Effects of yoga on pulmonary functions among asthmatic patients: A protocol synthesis

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=> array:4 [ "autoresLista" => "Dwi Puji Putranti, Eldad Onesiforus Pulo, Caecilia Arita, Anggi Lukman Wicaksana" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Dwi Puji" "apellidos" => "Putranti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Eldad Onesiforus" "apellidos" => "Pulo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Caecilia" "apellidos" => "Arita" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:4 [ "nombre" => "Anggi Lukman" "apellidos" => "Wicaksana" "email" => array:1 [ 0 => "anggi.l.wicaksana@ugm.ac.id" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Master of Nursing Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Medical Surgical Nursing, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "The Sleman Health and Demographic Surveillance System, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1819 "Ancho" => 2917 "Tamanyo" => 411113 ] ] "descripcion" => array:1 [ "en" => "Literature searching flowchart." ] ] ] "textoCompleto" => "IntroductionAsthma is ranked on 16th among the leading causes of years lived with disability in global.<a class="elsevierStyleCrossRef" href="#bib0130">1</a> It means that asthma has significant negative impacts on patients’ life due to uncontrolled symptoms, continuous medications, and anxiety on asthma trigger exposures. In addition, asthma also cause sleep disorders, chronic anxiety, and major depression.<a class="elsevierStyleCrossRefs" href="#bib0135">2–4</a> Adult asthmatic patients have higher morbidity and health cost as compared to children due to their coexisting conditions such as occupational exposure to airway irritants, higher psychological problems, and cigarette smoking that may exacerbating their asthma symptoms.<a class="elsevierStyleCrossRef" href="#bib0150">5</a> Controlling of asthmatic symptoms which aimed to minimize or dissolve disrupting symptoms has been becoming the focus discussion to treat adult asthmatic patients.<a class="elsevierStyleCrossRefs" href="#bib0155">6–8</a> Besides the pharmacological management, non-pharmacological management is being considered as Complementary Alternative Medicine (CAM).<a class="elsevierStyleCrossRef" href="#bib0160">7</a> Breathing practice is one of effective non-pharmacological management that could facilitate improving symptoms control and prevents exacerbation that represented by positive outcomes on pulmonary function parameters which are forced expiration volume in 1 second (FEV1), peak expiratory flow rate (PEFR), forced vital capacity (FVC) and comparison between FEV1 and FVC. The lower of FEV1 and PEFR means the higher airflow limitation in the individual airway. When the FEV1/FVC is decreasing, it indicates the barrier (i.e. obstruction) of air flow inside the airway.<a class="elsevierStyleCrossRefs" href="#bib0170">9–11</a>Yoga is one of CAM therapy that could balance physical and mental states to achieve peaceful mind and body to produce a relaxed state and being used as treatment.For various medical conditions, including asthma,<a class="elsevierStyleCrossRefs" href="#bib0180">11,12</a> Pranayama is one of eight pillars of yoga elements that is focused on breathing techniques. It regulates the process of inhalation and exhalation of the lung.<a class="elsevierStyleCrossRef" href="#bib0185">12</a> Many studies reported significant improvement of FEV1, PEFR, FVC, and FEV1/FVC of asthmatic patients due to pranayama abilities that can enhancing parasympathetic nervous activity, increasing chest wall and lung expansion, widening alveolar surface area, and regulate the bronchi to dilate.<a class="elsevierStyleCrossRefs" href="#bib0190">13–16</a> But, several studies reveal their own pranayama protocol which vary in practice for asthmatic patients. Some only focus of pranayama yoga but others combine the several steps of yoga. Thus, this study aimed to find the latest evidence of the effect of yoga pranayama on the lung functional capacity of adult asthmatic patients and synthesize the protocol of pranayama practice that useful for adult asthma based on current literature evidence of the effect of pranayama on lung function in adult asthmatic patients. Combining pranayama steps of each included studies and arranging those steps into the new integrated pranayama protocol for adult asthmatic patients conducted the synthesizing method.MethodA literature review on databases (PubMed, Science Direct, EBSCO, and Scopus) was conducted within the keywords: Asthma OR Asthma in Adult OR Asthmatic AND Yoga AND Lung Function OR Pulmonary Function. The articles were defined regarding inclusion and exclusion criteria. Inclusion criteria that we used were original article for bronchial asthma, published from 1999 to 2019, full text article, pulmonary function parameters as the outcomes, and articles should be written in English. The exclusion criteria were observational research articles, review or other uncompleted type of publication (i.e. abstract, conference). In addition, studies that did not declare the detail protocol for pranayama intervention were also excluded. Selected literature eligibility were conducted using the Joanna Bridge Institute (JBI) critical appraisal tools.<a class="elsevierStyleCrossRefs" href="#bib0210">17,18</a> Critical appraisal were conducted independently by 3 researchers (DPP, EOP, CA) to assess the feasibility of the articles that being included in the review process. After the review process, the pranayama intervention protocol was synthesized from the included articles to determine the types of pranayama techniques. After that, those pranayama techniques were being combined and arranged into the new integrated protocol.ResultsThe literature searching obtained total of 252 articles and only 4 articles met the criteria (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The reasons for exclusion were not asthmatic patients as respondents, children, other intervention, unmatched measured outcomes with study objectives, and undeclared Yoga protocols. Those 4 literatures were also eligible after the eligibility test using the JBI critical appraisal tools.<a class="elsevierStyleCrossRefs" href="#bib0210">17,18</a> The included articles providing the discussion of Yoga Pranayama techniques in adult asthmatic patients that affecting pulmonary function parameters; FEV1, PEFR, FVC, and FEV1/FVC. Data extractions of selected literatures are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Yoga Pranayama techniques from selected literatures are listed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionGINA<a class="elsevierStyleCrossRef" href="#bib0160">7</a> recommends non-pharmacological breathing techniques as one of the asthma management help to improve respiratory function. Breathing techniques are recommended as CAM therapy for asthmatic patients.<a class="elsevierStyleCrossRef" href="#bib0160">7</a> Yoga has a pillar called Pranayama that focuses on breathing patterns to provide energy in the mind and body aspects that can improve cardiopulmonary function in asthmatic patients.<a class="elsevierStyleCrossRefs" href="#bib0255">19,20</a> Four articles which were analyzed in this study conducted several types of pranayama technique in adult patients with bronchial asthma and its indicated to increase functional capacity of lungs among adult patients with mild to moderate severity. Pranayama techniques that being conducted include Bhastrika, Anulom – Vilom, Kapalbhati, Bahaya, Bhramari, Udgit Om Uchcharan, Surya Bhedana, Nadi Shuddi, Surya Nadi, Ujjayi, and Sukha Purvaka.<a class="elsevierStyleCrossRefs" href="#bib0190">13–15,21</a>Different study provide different pranayama protocol. Pranayama techniques that was conducted by Singh et al.<a class="elsevierStyleCrossRef" href="#bib0195">14</a> were Bhastrika, Anulom – Vilom, Kapalbhati, Bahaya, Bhramari, and Udgit Om Unchcharan. The pranayama was performed every day for 30–35min per training session in a period of 2 months. Study conducted by Agnihotri et al.<a class="elsevierStyleCrossRef" href="#bib0200">15</a> was examining Nadi Shodana, Bhastrika, and Bhramari pranayama techniques in adult patients with asthma. Respendents performed 5 times in a week for 30min each session and carried out over a period of 6 months. Sodhi et al.<a class="elsevierStyleCrossRef" href="#bib0190">13</a> instructs the respondents to performing Kapalbhati, Bhastrika, and Shuka Purvaka pranayama techniques twice a week for 45min in a period of 8 weeks. Different protocol of pranayama yoga were conducted in the study by Raghavendra et al.<a class="elsevierStyleCrossRef" href="#bib0260">21</a> which only use Kapalbhati pranayama technique and the outcomes were measured on the same day. Kapalbhati pranayama was being performed 2 times in 20min (10min per each time) with a 30min break session between the first and second session. From the included articles, the author declared that yoga pranayama could facilitate to enhance the capacity of pulmonary functions. In the intervention group, majority resulted significant the improvement of the FVC, FEV1, PEFR and FEV1/FVC. On the other hand, the pulmonary function on the control group showed the various outcomes, some indicated increasing but the decreasing trend were also observed.Pranayama breathing techniques from the selected literature in this study agreed that pranayama has the ability to increase the diffusion capacity of oxygen in lungs and enhance the lung function capacity.<a class="elsevierStyleCrossRefs" href="#bib0190">13–15,21</a> The physiological process of pranayama in improving lung function is based on the basic functions of yoga, that can help in controlling a stress and decreasing the autonomous sympathetic nervous system. The process occurred since there is increasing the dominance of the parasympathetic nervous system through controlling the inspiration and expiration period and muscle relaxation during pranayama breathing exercises.<a class="elsevierStyleCrossRefs" href="#bib0235">22,23</a>Pranayama practice with deep and slow breathing techniques will increase lung expansion greater than normal breathing which results in the larger alveolar surface area. The widened surface of the alveoli increasing the diffusion of oxygen through the alveolar membrane. In addition, pranayama practice also affects the bronchioles to dilate. Then, oxygen perfusion from the bronchioles and alveoli can occur more effectively.<a class="elsevierStyleCrossRef" href="#bib0205">16</a> The physiological effects are main reason of the increasing of four pulmonary functional capacity values (FEV1, FVC, FEV1/FVC and PEFR). The improvement of four parameters indicates the ability of bronchioles and alveoli to fully expand and carry out oxygen diffusion since the pranayama breathing techniques performed.<a class="elsevierStyleCrossRef" href="#bib0195">14</a> Moreover, the contractions of the abdominal and intercostal muscles that occurs when performing forceful expiration pranayama, increasing the resilience of the respiratory muscles so that the pulmonary organs can maximize the inspiration and expiration activity with a maximum volume of oxygen. Thus, in pranayama practice, FEV1 and FVC values can be enhanced.<a class="elsevierStyleCrossRef" href="#bib0260">21</a>Protocol of pranayama breathing techniques from the 4 studies can be combined into the new synthesized protocol for the implementation of structured pranayama yoga for adult asthmatic. The type of pranayama yoga steps was evidently showed positive outcomes to improve the scores pulmonary function parameters. The pranayama steps listed in 4 selected literature are combined with the procedures for implementing yoga. The Lacerda<a class="elsevierStyleCrossRefs" href="#bib0225">20,24</a> provide more applicative and detail practice in each types of pranayama yoga. The results of integrated steps in pranayama were arranged as shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. Based on four-selected literature, the effectiveness of this yoga pranayama practice could show positive outcomes after (at least) 2 months practicing regular pranayama. Measurements of FEV1, PEFR, FVC, and FEV1/FVC as pulmonary function parameters using spirometer are recommended at 6 months post-routine yoga pranayama practice.<a class="elsevierStyleCrossRefs" href="#bib0190">13–15,21,25</a><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>ConclusionYoga pranayama practice is able to enhance pulmonary functional capacity The systematic protocol for implementing yoga pranayama in adult patients with asthma includes 13 steps of implementation with 11 pranayama techniques. The procedure should be conducted 2–5 times in a week for period of 2–6 months and duration of 30–45min for each training session. The synthesized protocol as a result of this study is expected to be a pilot study of interventional program among adult asthmatic patients. Based on this study limitation due to lack of studies included because of numerous studies did not reveal the pranayama protocol in detail, this study suggest the future researches must put the detailed protocol on their publication, so that those protocols can be used clinically.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1329571" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1225146" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Method" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack459094" "titulo" => "Acknowledgement" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-08-27" "fechaAceptado" => "2019-12-16" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1225146" "palabras" => array:5 [ 0 => "Asthma" 1 => "Breathing technique" 2 => "Protocol" 3 => "Pulmonary function" 4 => "Yoga" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveThis study aimed to synthesize protocol of yoga pranayama's practice through combining yoga pranayama's steps into the new integrated formations of yoga pranayama's steps for adult asthmatic patients as a protocol. MethodLiterature review from the last 20 years publication of original trial articles on adult asthmatic subjects from 4 databases: PubMed, Science Direct, EBSCO, and Scopus was conducted. Review and non-trial articles were excluded. Articles were appraised using Joanna Bridge Institute (JBI) critical appraisal tools. ResultsThere were 4 out of 252 articles which met the criteria and being included in this study. The synthesized protocol resulting 11 pranayama steps in the new synthesized protocol. ConclusionsThe regular 13 yoga pranayama steps within 11 pranayama steps based on synthesized protocol takes 30–45min for each session and can be conducted 2–5 times a week for 2–6 months to be able to reveal pulmonary function outcomes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Peer-review under responsibility of the scientific committee of the International Conference of Indonesian National Nurses Association (ICINNA 2019). Full-text and the content of it is under responsibility of authors of the article." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1819 "Ancho" => 2917 "Tamanyo" => 411113 ] ] "descripcion" => array:1 [ "en" => "Literature searching flowchart." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "FEV1, forced expiration volume in 1s.FVC, forced vital capacity.PEFR, peak expiratory flow rate." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author(s) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Research Title \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Singh, Soni, Singh, Tandon<a class="elsevierStyleCrossRef" href="#bib0190">13</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Effect of Yoga Practice on Pulmonary Function Tests Including Transfer Factor of Lung for Carbon Monoxide (TLCO) in Asthma Patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intervention group: 30 asthma diagnosed patients for ≥1 year in mild to moderate severity were received yoga practice consisting of pranayama (30–35min), asanas (10min), and meditation (10min), and getting lifestyle modification therapy related to a healthy asthma dietControl group: 30 asthma diagnosed patients for ≥1 year in mild to moderate severity were received standard care in the form of standard pharmacological therapy for asthma patients. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">After 2 months, the YG group experienced a significant increase in pulmonary function values in FEV1, FVC, and PEFR parameters with detailed results of the two groups as follows:Intervention GroupFVC, pre=3.23±0.93; post=3.43±0.93 (P<0.001)FEV1, pre=2.62±0.67; post=2.80±0.71 (P<0.001)FEV1/FVC, pre=81, 35±7.08; post=82.19±5.24 (P=0.05)PEFR, pre=5.53±1.46; post=6.41±1.03 (P<0.001)Control groupFVC, pre=3.55±0.79; post=3.60±0.81 (P<0.001)FEV1, pre=2.76±0.59; post=2.80±0.58 (P<0.001)FEV1/FVC, pre=77, 32±3.31; post=79.41±3.56 (P=0.05)PEFR, pre=6.00±1.74; post=6.26±1.48 (P<0.001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Agnihotri, Kant, Kumar, Mishra, Mishra<a class="elsevierStyleCrossRef" href="#bib0195">14</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The Assessment Effects of Yoga on Pulmonary Functions in Asthmatic Patients: A Randomized Controlled Study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intervention group: 121 Asthma patients with FEV1 values>60% aged 12–60 years received treatment in the form of a yoga intervention consisting of pranayama, asanas, and meditation for 30min/session, carried out for 5 days/weeks for 6 months.Control group: 121 Asthma patients with FEV1 values>60% aged 12–60 years received standardized care in the form of standard pharmacological therapy for asthmatic patients. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Outcomes were measured before intervention, after 3 months of intervention, and after 6 months intervention with the detailed results as follows:Intervention group at 3 months (T1) and 6 months (T2) post interventionFVC increased by 6.09%, pre=80.90±5, 48; T1=83.09±4.07 (P=0.0003); T2=85.83±8.07 (P<0.0001).FEV1 increased by 14.89%, pre=68.23±5.87, T1=74.76±4.93 (P<0.0001); T2=78.39±4.55 (P<0.0001).FEV1/FVC decreased by 6.85%, pre=71.53±5.29; T1=68.61±6.78 (P=0.0002); T2=66.62±6.78 (P<0.0001).PEFR increased significantly by 17, 08%, pre=64.59±4.89; T1=72.07±5.61 (P<0.0001), T2=75.62±4.71 (P<0.0001).Control group at 3 months (T1) and 6 (T2) months post interventionFVC was not significantly increased (2.64%), pre=79.87±5.34; T1=80.46±5.59 (P=0.42); T2=81.98±5.32 (P=0.002)FEV1 increased by 2.29%, pre=67.77±4.95; T1=69.32±6.09 (P=0.01) but, decreased -3.82% on T2=65.18±3.64 (P<0.0001)FEV1/FVC decreased by 2.76%, pre=72.36±7.23; T1=70, 73±6.79 (P=0.10); T2=70.36±4.92 (P=0.02).PEFR increased by 9.28%, pre=63.69±5.87; T1=69.60±5.49 (P<0.0001); T2=65.08±5.21 (P=0.002). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Raghavendra, Shetty, Shetty, Manjunath, Saoji<a class="elsevierStyleCrossRef" href="#bib0200">15</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Effect of high-frequency yoga breathing on pulmonary functions in patients with asthmaA randomized clinical trial. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intervention group: 30 asthmatic patients with mild to moderate severity received Kapalbhati pranayama training for 20min which was divided into 2 sessions, the first 10min of Kapalbhati pranayama followed by a 30-s resting phase, then the respondent returned to Kapalbhati pranayama in the second 10min.Control group: 30 asthmatic patients with mild to moderate severity were perform deep breathing techniques for 20min which were divided into 6 breath cycles per minute. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The measurement results of 3 functional parameters were measured before the intervention and immediately after the intervention. The results showed that FEV1, FVC, and FEV1/FVC increased significantly in the EG group.Intervention Group:FEV1 increased significantly, pre=1.91±0.35; post=2.12±0.37 (P<0.05).FVC increased significantly, pre=2.62±0.68; post=2.70±0.57 (P<0.001)FEV1/FVC increased significantly, pre=0.75±0.12; post=0.80±0.10 (P<0.05).Control group:FEV1 not significantly increased, pre=1.89±0.31; post=1.91±0.37 (P>0.05).FVC not significantly increased, pre=2.589±0.74; post=2.59±0.62 (P>0.05)FEV1/FVC decreased, pre=0.76±0.14; post=0.75±0.08 (P>0.05). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sodhi, Singh, Dandona<a class="elsevierStyleCrossRef" href="#bib0205">16</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A Study of the Effect of Yoga Training on Pulmonary Functions in Patients with Bronchial Asthma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intervention group: 60 asthma patients aged 17–50 years with mild to moderate severity were given Kapalbhati, Bhastrika, Ujjayi, and Sukha Purvaka pranayama exercises 2 times a week for 8 weeks with 45min duration at each session.Control group: 60 asthma patients aged 17–50 years with mild to moderate severity were given standard care in the form of standard pharmacological therapy for asthma patients. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The measurement results of 4 functional parameters were measured before the intervention and 8 weeks after the intervention. The result shows that FEV1, FVC, FEV1/FVC, and PEFR increased significantly in group A with details as follows:Intervention group:FEV1 significantly increased, pre=79.63±10.35; post=83.16±10,497 (P<0.01).FVC significantly increased, pre=84.33±11.05; post=86.67±10.72 (P<0.01)FEV1/FVC significantly increased, pre=94.15±10.81; post=96.60±9.67 (P<0.01).PEFR significantly increased, pre=79.81±10.78; post=82.45±10.17 (P<0.01).Control groupFEV1 decreased, pre=77.48±9.67; post=77.26±9.86 (P>0.1).FVC decreased, pre=83.52±9.77; post=83.37±10.00 (P>0.1)FEV1/FVC decreased, pre=93.67±8.78; post=93.13±8.94 (P>0.1).PEFR decreased, pre=79.53±8.29; post=79.42±8.26 (P>0.1). \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2279010.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Data extraction of selected literatures." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author(s) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of pranayama \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration of implementation \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Singh, Soni, Singh, Tandon<a class="elsevierStyleCrossRef" href="#bib0190">13</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bhastrika, Anulom Vilom, Kapalbhati, Bahaya, Bhramari, and Udgit Om Unchcharan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Every day for 30–35min for each session in a period of 2 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Agnihotri, Kant, Kumar, Mishra, Mishra<a class="elsevierStyleCrossRef" href="#bib0195">14</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nadi Shodana, Bhastrika, and Bhramari \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Five times a week for 30min for each session in a period of 6 months. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Raghavendra, Shetty, Shetty, Manjunath, Saoji<a class="elsevierStyleCrossRef" href="#bib0200">15</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kapalbhati \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Two times for 20min (10min per each time) with a 30min break session between the first and second steps \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sodhi, Singh, Dandona<a class="elsevierStyleCrossRef" href="#bib0205">16</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kapalbhati, Bhastrika, Ujjayi, and Sukha Purvaka \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Two times a week for 45min in a period of 8 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2279009.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Type of pranayama based on selected literatures." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Steps of yoga pranayama pratice for adult asthmatic patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Do the Sukhasana Pose or Place your Own Body in Your Most Comfortable PositionMake your body position as relaxed as possible and close the eyes slowly.2. Do the pranayama Bhastrika for 2minPerform the inhalation and exhalation process through your nose with a count of 2s per 1 time breathing phase. In this breathing, the abdominal breathing muscles move forward and backward, while the diaphragm muscles should not move.3. Do the pranayama Anulom – Vilom for 6minInhale and exhale as usual but must be relaxed and focus on the exhalation and inhalation processes that being carried out. Firstly, focus the breathing process that occurs on the left nose for 2min, and do the same thing on the right nose for 2min, then in the next 2min, focus the mind on the inhalation process of the right nostril and exhalation from the left nostril.4. Do the pranayama Kapalbhati for 10minPerform inhalation using the abdominal breathing muscles slowly and relaxed, then exhaling through the nose strongly using abdominal breathing muscles.5. Do the pranayama Bahaya for 1minInhale as deep and relaxed as possible through the nose and exhale as deep as possible, then hold breathing for 10s.6. Do the pranayama Bhramari in 5 roundsInhale as deep and relaxed as possible slowly through the nose, then slowly exhale and make sound like a bee (buzzing) while exhaling through the mouth7. Do the pranayama Udgit Om Uchcharan in 10 roundsPerform inhalation slowly through the nose and slowly exhale while saying the word “Om” through the mouth8. Do the pranayama Surya Bhedana in 10 roundsCover your left nostril with your finger and inhale through your right nostril. Then cover your right nostril with your finger and exhale from the left nostril. Continue these step within the term that all inhalation processes are occurred through your right nostril and exhalation through your left nostril.9. Do the pranayama Nadi Shuddi pranayama in 5 roundsCover the your nostril with your left thumb and exhale through your right nostril. Then, inhale through your right nostril slowly, fill the lungs with air. Then, cover your right nostril by using your index or middle finger of the left hand and exhaling all the air through the left nostril. And then, inhale through your left nostril and fills the lungs with air while your right nostrils covered by your right thumb and then close the left nostril using your index or middle finger of your right hand and exhale through your right nostril until the air from your lung is completely empty.10. Do the pranayama Surya Nadi in 10 roundsCover your left nostril with your ring finger and exhale through the right nostril. And then, inhale slowly through your right nostril while your left nostril covered by you ring finger.11. Do the pranayama Ujjayi in 10 roundsInhale through your nose and exhale through your mouth. Whenever you exhale, imagine that you are trying to blur (make dew) on the glass.12. Do the pranayama Sukha Purvaka in 20 roundsCover your right nostril with your right thumb. Inhale slowly through your left nostril, then cover your left nostrils using your little and ring finger while your right nostril still covered by your right thumb. Hold your breath as long as possible. Then slowly exhale through your right nostrils after removing the thumb. Do the same process on the other side of the nose.13. End the pranayama sessionWrap your pranayama session up by restoring your breathing rhythm back to your normal breathing rythm and slowly opening your eyes. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2279008.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Synthesized protocol of structured pranayama for adult asthmatic patients." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gender and asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.L. Fuhlbrigge" 1 => "B. Jackson" 2 => "R.J. 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Dwi Puji Putrantia, Eldad Onesiforus Puloa, Caecilia Aritaa, Anggi Lukman Wicaksanab,c,

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anggi.l.wicaksana@ugm.ac.id

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a Master of Nursing Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

b Department of Medical Surgical Nursing, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

c The Sleman Health and Demographic Surveillance System, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Asthma is ranked on 16th among the leading causes of years lived with disability in global&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> It means that asthma has significant negative impacts on patients&#8217; life due to uncontrolled symptoms&#44; continuous medications&#44; and anxiety on asthma trigger exposures&#46; In addition&#44; asthma also cause sleep disorders&#44; chronic anxiety&#44; and major depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2&#8211;4</span></a> Adult asthmatic patients have higher morbidity and health cost as compared to children due to their coexisting conditions such as occupational exposure to airway irritants&#44; higher psychological problems&#44; and cigarette smoking that may exacerbating their asthma symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> Controlling of asthmatic symptoms which aimed to minimize or dissolve disrupting symptoms has been becoming the focus discussion to treat adult asthmatic patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">6&#8211;8</span></a> Besides the pharmacological management&#44; non-pharmacological management is being considered as Complementary Alternative Medicine &#40;CAM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> Breathing practice is one of effective non-pharmacological management that could facilitate improving symptoms control and prevents exacerbation that represented by positive outcomes on pulmonary function parameters which are forced expiration volume in 1 second &#40;FEV1&#41;&#44; peak expiratory flow rate &#40;PEFR&#41;&#44; forced vital capacity &#40;FVC&#41; and comparison between FEV1 and FVC&#46; The lower of FEV1 and PEFR means the higher airflow limitation in the individual airway&#46; When the FEV1&#47;FVC is decreasing&#44; it indicates the barrier &#40;i&#46;e&#46; obstruction&#41; of air flow inside the airway&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">9&#8211;11</span></a>Yoga is one of CAM therapy that could balance physical and mental states to achieve peaceful mind and body to produce a relaxed state and being used as treatment&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">For various medical conditions&#44; including asthma&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">11&#44;12</span></a> Pranayama is one of eight pillars of yoga elements that is focused on breathing techniques&#46; It regulates the process of inhalation and exhalation of the lung&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a> Many studies reported significant improvement of FEV<span class="elsevierStyleInf">1</span>&#44; PEFR&#44; FVC&#44; and FEV<span class="elsevierStyleInf">1</span>&#47;FVC of asthmatic patients due to pranayama abilities that can enhancing parasympathetic nervous activity&#44; increasing chest wall and lung expansion&#44; widening alveolar surface area&#44; and regulate the bronchi to dilate&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">13&#8211;16</span></a> But&#44; several studies reveal their own pranayama protocol which vary in practice for asthmatic patients&#46; Some only focus of pranayama yoga but others combine the several steps of yoga&#46; Thus&#44; this study aimed to find the latest evidence of the effect of yoga pranayama on the lung functional capacity of adult asthmatic patients and synthesize the protocol of pranayama practice that useful for adult asthma based on current literature evidence of the effect of pranayama on lung function in adult asthmatic patients&#46; Combining pranayama steps of each included studies and arranging those steps into the new integrated pranayama protocol for adult asthmatic patients conducted the synthesizing method&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="par0010" class="elsevierStylePara elsevierViewall">A literature review on databases &#40;PubMed&#44; Science Direct&#44; EBSCO&#44; and Scopus&#41; was conducted within the keywords&#58; Asthma OR Asthma in Adult OR Asthmatic AND Yoga AND Lung Function OR Pulmonary Function&#46; The articles were defined regarding inclusion and exclusion criteria&#46; Inclusion criteria that we used were original article for bronchial asthma&#44; published from 1999 to 2019&#44; full text article&#44; pulmonary function parameters as the outcomes&#44; and articles should be written in English&#46; The exclusion criteria were observational research articles&#44; review or other uncompleted type of publication &#40;i&#46;e&#46; abstract&#44; conference&#41;&#46; In addition&#44; studies that did not declare the detail protocol for pranayama intervention were also excluded&#46; Selected literature eligibility were conducted using the Joanna Bridge Institute &#40;JBI&#41; critical appraisal tools&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">17&#44;18</span></a> Critical appraisal were conducted independently by 3 researchers &#40;DPP&#44; EOP&#44; CA&#41; to assess the feasibility of the articles that being included in the review process&#46; After the review process&#44; the pranayama intervention protocol was synthesized from the included articles to determine the types of pranayama techniques&#46; After that&#44; those pranayama techniques were being combined and arranged into the new integrated protocol&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0015" class="elsevierStylePara elsevierViewall">The literature searching obtained total of 252 articles and only 4 articles met the criteria &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The reasons for exclusion were not asthmatic patients as respondents&#44; children&#44; other intervention&#44; unmatched measured outcomes with study objectives&#44; and undeclared Yoga protocols&#46; Those 4 literatures were also eligible after the eligibility test using the JBI critical appraisal tools&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">17&#44;18</span></a> The included articles providing the discussion of Yoga Pranayama techniques in adult asthmatic patients that affecting pulmonary function parameters&#59; FEV<span class="elsevierStyleInf">1</span>&#44; PEFR&#44; FVC&#44; and FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#46; Data extractions of selected literatures are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Yoga Pranayama techniques from selected literatures are listed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">GINA<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> recommends non-pharmacological breathing techniques as one of the asthma management help to improve respiratory function&#46; Breathing techniques are recommended as CAM therapy for asthmatic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> Yoga has a pillar called Pranayama that focuses on breathing patterns to provide energy in the mind and body aspects that can improve cardiopulmonary function in asthmatic patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">19&#44;20</span></a> Four articles which were analyzed in this study conducted several types of pranayama technique in adult patients with bronchial asthma and its indicated to increase functional capacity of lungs among adult patients with mild to moderate severity&#46; Pranayama techniques that being conducted include Bhastrika&#44; Anulom &#8211; Vilom&#44; Kapalbhati&#44; Bahaya&#44; Bhramari&#44; Udgit Om Uchcharan&#44; Surya Bhedana&#44; Nadi Shuddi&#44; Surya Nadi&#44; Ujjayi&#44; and Sukha Purvaka&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">13&#8211;15&#44;21</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Different study provide different pranayama protocol&#46; Pranayama techniques that was conducted by Singh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> were Bhastrika&#44; Anulom &#8211; Vilom&#44; Kapalbhati&#44; Bahaya&#44; Bhramari&#44; and Udgit Om Unchcharan&#46; The pranayama was performed every day for 30&#8211;35<span class="elsevierStyleHsp" style=""></span>min per training session in a period of 2 months&#46; Study conducted by Agnihotri et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> was examining Nadi Shodana&#44; Bhastrika&#44; and Bhramari pranayama techniques in adult patients with asthma&#46; Respendents performed 5 times in a week for 30<span class="elsevierStyleHsp" style=""></span>min each session and carried out over a period of 6 months&#46; Sodhi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> instructs the respondents to performing Kapalbhati&#44; Bhastrika&#44; and Shuka Purvaka pranayama techniques twice a week for 45<span class="elsevierStyleHsp" style=""></span>min in a period of 8 weeks&#46; Different protocol of pranayama yoga were conducted in the study by Raghavendra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a> which only use Kapalbhati pranayama technique and the outcomes were measured on the same day&#46; Kapalbhati pranayama was being performed 2 times in 20<span class="elsevierStyleHsp" style=""></span>min &#40;10<span class="elsevierStyleHsp" style=""></span>min per each time&#41; with a 30<span class="elsevierStyleHsp" style=""></span>min break session between the first and second session&#46; From the included articles&#44; the author declared that yoga pranayama could facilitate to enhance the capacity of pulmonary functions&#46; In the intervention group&#44; majority resulted significant the improvement of the FVC&#44; FEV1&#44; PEFR and FEV1&#47;FVC&#46; On the other hand&#44; the pulmonary function on the control group showed the various outcomes&#44; some indicated increasing but the decreasing trend were also observed&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Pranayama breathing techniques from the selected literature in this study agreed that pranayama has the ability to increase the diffusion capacity of oxygen in lungs and enhance the lung function capacity&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">13&#8211;15&#44;21</span></a> The physiological process of pranayama in improving lung function is based on the basic functions of yoga&#44; that can help in controlling a stress and decreasing the autonomous sympathetic nervous system&#46; The process occurred since there is increasing the dominance of the parasympathetic nervous system through controlling the inspiration and expiration period and muscle relaxation during pranayama breathing exercises&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Pranayama practice with deep and slow breathing techniques will increase lung expansion greater than normal breathing which results in the larger alveolar surface area&#46; The widened surface of the alveoli increasing the diffusion of oxygen through the alveolar membrane&#46; In addition&#44; pranayama practice also affects the bronchioles to dilate&#46; Then&#44; oxygen perfusion from the bronchioles and alveoli can occur more effectively&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> The physiological effects are main reason of the increasing of four pulmonary functional capacity values &#40;FEV<span class="elsevierStyleInf">1</span>&#44; FVC&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC and PEFR&#41;&#46; The improvement of four parameters indicates the ability of bronchioles and alveoli to fully expand and carry out oxygen diffusion since the pranayama breathing techniques performed&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> Moreover&#44; the contractions of the abdominal and intercostal muscles that occurs when performing forceful expiration pranayama&#44; increasing the resilience of the respiratory muscles so that the pulmonary organs can maximize the inspiration and expiration activity with a maximum volume of oxygen&#46; Thus&#44; in pranayama practice&#44; FEV1 and FVC values can be enhanced&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Protocol of pranayama breathing techniques from the 4 studies can be combined into the new synthesized protocol for the implementation of structured pranayama yoga for adult asthmatic&#46; The type of pranayama yoga steps was evidently showed positive outcomes to improve the scores pulmonary function parameters&#46; The pranayama steps listed in 4 selected literature are combined with the procedures for implementing yoga&#46; The Lacerda<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">20&#44;24</span></a> provide more applicative and detail practice in each types of pranayama yoga&#46; The results of integrated steps in pranayama were arranged as shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; Based on four-selected literature&#44; the effectiveness of this yoga pranayama practice could show positive outcomes after &#40;at least&#41; 2 months practicing regular pranayama&#46; Measurements of FEV1&#44; PEFR&#44; FVC&#44; and FEV1&#47;FVC as pulmonary function parameters using spirometer are recommended at 6 months post-routine yoga pranayama practice&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">13&#8211;15&#44;21&#44;25</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Yoga pranayama practice is able to enhance pulmonary functional capacity The systematic protocol for implementing yoga pranayama in adult patients with asthma includes 13 steps of implementation with 11 pranayama techniques&#46; The procedure should be conducted 2&#8211;5 times in a week for period of 2&#8211;6 months and duration of 30&#8211;45<span class="elsevierStyleHsp" style=""></span>min for each training session&#46; The synthesized protocol as a result of this study is expected to be a pilot study of interventional program among adult asthmatic patients&#46; Based on this study limitation due to lack of studies included because of numerous studies did not reveal the pranayama protocol in detail&#44; this study suggest the future researches must put the detailed protocol on their publication&#44; so that those protocols can be used clinically&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aimed to synthesize protocol of yoga pranayama&#39;s practice through combining yoga pranayama&#39;s steps into the new integrated formations of yoga pranayama&#39;s steps for adult asthmatic patients as a protocol&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Literature review from the last 20 years publication of original trial articles on adult asthmatic subjects from 4 databases&#58; PubMed&#44; Science Direct&#44; EBSCO&#44; and Scopus was conducted&#46; Review and non-trial articles were excluded&#46; Articles were appraised using Joanna Bridge Institute &#40;JBI&#41; critical appraisal tools&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were 4 out of 252 articles which met the criteria and being included in this study&#46; The synthesized protocol resulting 11 pranayama steps in the new synthesized protocol&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The regular 13 yoga pranayama steps within 11 pranayama steps based on synthesized protocol takes 30&#8211;45<span class="elsevierStyleHsp" style=""></span>min for each session and can be conducted 2&#8211;5 times a week for 2&#8211;6 months to be able to reveal pulmonary function outcomes&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Singh&#44; Soni&#44; Singh&#44; Tandon<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Effect of Yoga Practice on Pulmonary Function Tests Including Transfer Factor of Lung for Carbon Monoxide &#40;TLCO&#41; in Asthma Patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Intervention group&#58;</span></span> 30 asthma diagnosed patients for &#8805;1 year in mild to moderate severity were received yoga practice consisting of pranayama &#40;30&#8211;35<span class="elsevierStyleHsp" style=""></span>min&#41;&#44; asanas &#40;10<span class="elsevierStyleHsp" style=""></span>min&#41;&#44; and meditation &#40;10<span class="elsevierStyleHsp" style=""></span>min&#41;&#44; and getting lifestyle modification therapy related to a healthy asthma diet<span class="elsevierStyleItalic"><span class="elsevierStyleBold">Control group&#58;</span></span> 30 asthma diagnosed patients for &#8805;1 year in mild to moderate severity were received standard care in the form of standard pharmacological therapy for asthma patients&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">After 2 months&#44; the YG group experienced a significant increase in pulmonary function values in FEV1&#44; FVC&#44; and PEFR parameters with detailed results of the two groups as follows&#58;<span class="elsevierStyleHsp" style=""></span>Intervention Group<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FVC&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;93&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;93 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;67&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;71 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>81&#44; 35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;08&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;24 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PEFR&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;46&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;03 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;<span class="elsevierStyleHsp" style=""></span>Control group<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FVC&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;79&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;81 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;59&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;58 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>77&#44; 32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;31&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;56 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PEFR&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;74&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;48 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Agnihotri&#44; Kant&#44; Kumar&#44; Mishra&#44; Mishra<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">The Assessment Effects of Yoga on Pulmonary Functions in Asthmatic Patients&#58; A Randomized Controlled Study</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Intervention group&#58;</span></span> 121 Asthma patients with FEV1 values<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60&#37; aged 12&#8211;60 years received treatment in the form of a yoga intervention consisting of pranayama&#44; asanas&#44; and meditation for 30<span class="elsevierStyleHsp" style=""></span>min&#47;session&#44; carried out for 5 days&#47;weeks for 6 months&#46;<span class="elsevierStyleItalic"><span class="elsevierStyleBold">Control group</span></span>&#58; 121 Asthma patients with FEV1 values<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60&#37; aged 12&#8211;60 years received standardized care in the form of standard pharmacological therapy for asthmatic patients&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Outcomes were measured before intervention&#44; after 3 months of intervention&#44; and after 6 months intervention with the detailed results as follows&#58;<span class="elsevierStyleHsp" style=""></span>Intervention group at 3 months &#40;T1&#41; and 6 months &#40;T2&#41; post intervention<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FVC increased by 6&#46;09&#37;&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>80&#46;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44; 48&#59; T1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>83&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;07 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0003&#41;&#59; T2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>85&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;07 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span> increased by 14&#46;89&#37;&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&#46;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;87&#44; T1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74&#46;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;93 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#59; T2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>78&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;55 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC decreased by 6&#46;85&#37;&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>71&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;29&#59; T1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&#46;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;78 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0002&#41;&#59; T2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>66&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;78 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PEFR increased significantly by 17&#44; 08&#37;&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>64&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;89&#59; T1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>72&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;61 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; T2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;71 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;<span class="elsevierStyleHsp" style=""></span>Control group at 3 months &#40;T1&#41; and 6 &#40;T2&#41; months post intervention<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FVC was not significantly increased &#40;2&#46;64&#37;&#41;&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;34&#59; T1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>80&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;59 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;42&#41;&#59; T2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>81&#46;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;32 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span> increased by 2&#46;29&#37;&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;95&#59; T1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>69&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;09 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; but&#44; decreased -3&#46;82&#37; on T2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>65&#46;18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;64 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC decreased by 2&#46;76&#37;&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>72&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;23&#59; T1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#44; 73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;79 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;10&#41;&#59; T2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;92 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#46;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PEFR increased by 9&#46;28&#37;&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;87&#59; T1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>69&#46;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;49 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#59; T2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>65&#46;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;21 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Raghavendra&#44; Shetty&#44; Shetty&#44; Manjunath&#44; Saoji<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Effect of high-frequency yoga breathing on pulmonary functions in patients with asthma</span><span class="elsevierStyleItalic">A randomized clinical trial&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Intervention group</span></span>&#58; 30 asthmatic patients with mild to moderate severity received Kapalbhati pranayama training for 20<span class="elsevierStyleHsp" style=""></span>min which was divided into 2 sessions&#44; the first 10<span class="elsevierStyleHsp" style=""></span>min of Kapalbhati pranayama followed by a 30-s resting phase&#44; then the respondent returned to Kapalbhati pranayama in the second 10<span class="elsevierStyleHsp" style=""></span>min&#46;<span class="elsevierStyleItalic"><span class="elsevierStyleBold">Control group&#58;</span></span> 30 asthmatic patients with mild to moderate severity were perform deep breathing techniques for 20<span class="elsevierStyleHsp" style=""></span>min which were divided into 6 breath cycles per minute&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The measurement results of 3 functional parameters were measured before the intervention and immediately after the intervention&#46; The results showed that FEV1&#44; FVC&#44; and FEV1&#47;FVC increased significantly in the EG group&#46;<span class="elsevierStyleHsp" style=""></span>Intervention Group&#58;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV1 increased significantly&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;35&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;37 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FVC increased significantly&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;68&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;57 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV1&#47;FVC increased significantly&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;12&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;10 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;<span class="elsevierStyleHsp" style=""></span>Control group&#58;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span> not significantly increased&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;31&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;37 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FVC not significantly increased&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;589<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;74&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;62 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV1&#47;FVC decreased&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;14&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;08 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sodhi&#44; Singh&#44; Dandona<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">A Study of the Effect of Yoga Training on Pulmonary Functions in Patients with Bronchial Asthma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Intervention group</span></span><span class="elsevierStyleBold">&#58;</span> 60 asthma patients aged 17&#8211;50 years with mild to moderate severity were given Kapalbhati&#44; Bhastrika&#44; Ujjayi&#44; and Sukha Purvaka pranayama exercises 2 times a week for 8 weeks with 45<span class="elsevierStyleHsp" style=""></span>min duration at each session&#46;<span class="elsevierStyleItalic"><span class="elsevierStyleBold">Control group</span></span>&#58; 60 asthma patients aged 17&#8211;50 years with mild to moderate severity were given standard care in the form of standard pharmacological therapy for asthma patients&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The measurement results of 4 functional parameters were measured before the intervention and 8 weeks after the intervention&#46; The result shows that FEV1&#44; FVC&#44; FEV1&#47;FVC&#44; and PEFR increased significantly in group A with details as follows&#58;<span class="elsevierStyleHsp" style=""></span>Intervention group&#58;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span> significantly increased&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#46;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;35&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>83&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;497 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FVC significantly increased&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>84&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;05&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>86&#46;67&#177;10&#46;72 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC significantly increased&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#46;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;81&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>96&#46;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;67 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PEFR significantly increased&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;78&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;17 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;<span class="elsevierStyleHsp" style=""></span>Control group<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span> decreased&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>77&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;67&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>77&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;86 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#41;&#46;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FVC decreased&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>83&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;77&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>83&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;00 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC decreased&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>93&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;78&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>93&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;94 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#41;&#46;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PEFR decreased&#44; pre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;29&#59; post<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#46;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;26 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Data extraction of selected literatures&#46;</p>"
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          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author&#40;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of pranayama&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration of implementation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Singh&#44; Soni&#44; Singh&#44; Tandon<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Bhastrika&#44; Anulom Vilom&#44; Kapalbhati&#44; Bahaya&#44; Bhramari&#44;</span> and <span class="elsevierStyleItalic">Udgit Om Unchcharan</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Every day for 30&#8211;35<span class="elsevierStyleHsp" style=""></span>min for each session in a period of 2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Agnihotri&#44; Kant&#44; Kumar&#44; Mishra&#44; Mishra<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Nadi Shodana&#44; Bhastrika&#44;</span> and Bhramari&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Five times a week for 30<span class="elsevierStyleHsp" style=""></span>min for each session in a period of 6 months&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raghavendra&#44; Shetty&#44; Shetty&#44; Manjunath&#44; Saoji<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Kapalbhati</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Two times for 20<span class="elsevierStyleHsp" style=""></span>min &#40;10<span class="elsevierStyleHsp" style=""></span>min per each time&#41; with a 30<span class="elsevierStyleHsp" style=""></span>min break session between the first and second steps&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sodhi&#44; Singh&#44; Dandona<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Kapalbhati&#44; Bhastrika&#44; Ujjayi&#44;</span> and <span class="elsevierStyleItalic">Sukha Purvaka</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Two times a week for 45<span class="elsevierStyleHsp" style=""></span>min in a period of 8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Type of pranayama based on selected literatures&#46;</p>"
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      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Steps of yoga pranayama pratice for adult asthmatic patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">1&#46; Do the Sukhasana Pose or Place your Own Body in Your Most Comfortable Position</span>Make your body position as relaxed as possible and close the eyes slowly&#46;<span class="elsevierStyleBold">2&#46; Do the pranayama Bhastrika for 2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">min</span>Perform the inhalation and exhalation process through your nose with a count of 2<span class="elsevierStyleHsp" style=""></span>s per 1 time breathing phase&#46; In this breathing&#44; the abdominal breathing muscles move forward and backward&#44; while the diaphragm muscles should not move&#46;<span class="elsevierStyleBold">3&#46; Do the pranayama Anulom &#8211; Vilom for 6</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">min</span>Inhale and exhale as usual but must be relaxed and focus on the exhalation and inhalation processes that being carried out&#46; Firstly&#44; focus the breathing process that occurs on the left nose for 2<span class="elsevierStyleHsp" style=""></span>min&#44; and do the same thing on the right nose for 2<span class="elsevierStyleHsp" style=""></span>min&#44; then in the next 2<span class="elsevierStyleHsp" style=""></span>min&#44; focus the mind on the inhalation process of the right nostril and exhalation from the left nostril&#46;<span class="elsevierStyleBold">4&#46; Do the pranayama Kapalbhati for 10</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">min</span>Perform inhalation using the abdominal breathing muscles slowly and relaxed&#44; then exhaling through the nose strongly using abdominal breathing muscles&#46;<span class="elsevierStyleBold">5&#46; Do the pranayama Bahaya for 1</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">min</span>Inhale as deep and relaxed as possible through the nose and exhale as deep as possible&#44; then hold breathing for 10<span class="elsevierStyleHsp" style=""></span>s&#46;<span class="elsevierStyleBold">6&#46; Do the pranayama Bhramari in 5 rounds</span>Inhale as deep and relaxed as possible slowly through the nose&#44; then slowly exhale and make sound like a bee &#40;buzzing&#41; while exhaling through the mouth<span class="elsevierStyleBold">7&#46; Do the pranayama Udgit Om Uchcharan in 10 rounds</span>Perform inhalation slowly through the nose and slowly exhale while saying the word &#8220;Om&#8221; through the mouth<span class="elsevierStyleBold">8&#46; Do the pranayama Surya Bhedana in 10 rounds</span>Cover your left nostril with your finger and inhale through your right nostril&#46; Then cover your right nostril with your finger and exhale from the left nostril&#46; Continue these step within the term that all inhalation processes are occurred through your right nostril and exhalation through your left nostril&#46;<span class="elsevierStyleBold">9&#46; Do the pranayama Nadi Shuddi pranayama in 5 rounds</span>Cover the your nostril with your left thumb and exhale through your right nostril&#46; Then&#44; inhale through your right nostril slowly&#44; fill the lungs with air&#46; Then&#44; cover your right nostril by using your index or middle finger of the left hand and exhaling all the air through the left nostril&#46; And then&#44; inhale through your left nostril and fills the lungs with air while your right nostrils covered by your right thumb and then close the left nostril using your index or middle finger of your right hand and exhale through your right nostril until the air from your lung is completely empty&#46;<span class="elsevierStyleBold">10&#46; Do the pranayama Surya Nadi in 10 rounds</span>Cover your left nostril with your ring finger and exhale through the right nostril&#46; And then&#44; inhale slowly through your right nostril while your left nostril covered by you ring finger&#46;<span class="elsevierStyleBold">11&#46; Do the pranayama Ujjayi in 10 rounds</span>Inhale through your nose and exhale through your mouth&#46; Whenever you exhale&#44; imagine that you are trying to blur &#40;make dew&#41; on the glass&#46;<span class="elsevierStyleBold">12&#46; Do the pranayama Sukha Purvaka in 20 rounds</span>Cover your right nostril with your right thumb&#46; Inhale slowly through your left nostril&#44; then cover your left nostrils using your little and ring finger while your right nostril still covered by your right thumb&#46; Hold your breath as long as possible&#46; Then slowly exhale through your right nostrils after removing the thumb&#46; Do the same process on the other side of the nose&#46;<span class="elsevierStyleBold">13&#46; End the pranayama session</span>Wrap your pranayama session up by restoring your breathing rhythm back to your normal breathing rythm and slowly opening your eyes&#46;&nbsp;\t\t\t\t\t\t\n
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