From:Dr. ATHIRA. T. R. Post Graduate Trainee.Dept. of Organon of Medicine and Homoeopathic Philosophy.DBHP Sabha’s Dr. B.D. Jatti Homoeopathic Medical College, Hospital and Post Graduate Research Centre.D.C. Compound.Dharwad- 580001.

To:The RegistrarRajiv Gandhi University of Health Sciences, Karnataka.Bangalore.

Through:The Principal. DBHP Sabha’s. Dr. B.D. Jatti Homoeopathic Medical College,Hospital and Post Graduate Research Centre.D.C. Compound.Dharwad- 580001.

Respected Sir,

Subject: Submission of Completed Proforma for Registration of Subject for Dissertation.

I request you to kindly register the below mentioned subject against my name

for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore for partial fulfillment for the award of the degree of M.D.(Homoeopathy.) in Organon of Medicine and Homoeopathic Philosophy.

Title of Dissertation: “A CLINICAL STUDY OF BRONCHIAL ASTHMA IN CHILDREN AND ITS HOMOEOPATHIC MANAGEMENT.”

I am herewith enclosing completed Proforma for registration of subject for dissertation.

Thanking you,Yours faithfully,

Place: Dharwad.( Dr. ATHIRA.T.R. )

Date:

1

“A CLINICAL STUDY OF BRONCHIAL ASTHMA IN

CHILDREN AND ITS HOMOEOPATHIC MANAGEMENT.”

SYNOPSIS

Submitted to

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA.

BANGALORE.

BY

Dr. ATHIRA. T. R.

Through

DBHPS’s

Dr. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL AND

POST GRADUATE RESEARCH CENTRE.

D.C. COMPOUND.

DHARWAD- 580001. (KARNATAKA.)

In partial fulfillment of requirement for the

DOCTOR OF MEDICINE (HOMOEOPATHY) in

ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY.

Under the guidance of

Dr. G.C. HIREMATH. MD.(Hom.)

Professor, Guide and Head.

Dept. of Organon of Medicine and Homoeopathic Philosophy.

Dr. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL AND

POST GRADUATE RESEARCH CENTRE.

D.C. COMPOUND.

DHARWAD- 580001 (KARNATAKA).

2

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA.

BANGALORE.

ANNEXURE – II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE:

PRESENT ADDRESS:

Dr. ATHIRA.T.R.POST GRADUATE TRAINEE.DBHPS’s. Dr. B.D.JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL AND POST GRADUATE RESEARCH CENTRE.D.C. COMPOUND.DHARWAD- 580001.KARNATAKA.

PERMANENT ADDRESS:

D/O. V. THANKAPPAN. PILLAI.AIKKARA MELLOOTTU VEEDU.PO: PAVITHRESWARAM.VIA: PUTHOORKOLLAM- 691507.KERALA.

2. NAME OF THE INSTITUTION:

DBHPS’s. Dr. B.D.JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL AND POST GRADUATE RESEARCH CENTRE. D.C. COMPOUND.DHARWAD- 580001.KARNATAKA.

3. COURSE OF THE STUDY AND SUBJECT

DOCTOR OF MEDICINE (HOMOEOPATHY) inORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY.

4. DATE OF ADMISSION TO COURSE:

21-05-2012.

5. TITLE OF TOPIC: “A CLINICAL STYDY OF BRONCHIAL ASTHMA IN CHILDREN AND ITS HOMOEOPATHIC MANAGEMENT.’’

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6 BRIEF RESUME OF THE INTENDED WORK.

6.1

NEED FOR THE STUDY:

Bronchial Asthma is a disease characterized by an increased

responsiveness of the trachea and bronchi to various stimuli. It manifests

by widespread narrowing of the airways causing paroxysmal dyspnea,

wheezing or cough. The diffuse obstruction to the airflow is reversible in

a large majority of cases, either spontaneously or in response to

treatment.

In India prevalence of Bronchial Asthma in school going children has

been reported between 4-20% in different geographic regions. The

prevalence has increased by two fold in last two decades. Bronchial

Asthma is one of the commonest chronic illnesses during childhood. It is

responsible for significant social, economic and psychological impact on

the family.

Acute Bronchial Asthma leads to disturbed sleep, restriction in day to

day activities and school absenteeism. About half of the case develops

before age 10. In childhood, there is 2:1 male/female predominance but

sex ratio equalizes by age. The development of Bronchial Asthma

appears to be related to the complex interplay of genetic and

environmental factors.

The efficacy of other system in Bronchial Asthma is less as there is no

long lasting relief. The side effects of conventional system take the

disease inside making the person prone to other serious health hazards.

The disease through the suppressive treatment makes the person

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incurable in the long run.

In Homoeopathy, treatment is based on the totality of the symptoms

formed by mental, physical and characteristic particulars and considering

past and family history of the person and miasmatic background also will

be taken into consideration. The selected Similimum can, not only relieve

the symptoms, but also can cure it permanently and provides the person

immunity.

In children, as the case is brought to the Physician in the initial stage

of disease itself, the treatment is possible by administering selected

Homoeopathic remedy and can make them healthy.

It is my sincere effort to study the efficacy of Homoeopathic medicine

in treating Bronchial Asthma in children, where conventional system can

give only partial relief of the symptoms.

RESEARCH HYPOTHESIS:

Homoeopathy is effective in the treatment of Bronchial Asthma in

children.

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6.2

REVIEW OF LITERATURE:

Historical review:

Bronchial Asthma is derived from Greek word signified panting.

Originally it was used as a general term to describe the symptom of

virtually all respiratory illness and synonym for breathlessness1.

Definition:

Bronchial Asthma is characterized by episodic airflow obstruction

with at least initially is fully reversible. Clinically, Bronchial Asthma

presents as paroxysms of dyspnea, wheezing and cough. The attack may

last from a few minutes to hours or even days and subsides with

medication, at times spontaneously in between the attacks the person is

usually absolutely normal, unless he is in persistent broncho

constriction.2

Magnitude of the problem:

In India prevalence of Bronchial Asthma in school going children has

been reported between 4-20% in different geographic regions. Prevalence

has increased by two folds in last two decades. Risk factors associated

with development of asthma include family history of Bronchial Asthma

and Atopic diseases, Bronchiolitis during infancy, sensitization to

allergens during childhood and passive smoking. In childhood, Bronchial

Asthma is more common in boys, but following puberty females are

more frequently affected.3

Triggers of an attack of Bronchial Asthma:

a. Allergy: only few cases are directly related to the specific allergen

6

exposure. Out of these important ones is smoke, hydrocarbons,

drugs such as Aspirin, NSAID.

b. Viral infections: Most frequent triggers of airway narrowing in the

young children.

c. Exercise: Occurs in genetically susceptible individuals with hyper

reactive airways because of the loss of water and heat from the

respiratory tract following exercise.

d. Weather change: Sudden weather change may result in

1. Loss of heat and water from lower airways.

2. Sudden release of airborne allergens in atmosphere.

e. Emotional factors: Emotional stress operated through vagus,

initiating bronchial smooth muscles to contract.

f. Endocrine factors: Some endocrine changes may increase symptoms

of Bronchial Asthma. Children may get increase in symptoms

during puberty.4

Classification of Bronchial Asthma:

Extrinsic Asthma: Three types of extrinsic asthma are recognized.

1. Atopic Asthma.

2. Occupational Asthma.

3. Allergic broncho pulmonary aspergillosis.

Intrinsic Asthma: Triggering mechanisms are non-immune. In this form,

a number of stimuli that have little or no effect in normal subjects can

trigger broncho-spasm. Such factors include aspirin, pulmonary

infections, especially those caused by viruses, cold, psychological stress,

exercise and inhaled irritants such as sulphur dioxide.5

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Clinical features:

Symptoms may vary from simple recurrent cough to severe

wheezing.

Children may present with recurrent cough with or without

wheezing.

The symptoms occur with change in season, aggravation by

exercise and more in night.

Acute Asthma may begin with a cold, or bouts of spasmodic

nocturnal coughing. In early phase of the attack, cough is non-

productive.

The patient becomes dyspnea, with prolonged expiration and

wheezing.

The child sweats profusely, may develop cyanosis and becomes

apprehensive and restless and looks fatigued.3

With itching under the chin, discomfort between the scapulae, or

inexplicable fear (impending doom).

Typical physical signs are inspiratory and to a great extent

expiratory. Rhonchi through the chest. There may be

hyperinflation.6

Diffrential diagnosis:

1. Bronchiolitis

2. Congenital malformations

3. Aspiration of foreign body

4. Extrinsic allergic alveolitis or hypersensitivity pneumonitis

5. Cystic fibrosis.3

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Diagnosis:

The diagnosis of Bronchial Asthma is made on the basis of clinical

history in most of the cases. But in doubtful cases or in monitoring of

response of treatment, the following objective measures are used.

Routine pulmonary function test: Decreased FEV1, hyperinflation,

improvement with broncho-dilator.

Special pulmonary function test indicates the presence of, non-specific

bronchial: Hyperactivity, broncho-constriction, occurs at lower dose in

asthma.

Challenge with specific agents occasionally performed.

Chest radiographs: Fleeting infiltrates and central Bronchiectasis in

ABPA.

Skin test: Demonstrate atopy, little value except prick test to

Aspergillus fumigatus positive in ABPA.

Blood test: Eosinophils and IgE usually increased.2

Characteristic:

1. Airflow obstruction.

2. Airway inflammation.

3. Bronchial hyper-responsiveness

Factors that may protect against asthma:

Living on farms.

Large families.

Childhood infections, including parasites.

Predominance of lactobacilli in gut flora.

Exposure to pets in early life. 4

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HOMOEOPATHIC APPROACH:

SAMUEL HAHNEMANN: §5- Useful to the physician in assisting

him to cure are the particulars of the most probable exciting cause of the

acute disease, as also the most significant points in the whole history of

the chronic disease, to enable him to discover its fundamental cause,

which is generally due to a chronic miasm. In these investigations, the

ascertainable physical constitution of the patient (especially when the

disease is chronic), his moral and intellectual character, his occupation,

mode of living and habits, his social and domestic relations, his age,

sexual function, etc., are to be taken into consideration.7

CLOSE STUART: When the Homeopathically selected medicine

administered to a sick person, the disappearance of symptom and

restoration of patient to health represents the reaction of the susceptible

organism to the impression of curative remedy.8

RICHARD HUGHES: After obtaining similar remedy we have only

to consider how to administer it. As we divided its elements of similarity

into generic, specific and individual, it should be administered, as a rule,

singly, rarely, constitutionally and minutely.9

IYER TS: In acute troubles which occur principally at nights, it is best

to administer the indicated remedy in watery solution in tea spoon doses

every two to four hours according to the severity of the case, till the acute

spasm subside and at other times, in single doses morning and evening

for a few days, till there is relief. For the better action of the remedy, the

watery solution should be stirred well each time before the doses are

taken. For chronic troubles the indicated remedy may be given weekly, or

10

at longer intervals.10

ALLEN JH: As no part of the organism is freed from the presence of

miasms, When they are at all present, so the chest cavity with its contents

is a fruitful so for both these benign and malignant shadings of miasmatic

action.11

TIWARI SK: The nosological classification of disease (for eg.

Asthma, Eczema, Gastric Ulcer, and Colitis) do not reveal much about

the symptoms of person. Therefore without taking a case in detail, it is

not possible to classify a disease in terms of miasms.12

6.3

Aims and objectives of the study:

1) To study the clinical presentation of Bronchial Asthma in

children.

2) To study the Homoeopathic management of Bronchial Asthma in

children.

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7. MATERIALS AND METHODS:

7.1

Primary source:

The subjects for this study will be collected from OPD, IPD and

peripheral OPD of Dr. B.D. Jatti Homoeopathic Medical College,

Hospital and Post graduate Research Centre, Dharwad.

7.2

Method of collection of data:

Subjects will be selected on inclusion / exclusion criteria, history and

finding. The data will be represented in the standardized case proforma

prepared for cases. Every case is analyzed, with miasmatic presentation

and reference from Materia Medica, Repertory and therapeutics as per

the requirement. Treatment for each case will be on the bases of

individualization. The potency selection and repetition of the doses will

be done according to the principles of Homoeopathy. Follow up would be

analyzed as per criteria set up in each case.

In this study, the following parameters will be applied in collecting

data.

1. Study design- Non-control trial based upon simple random

sampling method

2. Type of research- Prospective case study.

Sampling size: Prevalence rate of Bronchial asthma is of 2% in our

OPD/IPD. Considering the 95% confidence interval at 5% permissible

error, sample size works out to be 32 cases. Since it is a time bound

12

study, all admitted and OPD cases are included in my study period.

Inclusion criteria:

1. Patients belonging to all pediatric age group (5-12 years) of both

sex.

2. Patients irrespective of ethnic group, socio-economic status and

occupation will be considered.

3. All the patients with signs and symptoms of Bronchial Asthma

are considered.

Exclusion criteria:

1. Patients with complication of Bronchial Asthma, including Status

asthamaticus.

2. Patients suffering from immune-compromised diseases, HIV and

other chronic diseases including systemic affections of

irreversible pathological changes in the body.

3. Subjects suffering from terminal illness, those undergoing active

treatment from other systems of medicine, surgical cases, those

who are not able to communicate their symptoms.

STUDY DESIGN:

Parameters used:

Change in clinical findings like the presenting symptoms and signs,

are parameter for assessing recovered, improved and not improved

criteria.

Recovered: Total disappearance of all the clinical features of

Bronchial Asthma and general well-being of the patient for a period of at

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least 6-9months.

Improved: Disappearance of clinical features of Bronchial Asthma,

but reoccurrence of the same with less severity, and general well-being of

patient, within the period of 6 months.

Not improved: Points to be considered are,

a. No relief of complaints even after sufficient period of treatment,

till the end of this study period.

b. Dropped out (cases that have left the treatment during the study

period.)

Study period:

From 01st May 2013 to 30th April 2015.

Statistical test:

Appropriate test will be used depending upon the data available at the

end of the study.

Follow up:

Follow up of cases depend on severity of the symptoms and as per the

need and necessity of the cases, preferably once in a week in the

beginning and later every fortnight, and then monthly once, for a

minimum period of 6months.

7.3

Does the study require any investigations or any interventions to be

conducted on patients? If so describe briefly.

Bronchial Asthma is easily diagnosed on clinical examination

however to confirm the diagnosis of Bronchial Asthma in most doubtful

cases necessary investigations will be carried as per the need of case. The

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study requires following investigation.

Lung function tests:

Spirometry and Peak flow meter.

Other tests:

Chest X-ray, Skin prick test, Measurement of airway hyper

responsiveness, Sputum examination and Blood eosinophilia.

7.4

Has ethical clearance been obtained from your institute in case of

7.3?

Yes, Ethical clearance has been obtained from the institution.

15

8. LIST OF REFERENCE:

1. Shah Siddharth N. API Text Book of Medicine. 7th Edition,

Association of Physicians of India, New Delhi. 2003. p: 291.

2. Carpenter, Griggs, Losscolso, Andreoli. Cecil Essentials of

Medicine. 5th Edition. Hart court India (P) Ltd, New Delhi. 2001. p:

187.

3. Ghai. OP. Piyush Gupta. Paul VK. Ghai Essential Paediatrics. 6th

Edition, Dr Ghai. Delhi-92. 2008. p: 354.

4. Boon Nicholas A. Nicki R. Colledge. Brain. R. Walkder.

Davidson’s Principals and Practice of Medicine. 20th

EditionChurchill Livingstone. Edinburg. 2006. p: 670.

5. Vinay Kumar. Cotran. S. Ramzi. Robbins. L. Stanley. Basic

Pathology. 6th Edition, Reprint. Harcourt India (P) Ltd, New Delhi.

20 p: 395.

6. Kasper., Braunwald., Fauci., Hauci., Haucer., Longo., Jameson.,

Harrisons Principles of Internal Medicine. 17th Edition. McGraw-

Hill Medical Publishing division, New York. 2008. p: 1601.

7. Hahnemann Samuel. Organon of Medicine. 6th Edition. B. Jain

Publishers (P) Ltd. New Delhi 2009. p: 95.

8. Close Stuart. The Genius of Homoeopathy. 1st Edition. 2009. B.

Jain Publishers (P) Ltd. New Delhi. 2009. p: 76.

9. Hughes Richard. The Principles and Practice of Homoeopathy. 1st

16

Edition. B. Jain Publishers (P) Ltd. New Delhi. 2004. p: 106.

10. Iyer T.S. Beginners guide to Homoeopathy. 1st Edition, B. Jain

publishers (P) Ltd, New Delhi. 1994. p: 109.

11. Allen. J.H. The Chronic Miasms. Volume 1& 2; Edition B. Jain

Publishers (P) Ltd. New Delhi. 1994. p: 212.

12. Tiwari S.K. Homoeopathy and Child care, Principles, Therapeutics,

Children’s Type, Repertory. 1st Edition, B. Jain publishers, New

Delhi. 1998. p: 18.

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9. SIGNATURE OF CANDIDATE.

10. REMARKS OF THE GUIDE.

11. 11.1 NAME AND DESIGNATION OF GUIDE.

Dr .G.C.HIREMATH. MD.(Hom.)Professor, Guide and Head.Dept. of Organon of Medicine and Homoeopathic Philosophy.DBHPS’s. Dr. B.D. Jatti Homoeopathic Medical College, Hospital and Post Graduate Research Centre.Dharwad- 580001.

11.2 SIGNATURE.

11.3 HEAD OF DEPARTMENT. Dr .G.C.HIREMATH. MD.(Hom.)Professor, Guide and Head.Dept. of Organon of Medicine and Homoeopathic Philosophy.DBHPS’s. Dr. B.D. Jatti Homoeopathic Medical College, Hospital and Post Graduate Research Centre.Dharwad- 580001.

11.4 SIGNATURE.

12. 12.1 REMARKS OF PRINCIPAL.

12.2 SIGNATURE.

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