P.K. Vedanthan, MD: Allergy and Asthma
Specialist
Quantitative studies of yoga’s respiratory benefits and of
the hygiene hypothesis in developing countries are among this
“retired” physician’s current activities. On the horizon is an
integrative medicine clinic specializing in care for
respiratory patients.
Vedanthan believes a
combination of Eastern and Western approaches is the best
treatment for chronic diseases such as asthma and
COPD.
The golf courses that lure most retirees hold little appeal
to P.K. Vedanthan, MD. As a highly respected member of the
Colorado medical community, Vedanthan has served as president
of the Colorado Allergy and Asthma Society and as chief of
pediatrics at Poudre Valley Hospital. On retiring from the
successful asthma and allergy practice he had established in
Fort Collins, Colo, in 1976, Vedanthan quickly found himself
immersed in advocacy projects and clinical research
assignments on a global scale.
In “retirement” he found more time to devote to the
International Asthma Services (IAS), a nonprofit organization
he had established in 1987 with the goal of addressing the
increasing needs for asthma education throughout the world.
Principally active in Kenya, the Philippines, and India (his
homeland), IAS provides free respiratory care, education
seminars, public symposiums, and asthma camps to the most
needy.
Yoga, COPD, and Asthma
Vedanthan has
practiced yoga most of his life, and began early studies of
the disciline with patients in his medical practice. In
studies published in 1998, he established that yoga and
breathwork (pranamyana) techniques substantially improved the
quality of life scores for patients with asthma and COPD. “We
found they were able to reduce their medications, they felt a
lot better, and their breathing attacks were comparatively
less,” he says. Best-selling author and integrative medicine
guru Andrew Weil, MD, concurs, saying, “There’s no single more
powerful—or more simple—daily practice to further your health
and well-being than breathwork.” Weil published an
instructional CD and booklet to promote breathwork, called
“Breathing: The Master Key to Self Healing.”
“For people with chronic diseases like COPD, allergies, and
asthma, Western medicine helps them feel better, makes their
physiology better, and even corrects the problem to some
extent. But it does not offer a holistic solution. I feel a
combination of Eastern and Western approaches is more
appropriate,” says Vedanthan.
In December 2003, Vedanthan published articles in the
International Journal of Yoga Therapy titled “Yoga Breathing
Techniques in Exercise Induced Asthma: A Pilot Study,” and
“Yoga Breathing Techniques in Chronic Obstructive Pulmonary
Disease (COPD): A Preliminary Study.” He has long believed
that complementary medicine should be studied objectively and
understood and used more widely in an integrative clinical
practice. “By teaching yoga breathing techniques, we were able
to show people how they can take charge of their breathing,
instead of letting their breathing take charge of them,” he
says. “With yoga, even if it does not improve your lung
functions, at the end you feel better, and that means you are
introducing that wellness factor without removing the
disease.”
The Hygiene Hypothesis
One of
Vedanthan’s most interesting projects involves his
contemporary work on the “hygiene hypothesis.” Clinicians have
long observed that children growing up in poorer, dirtier, and
generally less healthful environments suffer more from allergy
and asthma than children living in cleaner, more modern
environments. Paradoxically, children in rural environments,
with significantly higher exposure to livestock and other
antagonists, seemed to have a lower incidence of asthma.
The hygiene hypothesis was developed by epidemiologist D.P.
Strachan, who wrote in 1989 in the British Medical Journal1
that the rise in allergy cases may be linked to declining
family sizes, reduced exposure to germs, and higher standards
of cleanliness, providing less exposure to bacterial
endotoxins. The understimulated, developing immune system
would then be stimulated by harmless substances like pollen,
house dust, and animal dander, resulting in the development of
allergies. The hypothesis suggests that children who are
around numerous siblings or animals early in life are exposed
to more microbes, and their immune systems develop more
tolerance for the irritants that cause asthma. A study
appearing in the May 2000 issue of the American Journal of
Respiratory and Critical Care Medicine2 concluded that those
who grew up on farms and were exposed to animals were
significantly less likely to have asthma than those who did
not.
“There is a very distinct difference in asthma [rates]
between the inner city children and the children who are
brought up in the farming communities in the United States,”
says Vedanthan. “We have these pockets of inner city asthma,
like downtown Chicago, with a very high incidence of asthma
because of potential antigens like cockroaches, and
socioeconomic reasons—smoking. All these factors definitely
promote atopic sensitization in asthma.”
Against this background, Vedanthan saw an important
opportunity to further study the problem in India. “There are
already a lot of studies that have been done in the developed
nations, America, Europe, Australia, but not many studies done
in the developing nations. We thought this would be a good
thing to study there, because there is an incredibly distinct
difference between the urban and rural environments and
lifestyles [in India].”
Working with a leading respiratory center in the United
States, he devised a study protocol to investigate the hygiene
hypothesis in India, knowing it would have profound
implications for understanding and treating the problem in
developed nations as well. “We used an ISAAC (the
International Study of Asthma and Allergies in Childhood)
questionnaire that has 110 questions about living conditions.
We modified it, depending on the environment, because in some
environments you need to ask more questions about people’s
living habits, depending on how they live, and depending on
the language they speak. We interviewed a random sampling of
103 households, 53 rural, 50 urban; 164 children were studied.
We paid special attention to the animal and microbial exposure
the children had. We also skin-tested the children for common
household antigens.”
Dust samples were collected and analyzed for endotoxin
determination. “This is a measure of microbial exposure,” he
says. “Endotoxin is a very stable compound that indicates or
quantifies the microbial or gram-negative bacteria exposure.
It will tell us how much bacterial contamination is in that
environment.” Endotoxin also can be measured in ambient
air.
“Basically, it showed that the asthma and atopic
sensitization is five times more in the urban area;
conversely, the endotoxin level is much higher in the rural
homes,” he notes. “The exposure to animal contact was very
intense in the rural area. Many homes had cattle sleeping in
their house, and the exposure to cats, dogs, mice—both large
and small animals—was quite significantly high in the rural
homes compared to urban; 95% of the rural homes use cow dung
daily—people rub it on the floor as an antiseptic—it keeps
away flies and insects. It is also used as a fuel. The main
point is that the exposure of the rural family to cow dung is
very intense, compared to their urban counterparts. This could
be a factor in the different microbial exposures between the
locales.”
Vedanthan is presently crunching numbers and preparing a
paper to be published in a peer-reviewed journal. The
information gathered in India will have implications for
clinicians in industrialized nations as they begin to unravel
the paradox of the hygiene hypothesis.
On his retirement horizon, Vedanthan envisions the creation
of an integrative medicine clinic that will specialize in
treating respiratory patients with state-of-the-art
contemporary Western medical regimes and medications,
augmented by Eastern ayurvedic, yoga, and breathing
techniques. Regardless of where his muses guide him, the
respiratory community will continue to benefit from the
creativity and commitment of P.K. Vedanthan.
And the golf courses? They will simply have to wait.
John A. Wolfe, RRT, is a
member of RT’s editorial advisory board.
References:
1. Strachan DP. Hay fever,
hygiene, and household size. BMJ.
1989;299(6710):1259-1260.
2. Ernst P, Cormier Y. Relative
scarcity of asthma and atopy among rural adolescents raised on
a farm. Am J Respir Crit Care Med.
2000;161:1563-1566.