INDIAN NONI AS A BOON FOR ASTHMA PATIENTS

1. INDIAN NONI AS A BOON FOR ASTHMA PATIENTS A CLINICAL TRAIL ON BRONCHIAL ASTHMA DR. BHABAGRAHI PATRI B.H.M.S., M.D. (HOM) P.G.D. D&N.M (Utkal University) Dhabaleswar Homoeo Clinic & Research Centre Ranihat Canal Road, Cuttack – 753 003, Orissa

2. INTRODUCTION • Bronchial Asthma has long been recognized as an important global health problem affecting almost all age group. • A number of explanations have been proposed including increased environmental pollution from motor vehicles, growing industrialization, reduction on plant life on forest areas, dietary changes with allergens to cause Bronchial Asthma. • Now a days it is considered that between 100-150 million people around the globeare suffering from this distress.

3. Cont.. • Worldwide deaths from this condition have reached over 1,80,000 annually. • Advantageously enough for all these positive factors, befitting answers could be provided by Indian Noni. • Observing the positive effects of Indian Noni on Bronchial Asthma many people are now taking interest to administer the same in different types of chronic diseases. • Indian Noni is effective for such chronic diseases due to its high immuno-modulating power.

4. AIMS AND OBJECTIVES Keeping in view the above facts, a clinical trial was conducted in my personal clinic to study the efficacy of Indian Noni along with Homoeopathic Medicine. In case of both chronic and acute exacerbations of Bronchial Asthma.

5. WHAT IS ASTHMA • The American Society Committee on 1962 defined Asthma as “A disease characterized by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by widespread narrowing of the arrays that change in severity either spontaneously or as a result of treatment. • Asthma is characterized by episodic, reversible Bronchospasm, resulting from an exaggerated bronchoconstrictor response to various stimuli (Robins). • However Bronchial Asthma is due to a specific antigen antibody reaction (Type I immune Reaction – IgE mediated) resulting in the excitation of the Bronchial end organs. Bronchial hyper responsiveness due to the allergens and the mediators humoral like histamine and lucotrines cause following three facts. • Constriction of Bronchial smooth muscles. • Oedema of the mucous membrane. • Collection of mucous on the lumen.

6. Asthma has traditionally been classified into two basic types Intrinsic (Non immune mechanism, caused due to Extrinsic (intiated by IgE medicated Atopic asthma Occupational asthma (extrinsic non-atopic) Bronchopulmonary aspergilloses Pulmonary infections Cold Inhealed irritants Exercise Stress Ingestion of aspirin

7. AETIOLOGY Asthma is a complex disorder involving automatic, immunologic, infectious, endocrine and psycogenic factor in varying degrees in different individuals as the causative index. • Predisposing factors such as : • Heredity • Age – (Pediatric group most affected within 10 years of age) • Sex (Male : Female : : 2 : 1) within 10 year and equal on adults. • Allergens – Food, Inhalants, Bacteria. • Respiratory infections, pharmacologic stimulants, occupational factors, exercise, climatic factors, low socio-economic status. • Passive smoking • Air pollution • Obesity are responsible for producing Bronchial Asthma.

9. PATHOPHYSIOLOGY • A number of causes have been postulated for the increased airway reactivity of Asthma but basic mechanism remains unknown. • The most popular hypothesis at present is that of airway inflammation. • Increased number of mast cell, epithelial cells, neutrophils, oesinophils and lymphocytes have been found in the bronchoalveolar lavage fluid of patient with asthma, as have a variety of mediators. • It is widely believed that the physiologic and clinical features of asthma derive from an interaction among the resident and infiltrating inflammatory cells in the airways and the surface epithelium. • The cells who have to play important roles are mastcells, eosinophils, macrophages, neutrophils andlymphocytes.

10. Cont.. • The mediators released are histamine, bradykinin, leukotriens, platelet activating factors and prostaglandins they produce an intense, immediate inflammatory reaction involving bronchoconstriction, vascular congestion an oedema formation. • The leukotriens may also account for the other pathophysiologic features of asthma e.g. increased mucus production and impaired mucocilliary transport. • In early reaction mast cells and cosinophils play an important role like destroying the epithelium, which is then sloughed into the bronchial lumen in the form of Creole bodies. Such damages elicit the production of cytokines leading to further inflammation.

11. Cont.. • Lymphocytes play a quiet important role in inflammatory response. • They are present in increasing number in asthmatic airways and produce cytokines that activate the cell mediated immunity as well as humoral immune responses. • Cytokines e.g. interleukin (IL2) and interferon (IFN) can promote the growth and differentiation of B cells and activation of macrophages respectively. • The cytokine IL4 and IL5 stimulate B-cell growth and immunoglobulin secretion and IL5 promotes casinophil proliferation, differentiation and activation by stimulation of B lymphocytes (Humoral lympho), the antibody formation against the allergens enhanced which subsequently reduces the hyper responsiveness of tracheobronchial tree.

12. Cont.. • Clinical features • Shortness of breath. • Wheezing • Cough • Pain in abdomen in young children • Profuse Sweat • Symptoms of respiratory allergy. On Auscultatron, Ronchi and Crepitation in lungs field was found.

13. DIAGNOSTIC CRITERIA • Recurrent episodes of wheezing and cough. • Appearance of allergic state. • On auscultation – Rhonchi + crepitition + in lung field

14. LABORATORY DIAGNOSIS Blood investigation D.C., T.L.C., E.S.R. and radiology of chest, pulmonary function test.

15. MATERIAL & METHOD • A clinical study was carried out at Dhabaleswar Homoeo Clinic and Research Centre, Cuttack, Orissa for a period of 4 months. • 20 cases of Bronchial Asthma were screened out from the above private clinics for the study. • A uniform schema of case taking was maintained for level of the patients by one standardized case taking format which was prepared strictly according to Homoepathic methods of case taking with an emphasis to different aspect of Bronchial Asthma. • Indian Noni was administered to 10 patients along with Homeopathic medicines and 10 patients were administered only with Homeopathic medicines.

16. EVALUATION OF PARAMETERS • For clinical evaluation, preferred parameters are • Marked improvement-patient feels completely well with no recurrences of Asthmatic attach. • Moderate improvement-patients feels well with recurrent attack. • No improvement-patient not feeling well. • Dropped out.

17. OBSERVATION • 20 patients of Bronchial Asthma were taken for clinical study. Indian Noni was administered to 10 patients along with Homeopathic Medicine and only Homoeopathic Medicine to other 10 patients. • The results are shown in a tabular manner below.

19. ANALYSIS • ‘Morinda Citrifolia’ – a predominant ingredient of Indian Noni exhibits the following actions which controlled asthmatic attack quickly. • It stimulates IL1 and IL4 formation which subsequently helps for the growth of B lymphocytes (Humoral lymphocytes) which ultimately responsible for the more antibody formation in blood against the infiltrating allergens so that reducing the rate of allergic reactions. • Antibacterial activity : It acts against Bacillus subtilis, staphylococcus aureas, streptococcus, kilebsiella & pneucoccus by reducing the further superadded infection of Bronchial tree and long field. • Anti inflammatory activity : It reduces the airway inflammation by producing anti-hista minergic factors. • Antiviral Activity : Reduces the superadded infection. • C.N.S. effect : Anti cholinergic effect : • Producing bronchodilatation – Reducing asthmatic attack.

20. CONCLUSION • A clinical trial was conducted upon 20 patients of Bronchial Asthma. 10 patients were administered with Homoeopathic Medicines + Indian Noni and other 10 patients with only Homoeopathic medicine. • It was observed that more no. of patients i.e., 6 patients of Group – I exhibit marked improvement in comparison to 2 patients of Group – II i.e., (patients with only Homoeopathic Medicine). • Again the study reveals that the Homoeopathic Medicines + Indian Noni gives very quick improvement in acute exacerbations of Bronchial Asthma. So it may be concluded from the clinical trial that administration of Homoeopathic Medicines along with Indian Noni produces better and quick result than only Homoeopathic Medicines. • Bronchial asthma is usually a chromic disease and attacks are episodic. • Therefore to study the effect of Indian Nomi on patients it requires much time.

21. Cont.. • That's why within last 4 months the effect of Indian Nomi in acute excerbations was well studied and the result was quite positive, but the recurrence of episodes takes place though the interval increased to some extent. • In after 2 years of the clinical trial it can be concluded that whether adult bronchial asthma patients get permanent relief or not. • The study required more time and more number of patients to establish the positive effect of Indian Nomi. • May the Almighty shower this External Bliss upon this product so that it can occupy a better position in the Health map of the world. • Due to insufficiency of time and less number of cases it becomes quite difficult to study the effect of Indian Noni upon adult asthma cases as regards permanent cure.

22. Sathyprakash Dash, 2+ yrs S/O – Bishwaranjan Dash, Mundamala, Choudwar, Cuttack, Orissa, ( : 9338482947

23. Srusti Mohapatra, 10 yrs D/O – Suresh Ch. Mohapatra, Kapaleswar, Choudwar, Cuttack, Orissa,

24. Chandan Rout, 23 yrs Sikharpur, Upper Sahi, Cuttack, Orissa ( : 9338483662

25. Sarita Mishra, 25 yrs Sankarpur, Cuttack, Orissa ( : 0671- 2334759

26. Pratap Kr. Dalai , 26 yrs Baragodia, Jagatpur, Cuttack, Orissa ( : 9861242919

27. Mamata Mishra, 39 yrs Choudwar Girl’s High School, Choudwar, Cuttack, Orissa ( : 9861390114

28. Sudhansu Samal, 49 yrs Rahania, Balichandrapur, Jajpur, Orissa ( : 9937733566, 9861283839

29. Parbati Jena , 52 yrs Qr. No. – 2R-81, Labour Tournment, Charibatia, Cuttack, Orissa ( : 9861067111

30. Umesh Ch. Patnaik, 70 yrs Chauliaganja, Cuttack, Orissa ( : 9861063269

31. Thank you