called are the five types of breathing abnormalities in respiratory center. Pneumotaxic center located in the descending order of their seriousness. the pons modifies the discharges from medulla. Svasa is considered, in the context of Ayurveda, The chemical factors, which regulate respiration, to be the most serious condition, causing include mainly Pco2 P02 and H* concentration of immediate death. blood. The effect of changes in blood chemistry mediates via respiratory chemo-receptors located The term Svasa is derived from a Sanskrit root in carotid, aortic bodies and cells in the medulla. "Svas" meaning aliveness (Svas - Jivane). Normal PCo2 P02and H* concentration of blood is Breathing is the symbol of life and it is a result of maintained by a number of biochemical reactions series of mechanical and biochemical reactions. occur mainly in respiratory system, kidney and The sense of the term "Svas" represents whole blood . Any defect of these systems, which are process of respiration. potent enough to alter the chemistry of blood, affects the regulation of respiration resulting Svasa Breathing pattern abnormalities may arise as a or breathing abnormalities. It may occur as a result of defective regulation of respiration of complication or characteristic feature of a disease. various causes. Respiration is a rhythmic function consisting of two phases; i.e. inspiration and expiration. The rhythmic impulses, under the In the context of Ayurveda. Svasa is categorized control of discharges from brain, of motor under Mahavyadhi and is further divided into five neurons that innervates the respiratory muscles types on the basis of its clinical manifestation and HCRF 13 REVIEW JGWAI 2004(1) I: 13-16 severity. Mahasvasa, Urdhvasvasa and Chinna precede the development of this respiratory svasa occur as a result of respiratory failure at the pattern. terminal stage of the patient suffering from sever diseases of brain stem, cardiovascular system, Clnnasvasa: urinary system and other metabolic disorders Cinna svasa, the third type of the breathing ab­ such as metabolic acidosis. normality, is characterized by periodic breathing and severe pain in vital organs including heart, Mahasvasa: brain and kidney. Flatulence, excessive sweating, Mahasvasa is characterized by deep sighing, a unconsciousness, painful bladder, tear filled eyes, long drawn inspiration, which is accompanied by redness of one eye; flaccid limbs and excessive stertorous or stridor. The sound of stertorous weakness are the additional features. It occurs breathing, during the phase of inspiration, occurs as a result of defects of organs, directly respon­ due to the paralysis of soft palate causing it to sible in maintaining the life. vibrate as the air passes into the throat and the stridor due to partial paralysis of larynx. The periodic respiration and ataxic respiration can Unconsciousness, opened eyes and mouth, be directly compared with Chinnasvasa. The pe­ nystagmus (involuntary rhythmic oscillation of riodic Respiration refers to alternating hyperp- eyes), inability to speak, loud expiration and noea and apnoea, which is called Cheyne-Stokes generalized weakness are the additional Respiration. Cheyne-Stokes Respiration, which characteristics of the condition. Kussmaul is caused by the decrease in the sensitivity of res­ Respiration (Acidotfc Respiration) is also a piratory center to carbondioxide, has a cyclical similar breathing abnormality, described in variation in the depth of respiration. It represents modern medicine, of deep sighing a phase of very deep rapid breath, a period of hyperventilation that occurs principally in diabetic gradually deepening of respiration, a phase of ketoacidosis, uraemia, respiratory failure of other slowly decreasing respiratory movements and causes, in diseases of nervous system and in rate respectively. Finally respiration becomes deep metabolic coma specially in hepatic and quieter and may cease for several seconds (ap­ diabetic coma. noea) before the cycle is repeated. The apnoea occurs due to the lack of Co2 in blood. During the Urdhvashvasa: phase of apnoea, the alveolar P02 falls and the Urdhvashvasa, the second most serious breathing PCo2 rises. Breathing resumes because of hy­ abnormality, is characterized by deep sighing or poxic stimulation of carotid and aortic chemore- long drawn of inspiration, which is not ceptors and breathing stops until the alveolar P02 accompanied by stertorous or stridor. Presence falls again. of obstructed nose and mouth with secretions (phlegm or saliva), upward turning of eyes, Some patients of Cheyne - Stokes Respiration nystagmus, visual hallucinations, intermittent have increased sensitivity to Co2 apparently due unconsciousness, painfulness, paleness of the to the distruption of neural pathways that normally face and generalized weakness are the additional inhibits the respiration. In these individuals, Co2 symptoms of the condition. Central Neurogenic causes relative hyperventilation, which lowers the Hyperventilation or pontine hyperventilation is the arterial PCo2, results in apnoea. The arterial PCo2 sustained, rapid, deep, regular breathing seen in again rises and the respiratory mechanism over- patients with brainstem damages such as responds to Co,, leading to the cessation of reticular pontine infarction, central brainstem breathing and cycles repeat. Prolongation of the dysfunction secondary to transtentorial herniation lung to brain circulation time is another cause of associated with intra or extra cerebral space periodic respiration in respect of patients with occupying lesions. Deep sigh or yawns may 1:4 HCRF JGWAI 2004 (I) I: 13-16 REVIEW cardiac diseases. Periodic respiration occurs in In modem medicine this breathing abnormality is the presence of neurological diseases such as known as Bronchial Asthma. bilateral hemisphere dysfunction, lesions in the upper brainstem, coma of any cause and espe­ Bronchial Asthma is defined as bronchial cially in chronic pulmonary diseases with hyperresponsiveness together with intermittent carbondioxide retention. The Ataxic Respiration symptoms of wheezing, chest tightness or is the shallow halting respiration common in the cough.The causes of asthma have not been fully diseases of the respiratory center in Medulla Ob­ identified but there is an abnormality in the con­ longata and it is usually a pre - terminal event of trol of bronchial lumen, particularly in the control the patient. of the bronchial muscles. Excessive narrowing in the air way is due to wide variety of stimuli, Tamakasvasa, which is the fourth breathing which have no effect on the airways in normal abnormality, occurs mainly in the diseases of people. In atopic individuals they produce spasm respiratory system. It is characterized by the of bronchial muscles, swelling of mucous mem­ presence of shortness of breathing of airway brane and excessive secretion of mucus. In se­ hyperactivity (Asthma). It may occur in the defects vere acute asthma (Status Asthmaticus), many of many causes of both upper and lower smaller bronchi become obstructed by mucus respiratory system. Difficulty in breathing is leading to alveolar hypoventilation, severe arte­ resulted with abnormal function of airways and rial hypoxaemia and cardiac arrest. excessive production of secretion in the respiratory tract. Dynpnoea, accompanies with Bronchial Asthma is further divided into two sub rhinitis and wheezing. Symptoms are usually types on the basis of their aetiology and patho­ extensively shown, during the night and disturb physiology. Extrinsic Asthma, which is caused by the sleeping, patient speaks with great exertion. enterence of foreign bodies into the respiratory Some times upright position
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