P.K. Vedanthan, MD: Allergy and Asthma Specialist

Quantitative studies of yoga’s respiratory benefits and of the hygiene hypothesis in developing countries are among this “retired” physician’s current activities. On the horizon is an integrative medicine clinic specializing in care for respiratory patients.

 Vedanthan believes a combination of Eastern and Western approaches is the best treatment for chronic diseases such as asthma and COPD.

The golf courses that lure most retirees hold little appeal to P.K. Vedanthan, MD. As a highly respected member of the Colorado medical community, Vedanthan has served as president of the Colorado Allergy and Asthma Society and as chief of pediatrics at Poudre Valley Hospital. On retiring from the successful asthma and allergy practice he had established in Fort Collins, Colo, in 1976, Vedanthan quickly found himself immersed in advocacy projects and clinical research assignments on a global scale.

In “retirement” he found more time to devote to the International Asthma Services (IAS), a nonprofit organization he had established in 1987 with the goal of addressing the increasing needs for asthma education throughout the world. Principally active in Kenya, the Philippines, and India (his homeland), IAS provides free respiratory care, education seminars, public symposiums, and asthma camps to the most needy.

Yoga, COPD, and Asthma
Vedanthan has practiced yoga most of his life, and began early studies of the disciline with patients in his medical practice. In studies published in 1998, he established that yoga and breathwork (pranamyana) techniques substantially improved the quality of life scores for patients with asthma and COPD. “We found they were able to reduce their medications, they felt a lot better, and their breathing attacks were comparatively less,” he says. Best-selling author and integrative medicine guru Andrew Weil, MD, concurs, saying, “There’s no single more powerful—or more simple—daily practice to further your health and well-being than breathwork.” Weil published an instructional CD and booklet to promote breathwork, called “Breathing: The Master Key to Self Healing.”

“For people with chronic diseases like COPD, allergies, and asthma, Western medicine helps them feel better, makes their physiology better, and even corrects the problem to some extent. But it does not offer a holistic solution. I feel a combination of Eastern and Western approaches is more appropriate,” says Vedanthan.

In December 2003, Vedanthan published articles in the International Journal of Yoga Therapy titled “Yoga Breathing Techniques in Exercise Induced Asthma: A Pilot Study,” and “Yoga Breathing Techniques in Chronic Obstructive Pulmonary Disease (COPD): A Preliminary Study.” He has long believed that complementary medicine should be studied objectively and understood and used more widely in an integrative clinical practice. “By teaching yoga breathing techniques, we were able to show people how they can take charge of their breathing, instead of letting their breathing take charge of them,” he says. “With yoga, even if it does not improve your lung functions, at the end you feel better, and that means you are introducing that wellness factor without removing the disease.”

The Hygiene Hypothesis
One of Vedanthan’s most interesting projects involves his contemporary work on the “hygiene hypothesis.” Clinicians have long observed that children growing up in poorer, dirtier, and generally less healthful environments suffer more from allergy and asthma than children living in cleaner, more modern environments. Paradoxically, children in rural environments, with significantly higher exposure to livestock and other antagonists, seemed to have a lower incidence of asthma.

The hygiene hypothesis was developed by epidemiologist D.P. Strachan, who wrote in 1989 in the British Medical Journal1 that the rise in allergy cases may be linked to declining family sizes, reduced exposure to germs, and higher standards of cleanliness, providing less exposure to bacterial endotoxins. The understimulated, developing immune system would then be stimulated by harmless substances like pollen, house dust, and animal dander, resulting in the development of allergies. The hypothesis suggests that children who are around numerous siblings or animals early in life are exposed to more microbes, and their immune systems develop more tolerance for the irritants that cause asthma. A study appearing in the May 2000 issue of the American Journal of Respiratory and Critical Care Medicine2 concluded that those who grew up on farms and were exposed to animals were significantly less likely to have asthma than those who did not.

“There is a very distinct difference in asthma [rates] between the inner city children and the children who are brought up in the farming communities in the United States,” says Vedanthan. “We have these pockets of inner city asthma, like downtown Chicago, with a very high incidence of asthma because of potential antigens like cockroaches, and socioeconomic reasons—smoking. All these factors definitely promote atopic sensitization in asthma.”

Against this background, Vedanthan saw an important opportunity to further study the problem in India. “There are already a lot of studies that have been done in the developed nations, America, Europe, Australia, but not many studies done in the developing nations. We thought this would be a good thing to study there, because there is an incredibly distinct difference between the urban and rural environments and lifestyles [in India].”

Working with a leading respiratory center in the United States, he devised a study protocol to investigate the hygiene hypothesis in India, knowing it would have profound implications for understanding and treating the problem in developed nations as well. “We used an ISAAC (the International Study of Asthma and Allergies in Childhood) questionnaire that has 110 questions about living conditions. We modified it, depending on the environment, because in some environments you need to ask more questions about people’s living habits, depending on how they live, and depending on the language they speak. We interviewed a random sampling of 103 households, 53 rural, 50 urban; 164 children were studied. We paid special attention to the animal and microbial exposure the children had. We also skin-tested the children for common household antigens.”

Dust samples were collected and analyzed for endotoxin determination. “This is a measure of microbial exposure,” he says. “Endotoxin is a very stable compound that indicates or quantifies the microbial or gram-negative bacteria exposure. It will tell us how much bacterial contamination is in that environment.” Endotoxin also can be measured in ambient air.

“Basically, it showed that the asthma and atopic sensitization is five times more in the urban area; conversely, the endotoxin level is much higher in the rural homes,” he notes. “The exposure to animal contact was very intense in the rural area. Many homes had cattle sleeping in their house, and the exposure to cats, dogs, mice—both large and small animals—was quite significantly high in the rural homes compared to urban; 95% of the rural homes use cow dung daily—people rub it on the floor as an antiseptic—it keeps away flies and insects. It is also used as a fuel. The main point is that the exposure of the rural family to cow dung is very intense, compared to their urban counterparts. This could be a factor in the different microbial exposures between the locales.”

Vedanthan is presently crunching numbers and preparing a paper to be published in a peer-reviewed journal. The information gathered in India will have implications for clinicians in industrialized nations as they begin to unravel the paradox of the hygiene hypothesis.

On his retirement horizon, Vedanthan envisions the creation of an integrative medicine clinic that will specialize in treating respiratory patients with state-of-the-art contemporary Western medical regimes and medications, augmented by Eastern ayurvedic, yoga, and breathing techniques. Regardless of where his muses guide him, the respiratory community will continue to benefit from the creativity and commitment of P.K. Vedanthan.

And the golf courses? They will simply have to wait.

 John A. Wolfe, RRT, is a member of RT’s editorial advisory board.

1. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299(6710):1259-1260.
2. Ernst P, Cormier Y. Relative scarcity of asthma and atopy among rural adolescents raised on a farm. Am J Respir Crit Care Med. 2000;161:1563-1566.