RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE - II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE

AND ADDRESS

Dr. YASMIN I. SHAIKH.

PRESENT ADDRESS

Dr. YASMIN I. SHAIKH.

9, PICKET ROAD, CAMP

BELGAUM-01, KARNATAKA.

PERMANENT ADDRESS

Dr. YASMIN I.SHAIKH.

9, PICKET ROAD, CAMP

BELGAUM-01, KARNATAKA.

2. NAME OF THE INSTITUTION BHARATESH HOMOEOPATHIC

MEDICAL COLLEGE & HOSPITAL,

BELGAUM-590016.

3. COURSE OF STUDY AND

SUBJECT

DOCTOR OF MEDICINE

(HOMOEOPATHY) ORGANON &

HOMOEOPATHIC PHILOSOPHY.

4. DATE OF ADMISSION TO

THE COURSE

23nd March 2009

5. TITLE OF THE TOPIC “HOMOEOPATHIC

MANAGEMENT IN HYPER-

REACTIVE AIRWAY DISEASE IN

CHILDREN”

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6. BRIEF RESUME OF THE INTENDED WORK :

6.1. NEED FOR THE STUDY

HAD defined as “chronic inflammatory disease of airways that is

characterized by episodic airflow obstruction, paroxysms of dyspnea, wheezing

and cough, increased responsiveness of trachea-bronchial tree to a multiplicity

of stimuli”. Hyper-reactive Airway Disease (HAD) is a leading factor for

chronic illnesses in children, which is responsible for a significant loss in

schooling and decreased playing activities, thus affecting day-to-day

functioning of children. HAD is responsible for significant social, economic &

psychological impact on family. 1

HAD is commonly considered as a stigma and often subjected to

irrational treatment & unorthodox practices. In management of HAD, the

conventional system of medicine aims to decrease the airway inflammation by

using daily controllers, anti- inflammatory medicines along with frequent use of

glucocorticoids. They emphasize on controlling the morbid condition by

reducing the exposure to allergens. Inspite of all advances in management of

HAD, its incidence is increasing, because unless and until the basic factors are

not corrected there is no use of exhaustive management.

Allopathic medicines can only keep it suppressed but Homoeopathy has

definite role in treatment of HAD. Homoeopathic system of medicine deals

with any diseased condition in a holistic way. Management of HAD with the

help of Homoeopathic medicine with its individual approach in scientific

manner keeping our principles in view can drastically improve the health of

children and reduce the mortality and morbidity. These approaches have

prompted me to undertake the work on “Homoeopathic Management In Hyper-

Reactive Airway Disease in Children”

Hypothesis - Homoeopathic medicines are useful in the treatment of

Hyper- reactive Airway Disease (HAD).

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6.2. REVIEW OF LITERATURE.

HAD is defined as “chronic inflammatory disease of airways that is

characterized by episodic airflow obstruction, paroxysms of dyspnea, wheezing

and cough, increased responsiveness of trachea-bronchial tree to a multiplicity

of stimuli”. It is manifested physiologically by a widespread narrowing of the

air passages, and clinically by paroxysms of dyspnoea, cough and wheezing. 1

HAD has Greek etymological word “ ”, which means panting or

breathless. HAD means struggling for breath or breathe with open mouth due to

shortness of breath of any cause. Hippocrates (460-370 B.C), Aretaeus (81-138

A.D.) and Galen (139-199 A.D.) used the term HAD to describe any condition

associated with dyspnoea. HAD like symptoms were first recorded 3500 years

ago in an Egyptian manuscript called Ebers Papyrus. 2

It has already affected 120 million Indians and is one of the most commonly

encountered diseases in our daily OPD. Prevalence of HAD in Indian children

is estimated to be about 5% while globally it is around 10 %. It has been

observed that males were more prone to HAD than the female. While

the incidence was 63.3% in the male, it was 36.7% in the female.

The fatality rate with HAD has been estimated 1.5 % per 1000 patients per

year. Fifty percent of school children of HAD have evidence of

psychopathology. The disease is more common in English speaking world and

in some other areas such as France, of relatively lower prevalence in

Scandinavia and most southern and eastern Europe and very low prevalence in

some parts of rural Africa. It is more common in metropolitan locality

compared to rural and farming areas. This is because of increased pollution due

to rapid urbanization and industrialization. 3

Risk factors for occurrence include - It can occur at any age. Child is

mostly between the ages 4-10 years, poverty, black race, air pollution, infection

and infestation, poor diet, maternal age less than 20 yrs at the time of birth,

birth weight less than 2.5 kg, maternal smoking, small home size, large family

size and intense allergic exposure to smoke, noxious fumes, allergens, simple

chemicals, for e.g. aspirin. 4

Etiology

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Causes and precipitating factors of HAD are being considered

below:

Heredity: It is estimated that about 30 percent of patients will

give us a family history of allergy.

Allergies: Allergies can be allotted in large number of

patients for causing or precipitating asthmatic assaults. It is

estimated that around 1% of the population presents with an

allergic disease some time in their life.

Exercise: Strenuous physical exercise or work is one thing

which must be avoided by HAD.

Iatrogenic: Various drugs and chemicals are known to

precipitate HAD. Penicillin, Tartazine, is the most common

examples. It is estimated that about 3% of the adult

population is sensitive to Aspirin.

Thermal Stimuli (environmental causes): Winds, rains, sudden

changes in the climate aggravate allergic manifestations.

Physical agents like colds, heats, etc., do start an allergic

phenomenon and hence could be called as Pseudo-allergens .

Emotions: An unpleasant experience or very good, unexpected

news may trigger an acute attack. Hearty laughter, fear,

tension, all cases lead to acute attack.

Infections: Repeated upper respiratory tract infections are the

main precipitating factors in many cases. Whenever a patient

has an infection it ends up in an episode. About 25-30

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percent of wheezing episodes are associated with viral

infections. Commonly involved viruses are Influenza A, RSV

(Respiratory Syncitial Virus), Mysovirus, Cornavirus, etc. 5

Types of HAD

Two types :- Extrinsic and intrinsic

Extrinsic this entity has also been termed atopic or IgE- mediated.

There is hereditary disposition; it starts early in life and serum

levels of IgE are elevated. It is often associated with other allergic

conditions such as allergic rhinitis and atopic dermatitis. The attack

may be seasonal when precipitated by aeroallergens of pollens of

trees, grass and weeds. The attack may be perennial if the allergens

are animal dander or antigens of mites, house dust and moulds.

Intrinsic this is also known as idiopathic or cryptogenic. There is no

family or personal history of atopic disease. Serum IgE levels are

normal.6

Pathology of HAD:

During the paroxysms of HAD there is

(a) Constriction of the involuntary muscle of the bronchioles

and bronchi resulting into Airflow limitation.

(b) Over production of mucus by the bronchial glands

(c) Vascular turgescence of the mucus membrane

(d) Inflammation of bronchi with eosinophills, T lymphocytes, mast cells,

neutrophils, associated edema, smooth muscle hypertrophy and

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hyperplasia, thickening of basement membrane, mucous plugging and

epithelial damage. 7

Signs & Symptoms

HAD include cough, which sounds tight & is non-productive initially,

wheezing , tachypnea & dyspnoea with prolong expiration & use of accessory

muscles of respiration, cyanosis, hyper inflation of the chest, tachycardia &

pulsus paradoxus, which may be present to varying degrees depending upon the

stage & severity of the attack. A barrel chest deformity is a sign of the chronic,

unremitting airway obstruction of severe HAD. Clubbing of the fingers is rarely

observed which also suggests other causes of chronic obstructive lung disease

such as cystic fibrosis, etc. 8

Miasmatic background of HAD: - Hahnemann found that the factor which

renders the constitution sick and susceptible is an invisible dynamic disease

producing potential. It deranges the vital force of the economy. This factor he

termed as Miasm. They are the fundamental causes of all acute and chronic

ailments.9

Phyllis speight in her “comparison of chronic miasms” says that “cough of

Sycotic are usually bronchial” and cough of sycosis have very little

expectoration usually of clear mucous, occasionally this ropy and may also be

of clotting nature. Wide narrowing of the airway passage – Sycotic, Airway

obstruction – Sycotic, Pathology- the structural changes of trachio - bronchial

tree -Sycotic. Thus Hyper-reactive Airway Disease (HAD) constitutes a Sycotic

miasm. 10

Some of the most common remedies given in HAD:-

1) Antimonium tart

Unequal breathing, abdominal breathing, suffocative shortness

of breath; before cough or alternating with cough. Cough followed

by vomiting or sleeps worse anger. Must sit up to breathe or cough .

Paroxysms of coughing, with suffocating obstruction of respiration

(suffocating cough). Dyspnoea, compelling one to sit up. Shortness

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of breathing from suppressed expectoration. Suffocating attacks

with sensation of heat at the heart. Whooping-cough, preceded by

the child crying, or after eating or drinking, or when getting

warm in bed, Shortness of breath. Difficult respiration. Anxious

oppression of the chest, with a sensation of heat, which ascends to

the heart. Rattling of mucus in the chest when breathing. Fitful pain,

as from excoriation in the chest, especially on the left side. 11

2) Arsenic Alb

Unable to lie down; fears suffocation. Air-passages

constricted. Asthma worse midnight. Burning in chest with

Suffocative catarrh. Cough worse after midnight; worse lying on

back expectoration scanty, frothy. Darting pain through upper third

of right lung wheezing respiration. Haemoptysis with pain between

shoulders; burning heat all over. Cough dry, as from sulphur fumes;

after drinking. Worse at night: after midnight. Worst hour 2 a.m.

Periodic attacks: spasmodic. Worse cold air (rev. Of puls). Better

bending forward (kali carb. kali bi. lach. spong); leaps from bed; <

lying: lying impossible (kali carb.). Worse motion. Great debility

and burning in chest. Arsenic is typically restless: anxious; in fear.

Anguish. Agonizing, fear of death (Acon) worse for ices. Better for

heat applied and hot drinks. Hippocratic face. 11

3) Kali bich

Respiration oppressed, wakens 2 a. m. Sensation of choking

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on lying down. Sensation as from ulceration in larynx.

Accumulation of mucus in larynx, causing hawking. Hoarse, rough,

or nasal voice. Hoarseness (in evening). Tickling in larynx, every

inhalation causes cough (with hoarseness). Cough caused by eating.

At dinner, after first mouthful, great tickling in larynx, better on

eating more. Snuffles of infants, particularly in fat, chubby, little

babies, where there is a tough, stringy discharge from the

nose.Cough, with thick, heavy expectoration, bluish lumps of

mucus. Oppressed breathing, awakens at 2 a.m., palpitation,

Orthopnea: cold sensation and tightness about heart, expectoration

of yellow or yellowish green tough matter. 11

4) Medorrhinum

“HAD: choking from weakness or spasm of epiglottis. Larynx

stopped so that no air can enter. Only > by lying on face and

protruding tongue." Better seaside (Brom.). Where asthma is

connected, even remotely, with gonorrhea (Thuja). Hoarseness,

especially while reading, with occasional loss of voice. Choking

caused by a weakness or spasm of epiglottis, could not tell which,

larynx stopped so that no air could enter, only better by lying on

face and protruding tongue. Dryness of glottis, very annoying, with

pain during deglutition, great hoarseness. Soreness in larynx, as if

ulcerated. Tenacious mucus in larynx. Sensation of a lump in

larynx, severe pain on deglutition. 11

5) Natrum sulph

Profuse greenish purulent expectoration. Dyspnoea with

cough and copious expectoration. Humid asthma. “If in a child, give

it as first remedy". From damp weather: cold damp dwellings; night

air. Worse lying on left side. Loose cough with soreness and pain

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through left chest (Bry. with dry cough). Springs up in bed (Ars.)

and holds chest. Pain lower left chest (lower right chest, Ars.). 12

6) Psorinum

Asthma; anxious dyspnoea and palpitation. Worse sitting up;

better lying; the wider apart he can keep his arms, the better he

breathes. Worse in open air. Thinks he will die; will fail in business.

“A chilly edition of Sulphur ". From suppressed eruptions (Ars.

Sulph.) Suffocation in larynx when sitting bent backward, with

crawling, causing paroxysmal, dry, hacking cough, and at same time

contraction and heaviness in chest and pain in upper part of sternum.

Dyspnoea in evening. Short breath, in fresh air, better riding and

lying down. Want of breath on walking in fresh air; worse sitting,

better lying, with pain in chest. Whistling respiration on waking,

with constriction, again in evening whistling in chest. Breathes

easily when going some light work, as trimming trees. 12

7) Pulsatilla

Worse evenings: after eating. As if throat and chest

constricted; or as if fumes of sulphur had been inhaled. (Full of

smoke, Brom) In the Puls. Type: mild, weepy, craves sympathy;

intolerant of heat; craves air. Not hungry; not thirsty; not

constipated. Changeable symptoms, mental and physical.

Hoarseness, which does not permit one to speak a loud word.

Breathing, groaning, or rattling. Catarrh, with hoarseness,

roughness, dryness, scraping, and pain as from excoriation, in larynx

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and chest. Attacks of constriction in larynx, principally at night,

when lying in a horizontal posture. Dyspnoea, esp. when lying on

back at night, with giddiness and weakness in head. 12

8) Thuja Occidentalis

Asthma Sycotic; tubercular in children< night. Bronchial tract

powerfully influenced. Short breath from mucus in trachea (Ars.)

From fullness and constriction upper abdomen. Sensation of

adhesion of lungs. Drops in sleep. Worse from onions. Cases that

follow vaccination: or many vaccinations; or bad vaccination.

Greenish expectoration (Nat sul.). Copious sweat; offensive;

pungent; sweetish. Peculiar symptom, sweat only an uncovered

parts. Worse cold damp (Nat sul.). 3 am. (Kali carb) A left side

remedy. “Often the chronic of Ars." 12

6.3 Objectives of the Study :

1. To study the presentation of hyper -reactive airway disease in children.

2. To understand the role of constitutional study in hyper- reactive airway

disease in children.

3. To understand the miasmatic background and the approach in selection

of Homoeopathic remedies in hyper- reactive airway disease in children.

7. MATERIAL AND METHODS :

7.1 Source of Data :

The subject for this study will be taken from the Bharatesh

Homoeopathic Medical College and Hospital OPD / IPD / Village Health

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Camps.

7.2 Method of collection of data (including sampling procedure, if any)

1. Patients will be selected on the basis of inclusion and exclusion criteria.

Data will be collected on the basis of interview method as per the proforma

prepared for the topic.

2. Cases will be taken from 15th July 2009 to September 2011 and the study of

the cases will be done respectively.

3. The study will be done with simple random sample technique.

4. From registered cases 30 clinically cases of Hyper-reactive airway Disease

in children will be taken up on the basis of rule of thumb procedure.

5. All cases will be taken as per the proforma prepared for the topic. Thorough

history will be taken. All cases shall be thoroughly analyzed; symptoms are

evaluated over correct nosological diagnosis.

6. Treatment will be started after correction of existing and predisposing

causes.

7. Cases will be seen every week initially, every two weeks afterwards and as

and when necessary.

Result criteria: Assessment of results shall be recovered, improved and not

improved.

Following are the inclusion and exclusion criteria

Inclusion Criteria :

- Patient (children) diagnosed as hyper- reactive airway disease

will be taken up for studies on the basis of clinical history and findings.

- Patient of both sexes, irrespective of their socio-economic status

is to be considered.

Exclusion Criteria :

- Patient who are on active treatment for some other systemic

disorders.

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- Cases with congenital anomalies.

7.3 Does the study require any investigations or interventions to be

conducted on patients or other humans or animals? If so, please

describe briefly.

The diagnosis of the case will be done on the basis of the case history

and clinical findings, However, as and when required necessary investigation

will be conducted such as routine blood examination, Chest X-Ray, pulmonary

function test,etc.

7.4 Has ethical clearance been obtained from your institution in case of 7.3

Yes, ethical clearance has been obtained from the institution.

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8. LIST OF REFERENCES :

1. www.wikipedia.org/wiki/had accessed on 23-01-09

2. Anne Ballinger., Stephen Patchett. Pocket essential of clinical medicine;

14th edition, Elsevier Pvt. Ltd.: Toronto 2007. 14-15 pp.

3. Park K. Park’s Textbook of preventive & social medicine; 17th edition,

Banarsidas Bhanot Jabakpur India.: 2002 Reprinted 2003. 118-120.

4. Mathew George K., Praveen Agarwal. Preparation manual for

undergraduate Medicine; 2nd edition. New Delhi: Elsevier India Pvt.

Ltd.; Reprinted 2003. 152-154 pp.

5. Hunter John A.A, Davidson’s Principle and Practice of Medicine. India:

Elsevier Science Ltd; 19th ed, 2002. 513pp.

6. Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson

JL; Harrison’s principles of Internal medicine. New York : Mc Graw-

Hill Medical Publishing Division; 15th ed, 2001. 1456-1458pp.

7. Shaikh Wiqar, Allergy and asthma a tropical view. New Delhi: IJCP

Publication; 2001. 138pp.

8. www.who.in.org/had accessed on 21-03-01.

9. Sarkar B. K. Commentary, Organon of Medicine; 5 & 6 edition by

Samuel Hahnemann. M. Bhattacharyya & Co, Pvt. Ltd. Calcutta:

Reprinted 1998. 101,102 pp.

10. Speight Phyllis, A comparison of chronic miasms. New Delhi: B Jain

Publishers (P) Ltd.; 1998. 51pp.

11. Lilienthal Samuel. Homoeopathic Therapeutics Lilienthal. B. Jain

publishers Pvt ltd, New Delhi India reprinted edition 1987. 690-692 pp.

12. www.homoeopathy4all.com/had accessed on 26-05-87.

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9. Signature of the candidate

10. Remarks of the Guide

11. Name and designation of 11.1 Guide

Dr. RAMDAS AMBUGA M.D. PROFESSOR & GUIDE, DEPARTMENT OF ORGANON & HOM PHILOSOPHY.BHARATESH HOMOEOPATHIC MEDICAL COLLEGE, BELGAUM-590016.

11.2 Signature

11.3 Co-Guide (if any)

11.4 Signature

11.5 Head of the Dept. Dr. RAVINDRA NADHAN M.D.

PROFESSOR, GUIDE & H.O.D., DEPARTMENT OF ORGANON & HOM. PHILOSOPHY.BHARATESH HOMOEOPATHIC MEDICAL COLLEGEBELGAUM-590016.

11.6 Signature

12. 12.1 Remarks of the Chairman & Principal

12.2 Signature

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