Article by Dr Manasa S, B.A.M.S & Dr Raghuram Y.S. MD (Ay)
Exertional dyspnoea includes a condition wherein the person experiences ‘difficulty in breathing on exertion’ or ‘shortness of breath on exertion’. One may also experience shallowed and fastened breathing. Shortness of breath in many people is experienced after strenuous activities or exercise. If it is not a serious condition it should go away after rest. On the other hand, if shortness of breath is felt suddenly accompanied by symptoms like sweating, choking and dizziness, the condition should be evaluated in detail. When there is shortness of breath, the person feels inadequate air getting into the lungs or a need for more air to be taken in, before letting the inhaled air out.
In people who are involved and accustomed to strenuous physical activity or exertion, difficulty in breathing is a normal phenomenon. It usually happens. But the shortness of breath is restored to normal levels after resting for a while. But if shortness of breath occurs even when the person is not indulged in excessive physical activity is alarming and hence needs to be evaluated and treated promptly.
If the shortness of breath i.e. dyspnoea lasts for few hours to few days, it is considered to be acute. If it lasts for more than 4 to 8 weeks, it is considered to be chronic.
Related Reading – Exertional Dyspnoea
Exertional Dyspnoea – Ayurveda Understanding
The closest condition explained in Ayurveda that we can compare with Exertional Dyspnoea is Kshudra Shwasa.
Kshudra = minor, of lesser quantity, not serious
Shwasa = dyspnoea, shortness of breath
Kshudra Shwasa
Kshudra Shwasa is one among the five types of Shwasa Roga – diseases related to breathing and breathing apparatus. Shwasa is a term given for breathing disorders causing difficulty in breathing or dyspnoea or shortness of breath. This symptom is present in all the five types of shwasa in varying proportions.
Maha Shwasa, Urdhwa Shwasa and Chinna Shwasa are the most troublesome breathing disorders presenting with shortness of breath and are said to be incurable. Tamaka Shwasa – which is often compared to asthma or chronic bronchitis is manageable. It too presents with dyspnoea. The fifth type of Shwasa i.e. Kshudra Shwasa is the easiest among the lot in terms of prognosis. It can ease off with rest and minimal efforts and interventions.
रूक्षायासोद्भवः कोष्ठे क्षुद्रो वात उदीरयन्|
क्षुद्रश्वासो न सोऽत्यर्थं दुःखेनाङ्ग प्रबाधकः ||६५||
हिनस्ति न स गात्राणि न च दुःखो यथेतरे|
न च भोजनपानानां निरुणद्ध्युचितां गतिम् ||६६||
नेन्द्रियाणां व्यथां नापि काञ्चिदापादयेद्रुजम्|
स साध्य उक्तो बलिनः सर्वे चाव्यक्त लक्षणाः ||६७||
इति श्वासाः समुद्दिष्टा हिक्काश्चैव स्वलक्षणैः |६८|
Causes of Kshudra Shwasa
Ruksha Ahara Vihara – dry foods, drinks and regimens
Ayasa – exertion, excessive physical activities, exercise
Pathogenesis
Vayu, mildly aggravated in the Kostha (gastro intestinal tract) due to the above-mentioned etiological factors, causes Kshudra Shwasa (mild dyspnoea).
Symptoms
The dyspnoea / shortness of breath is mild in nature.
It does not cause much discomfort in the body. Therefore, the body is not excessively affected due to the impact of this shwasa.
It is not as painful as other forms of Shvasa.
It does not obstruct the proper movement of food and drinks.
It does not cause any pain or complication in the sense organs.
Prognosis
Kshudra Shwasa is a curable condition.
Shrama Shwasa
Ayurveda advices ‘not to withhold’ the naturally manifesting body urges or reflexes and they need to be helped out. Among them is ‘shrama shwasa’ which means shortness of breath or dyspnoea caused due to exertion. While in spell, one should sit, relax, breathe easily and allow the breathing pattern to come back to normalcy. If one is not suffering from chronic ailments at the backdrop, shrama shwasa is self-limiting and will come back to normal breathing within few minutes. If it does not, it is a point of concern and one should meet the doctor as soon as possible.
Other types of Shwasa and Exertional Dyspnoea
Note – All kinds of shwasa will have dyspnoea ranging from mild to severe nature. Exertional dyspnoea or shortness of breath too will be of the nature and severity of the shwasa with which it is associated. Exertional dyspnoea will be present in all the types of shwasa.
In Maha, Urdhwa and Chinna Shwasa, the exertional dyspnoea depicts bad prognosis or incurable nature of the disease. These diseases constitute wide array of breathing disorders of severe nature and involves many kinds of systemic, lung and heart conditions, especially those on long run and are associated with troublesome symptoms and complications. Dyspnoea on exertion will be severer.
In Tamaka Shwasa – dyspnoea on exertion will be manageable due to the manageable nature of Tamaka Shwasa. It will not be as severe and as frequent as it happens in Maha, Urdhwa and Chinna Shwasa.
In Kshudra Shwasa we can find the mildest form of dyspnoea on exertion and most times it is related to severe physical works out or exercises and activities which bring about dyspnoea. Most times it is self-limiting and does not require any treatment. But even kshudra shwasa can be troublesome if dyspnoea does not come down all by itself.
Shwasa Roga in general encompasses diseases pertaining to circulatory and respiratory systems. Though it should include only respiratory diseases, many symptoms related to the heart are found to be explained in the context of different types of shwasa.
Other conditions / disorders wherein exertional dyspnoea is a symptom
Medo Vruddhi – ‘Alpe api chestite shwasam’ which means ‘dyspnoea on doing simple activities’ is mentioned among the symptoms of ‘pathological increase of fat tissue’ in the body. This may get to be a serious condition if the errors in fat metabolism and increased body weight and BMI are not monitored and controlled well in time. Else, all those who are obese or overweight will definitely have mild to moderate types of ‘dyspnoea on exertion’.
Pranavaha Sroto Dushti – Symptoms mentioned in contamination of the pranavaha srotas i.e. channels responsible for transportation of vital air (oxygen) in the body indicate the presence of ‘dyspnoea on exertion’ in these conditions. These symptoms include –
- Ati baddha shwasam – too short breathing or shortness of breathing
- Kupitam shwasan – difficulty in breathing
- Ati srushta shwasam – too long or prolonged breathing
- Alpam alpam shwasam – frequent, interrupted or intermittent breathing
- Abheekshnam shwasam – highly disturbed breathing patterns which are scary
- Sa Shabda shwasam – abnormal sounds during breathing
- Sa shula shwasam – painful breathing
All these symptoms depict different grades and scales of dyspnoea or exertional dyspnoea.
This also shows that there can be different patterns of dyspnoea on exertion and the severity depends on ‘which disease or diseases it is a part of’.
More serious the disease causing the shortness of breath, more severe will be the dyspnoea on exertion.
We know that ‘pranavaha srotas’ includes Hridaya i.e. heart as one of its roots. Therefore, the symptoms of vitiation of pranavaha srotas are the bridge symptoms which encompasses both, the diseases of lungs and heart.
Rasavaha Srotas Dushti – Though dyspnoea on exertion or shwasa has not been mentioned amongst the symptoms of contamination of rasa carrying channels, there is a possibility that this symptom occurs in this condition because of the relationship of rasavaha srotas with Hridaya i.e. heart. Heart is a root of pranavaha srotas and also rasavaha srotas. Heart supplies nutrition to every corner of the body. When the nutrition of the person is not good and is imbalanced or when the person takes wrong and incompatible or mutually contradicting foods, there is either deficit formation of rasa or formation of unhealthy rasa. The same happens in cases of nutritional imbalance or malnutrition. We have seen that the people who have nutritional issues or nutritional disorders including emaciation or oversaturation or obesity or malnutrition, will have breathing difficulties and will have dyspnoea of various proportions on exercising or on doing minimal activities.
Manovaha Srotas Dushti – Heart is also the root of Manovaha Srotas i.e. channels responsible for mind functions. Those undergoing serious mental issues may also experience dyspnoea on exertion. When the heart as pranavaha, rasavaha and manovaha is involved there is triple surety that dyspnoea on exertion definitely occurs.
Pandu Roga – Arohana Ayasa or dyspnoea on walking uphill or climbing few steps is a characteristic feature / symptom of Pandu Roga vis-à-vis anaemia. This can be extended to ‘dyspnoea on mild to moderate exertion’. This is also a sign found in those suffering from heart, lung and liver disorders.
Udara Roga – ‘Gamane Ashaktah’ i.e. inability to walk for long distance is one of the symptoms of udara roga i.e. abdominal disorders including enlargement of liver, spleen and ascites and also intestinal obstruction and perforation. So, when there is enlargement of abdominal due to accumulation of water or increase in size of liver or spleen, one experiences dyspnoea on exertion. This happens due to the pressure of enlarged abdomen on the chest wall, heart and lungs. Hence in this condition the person will not be able to move around or walk easily even for few steps and would feel tired.
Ati Sthula – means too obese or corpulent. This condition is mentioned by Master Charaka as ‘nindita’ i.e. one of the undesirable body constituents. There are seven more such conditions. Javoparodha is one of the health defects in too obese persons. It means ‘slow in movement’. This means that they cannot move around fast. If they do, they will get dyspnoea. They will not tolerate simple easy walks and activities.
Dhatu Kshaya – destruction or deterioration of tissues will lead to vata increase. This will cause dyspnoea on exertion.
Ayurveda treatment principles of dyspnoea on exertion
Shrama Shwasa and Kshudra Shwasa are self-limiting and do not require treatment. If the symptoms do not go away after few minutes and if it stays for long, it demands immediate attention. One should not withhold shrama shwasa and should not neglect a kshudra shwasa which does not go away soon.
Kshudra Shwasa may present initially as harmless dyspnoea on exertion and may continue being so. On the other hand, if its initial manifestation is due to a big disease in the backdrop i.e. if it is secondary to yet another primary disease, it will get troublesome in future as the disease in the backdrop worsens. It is important to differentiate kshudra shwasa vis-à-vis exertional dyspnoea as primary or secondary. If it is secondary, the chief disease in its backdrop should be promptly treated.
The other part of treatment will include treating it on the basis of the srotas – channels involved in the causation of this condition.
Treatment principles include –
- Treatment of contamination or damage to pranavaha srotas, rasavaha srotas, manovaha srotas and medovaha srotas
- Treating Tamaka Shwasa, uncontrolled Kshudra Shwasa and other kinds of Shwasa
- Treating the primary disorders causing dyspnoea on exertion i.e. pandu roga, sthoulya, medo roga, dhatu kshaya and udara roga
The related diseases causing dyspnoea on exertion shall be treated with comprehensive approach including effective therapies, disease modifying medicines and dietetic regimen and essential lifestyle corrections.
